how to live with premenstrual dysphoric disorder (PMDD) at work

by Alison Green on January 24, 2024

What if you had a medical condition that caused you to have monthly fits of rage and sorrow? How would you deal with it at work?

PMDD, or premenstrual dysphoric disorder, is a mood condition that impacts 5-8% of menstruators. It can mean wild mood swings, rage, anxiety, depression, and lethargy during the second half of the person’s menstrual cycle, and about a third of people with PMDD have attempted suicide. Yet on average it takes 10 years to get a diagnosis, and many people have never even heard of it. That leaves those who suffer from PMDD to struggle alone — particularly at work.

For Shalene Gupta’s book, The Cycle: Confronting the Pain of Periods and PMDD, I spoke with her about how people with PMDD can manage it at work. The following is an excerpt from the book.

Excerpted from The Cycle. Copyright ©2024 by Shalene Gupta.
Excerpted by permission of Flatiron books, a division of Macmillan publishers. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Two of the biggest symptoms people with PMDD face that affect their work are meltdowns and brain fog. People who struggled at work told me about either arguing with coworkers, or having trouble concentrating because they felt so sleepy. The latter has been most challenging for me. I’ve struggled with the sluggishness and brain fog that comes along with PMDD as well as the physical pain of cramps. I often wished I could work from home. Doing the work wasn’t the problem: it was performing the role of A Working Professional when I was in pain or sluggish. Years of PMDD had trained me to work ahead of schedule, so I could often handle having a slow day without anyone noticing. But sitting at a desk, pretending to work, was frustrating when I just needed a nap. Similarly, when I had cramps, having to wear pants with tight waistbands instead of sweats seemed like an unnecessary struggle. Feigning positivity when I felt like a piranha was swimming around eating my organs felt like a waste of energy. I did it because I had to, but it seemed pointless.

However, not everyone can fake good health or has the freedom to work for themselves. Danielle Lenhard, a clinical social worker, told me she struggled during her PhD in Art History & Criticism. She had started to notice that during the beginning of her luteal phase, she would often end up sleeping for an entire day. She scheduled exams, conferences, and presentations around that time and was able to complete her PhD. Today, when she works with clients and notices some of them struggling at the same time of month, she urges them to track their cycles. Many people who had severe PMDD mentioned being grateful for a sympathetic dean who granted them a leave of absence or relaxed thesis deadlines. Others, like Anna, a cardiothoracic nurse, simply white-knuckled their way through their education, because they felt like they had no other choice.

So what do you do, if you have PMDD and you run into trouble at work? I turned to Alison Green, who runs the popular work advice blog Ask a Manager. People write in with a thorny work problem, and Green answers using a combination of diplomacy and office smarts, all underlaid with a strong sense of fairness. On the whole, Green isn’t a fan of telling your employer you have PMDD. She worries disclosing any health information for accommodations sets a precedent where everyone is expected to disclose their diagnosis. Furthermore, she warned, often times biases come into play when managers dole out promotions or assign high profile projects because they might worry an employee with a diagnosis can’t handle the stress. “Even people with the best of intentions might have unconscious bias,” she said. “If you talk about a mental health condition and then you have an off day, people might wonder if it’s because of your condition, when in reality everyone has an occasional off day.”

Rather than disclosing PMDD as a diagnosis when asking for accommodations, she recommends the following script: “I have a medical condition that increases my stress levels and irritability X days of the month. I’m working with my doctor to get it under control but in the meanwhile I’d like to ask for [accommodation].”

If possible, she advises asking for accommodations at least one or two months after you’ve established yourself at a new job. “By then you’re more of a known quantity,” she said. If you need the accommodations immediately, the soonest she recommended asking for them is after you have an offer in hand, to eliminate the chance of getting rejected because of conscious or unconscious bias. In addition, Green pointed out disclosing when you apply puts the employer in an awkward spot because if they reject you, it brings up the question of discrimination even if the rejection is for other reasons.

I also asked Green what to do in the event of brain fog or a meltdown.  Green didn’t think brain fog warranted a disclosure unless it was a repeated pattern. “Everyone has off days, and if you have a diagnosis, you’re probably more aware of your off days than other people are,” she said. If it is a repeated pattern, she recommended a variation of the earlier script while asking for appropriate accommodations: “I have a medical condition that [makes me forgetful/exhausted] X days of the month. I’m working with my doctor to get it under control but in the meanwhile I’d like to ask for [accommodation].”

If you have a meltdown—either from anxiety or rage–Green said the best thing to do is address it: “People are going to wonder, can this person handle feedback? Do I have to tiptoe around them?” Green gets mail about meltdowns that have nothing to do with PMDD and she says often people are tempted not to address them because it’s embarrassing, but that’s actually the worst thing you can do. “You want to signal that you understand what happened is a problem and you’re working to make sure it doesn’t happen again,” she said. She recommended the following script: “I know I had a strong reaction and I’m embarrassed. How I handled [the situation] wasn’t okay. I have some medical issues/stress going on and I’m working on it. I’m sorry about my reaction.”

She pointed out when you mention feeling embarrassed or mortified, you’re showing vulnerability and, in a reasonably healthy office, people will respond to that. If you know outbursts are a problem, you can ask for the flexibility to work from home or to avoid scheduling meetings on certain days.

She left me with one last thought. Employees at companies that have resource groups should consider bringing up PMDD with group leaders. “If about 8% of the population has PMDD, there are probably other people at the office who have it, and this is something employers need to figure out,” she said. However, if you are worried about being stigmatized for having PMDD but do want to talk to a resource group, she recommended asking the resource groups what their confidentiality rules are before sharing your diagnosis.

You can preorder The Cycle here. Preorders signal to bookshops and publishers that audiences are interested in a particular topic. 

* I make a commission if you use the Amazon links on this page.

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  1. bamcheeks*

    This is really interesting, thank you! And such a big crossover with all the other under-diagnosed and under-researching conditions that affect people who menstruate.

    1. Bunny Lake Is Found*

      It’s almost like people who menstruate weren’t allowed in science or medicine (or much in the way of educational institutions) in Western culture for, like, hundreds of years or so. When you aren’t invited to the ball, you can’t dance with the prince or get your gift bag.

      Reminds me of the folks who designed…I want to say the Apple Health app for the Apple Watch. The original design didn’t include a period tracker. Then, when it did, the design was pretty much aimed at allowing women to make sure they aren’t pregnant and when they can engage in activity without risk of pregnancy. The developers were legitimately shocked to find that more women were using the app with the express intention of getting pregnant, rather than avoiding the condition. It should surprise no one that the developers were dudes in their 20s.

      2. I take tea*

        I hope this isn’t too much advertisment, but I’ve really liked the app Clue, because it has a bunch of different settings. It’s designed by people who understand what a menstruating person might want. You can choose if you want to track your period or also fertility or other things. I especially like that you can hide the functions you don’t want. And it’s not cloyingly cute.

        It is really useful for warning about PMS and also for tracking irregularities. You know, for when the doctor asks “and how long has this been going on?”

        1. Freya*

          I like it because I can track pain levels and then cross-reference to what I’m doing in the rest of my life. So now I’m in less pain during my period because I take it easy on core exercises in the lead up and avoid certain digestive upset triggers that I can indulge in at other times with far lesser consequences!

        2. Wry*

          I love Clue! I’ve been using it for years just to track my periods and know when to expect the next one (I’m very regular so in my case the predictions are usually accurate). As a woman who’s only ever been with other women, I’ve never been in need of the fertility features of the app (either for avoiding pregnancy or trying to get pregnant) and I’ve never felt like the app pushes those features or gives the impression that fertility is the primary reason you’d use the app, which is really great.

          1. Ann Nonymous*

            I almost hate to bring this up, but I would be very wary of any period tracking apps in this climate. Nothing is truly private.

  2. Medical Librarian*

    Thanks for bringing attention to this health topic, Shalene and Alison. If you’re interacting with health professionals who may not be very familiar with PDD, a good open access starting reference for them is in StatPearls. Link in a comment.

  3. Auntie Social*

    I was a paralegal at a litigation firm. When I had raging PMDD, my boss would set me on a pile of discovery, like Rumplestiltskin. He said as long as I was raging, I might as well use my powers for good.

    2. Sociology Rocks!*

      I love this, because it’s acknowledging you’re not you’re usual self, and accommodating that but in a positive way!

    3. Reluctant Mezzo*

      This reminds me of a comedy sketch for FemmeRage, which allows a woman to act the way dudes do all the time…

  4. Sparkly Tuxedo*

    “I have a medical condition that affects me X days of the month” just reads as “menstrual cycle” to me, and I’d be worried about an employer realizing it’s period related anyway.

    1. londonedit*

      I agree – I wasn’t a huge fan of that phrasing. I’d probably say something more like ‘I have a medical condition that [sometimes/occasionally] means I struggle with [stress and exhaustion]’.

      1. MigraineMonth*

        “Every few weeks” might be a good substitute for “month”.

        For example, I have to leave work early due to migraines “every few weeks”. (Every four weeks, to be precise, because all of my health issues are timed to my menstrual cycle.)

    2. kristinyc*

      Is that bad though? If we keep trying to hide it or cover it up, it just stays that much more taboo. Enough people in the workforce have periods that it should be a pretty normal thing. Some may need extra care and accommodations for it, and the more normalized that is, the easier it is for people who need it.

      1. WellRed*

        In a more worker and woman friendly world, sure, but look at all the centuries of “hysterical” fragile or grumpy women who are “ too emotional” for the promotion to see why this isn’t so easy.

      2. 1-800-BrownCow*

        I would love for it to not be taboo. But I work in a male dominant field and I know how it would be seen. And as WellRed pointed out, forget promotions or priority on projects or anything related to management thinking I can’t do something because I can’t handle my monthly cycle.

        1. Vio*

          We men are given a lot of misinformation about periods, largely from movies and TV shows where a woman is dismissed as “being that time of the month” or something similar. It’s not as common in more recent media but still happens and has been so pervasive previously that it’s not taken as seriously as it should be. Since the majority of women do not seem to be as irritable, in pain, etc on a monthly basis it’s treated like many invisible conditions, as the person exaggerating or making a fuss over nothing.
          “Oh my wife doesn’t make as big a deal about her periods,” or “Yes dear, we all get it every month so don’t let the side down by making a drama of it,” are unfortunately common attitudes apparently. Which is basically like saying “I stubbed my toe and got over it so get out of your wheelchairs and get walking,” but I doubt many people would say such a thing. Sadly people have a much more dismissive attitude over what they can’t see.

      3. Dust Bunny*

        Should it be? No. Will it be in a lot of workplaces? Yes. It wouldn’t be where I am but I’m in a woman-dominated discipline and also my superiors aren’t jerks.

        And an employer who has a problem with it will think “period issues” first because what else is monthly and also applies to women (and is often the butt of crass jokes and complaints by a certain type of person)?

      4. ampersand*

        Exactly. We need to normalize this because roughly half the population have periods. No one at work needs to hear the details, but the more we can normalize menstruation being a typical thing that happens, the better. Even if it takes decades to get to a place where it’s accepted–we have to start somewhere!

        1. Vio*

          During Lockdown I did some shopping for a few people and several women were very hesitant about asking a man to buy their tampons or pads. It’s ridiculous that something so important is so stigmatised. We’re all human, we all have needs and bodily functions. It’s not appropriate to flaunt them publicly but that doesn’t mean we should go to the opposite extreme of being ashamed of them.
          I remember as a child when the advertisements for ‘womens products’ came on TV they were so careful about wording not to talk about menstruation at all but emphasising how absorbent their products were that I got the impression that many women were incontinent since the adverts were almost identical to the way nappies were advertised, including the weirdly blue water so nobody would think of something that came from a human body like the one that we all have…

      5. Greg*

        I am a male who had never heard of PMDD until I read this article. If I had had a female employee who used Alison’s phrasing, I would have assumed she was saying that she had particularly severe symptoms from PMS. I’m not saying I would have judged her or held it against her, but that’s what would have come to mind. If, as Alison says, the goal is to avoid setting a precedent that employees are required to share details about their medical condition, I think giving the impression that it’s PMS when it’s actually something more serious does not achieve that goal.

        In any event, I doubt many managers are going to chart the employee’s behavior and realize that it occurs on any sort of a monthly schedule. I think substituting words like “sometimes” or “intermittently” should be fine.

        1. amoeba*

          I’m by no means an expert, but the definitions I’ve found have PMDD as a particularly severe form of PMS, so your impression at least wouldn’t be that far off!

    3. Harper the Other One*

      I think you assume that because of the framing of this discussion, but there are lots of medical conditions that require routine treatment that would affect you monthly. My FIL is on a maintenance chemo regimen that he gets every four weeks, for example, and for several days after he is (understandably!) not feeling his best – he is retired but if he wasn’t he would need leave days.

    4. Mid*

      Honestly, if you’re someone your employer thinks of as a woman, they’ll likely assume menstrual cycle regardless, but many conditions can be cyclical and monthly without being a period. So that bias isn’t really escapable, unfortunately.

    5. Person from the Resume*

      I disagree. If you have migraines twice a month you could say I get migraines 2 days of the month as a disclosure for the expected impact on a monthly basis. If you imply a cycle /every 4 weeks that’s getting into a place where they could guess menstrual cycle related.

      2. Zap R.*

        Man, I wish I could be be werewolf. That would be badass. Instead I put on 10 pounds of water weight, sweat like a wildebeest, and have intense flashes of suicidal ideation.

        1. DeskApple*

          oh there with ya on the suicidal ideation. my doc wanted to diagnose me as bipolar but my husband was there and said “I didn’t know bipolar ran on a monthly schedule” and the docs eyes got so big and he said “oh you need to go to a lady doc, I don’t do women’s hormones”. he was a 72 year old practitioner trained on the male medical model and knew that women had ovaries and estrogen and that was about it.

          1. Akili*

            Same here – took me FOREVER to realize it was cyclical because I’m not in a relationship and wasn’t tracking things super closely. Plus every time it came up I would conveniently forget that only a month earlier I’d felt the same thing, or a week later my period showed up. The only thing that helped me was a supplement called DIM. Of course, it gave me other PMS symptoms as it balanced my hormones. I didn’t have cramps for 15 years, but now I have cramps. But I don’t suffer from suicidal ideation anymore, so….a win in my books, but results may vary. I’m not a scientist, but I had to research it all myself and fight to get tests done, and my best guess is that my progesterone was too high and my estrogen was too low – which is often the opposite problem people with PMDD have, so the usual solutions failed

            1. Banana Pyjamas*

              Just wanted to say the UIC did a press release in December. They did a study on increased risk of suicide during menstruation. While the study did find there is increased risk for PMDD folks, it also found that up to 40% of people experience si during the luteal phase of their cycle whether they have PMDD or not. I’ll drop a link.

      3. Serious silly putty*

        Love this!
        You: “Hey boss, I have a… condition. It can causes… uh, mood swings… and then after that I may feel tired. Can I work from home a few days a month”
        Boss: “Girl say no more. Do what you gotta do. Have you tried an IUD? It worked wonders for me.”
        You: “What? No I don’t… um, no I haven’t tried that yet but I definitely will look into this reasonable solution for the very normal conditions I have.”

          1. BubbleTea*

            Even if you suspect they’re a werewolf and don’t know about the secret room where they can hide in the woods to avoid biting people?

      4. Liz*

        I have to recommend the novel Lycanthropy and Other Chronic Illnesses by Kristen O’Neal
        because it features _exactly_ that confusion! (It’s also a hilarious and well-written book.)

        2. I turn into Cookie Monster Once a Month*

          just grabbed this from the library to read. Thanks for the recommendation!

        3. kitryan*

          Similarly, the Canadian indie horror movie Ginger Snaps – is it puberty or are you becoming a werewolf – who’s to know? One of my very favorite movies.

          1. Gatomon*

            I’ll look that one up too!

            The closest I can come up with was a Goosebumps book where the kids turned into dogs, but the protagonist was male, unfortunately. And friendly, for he was a lab, IIRC.

            1. kitryan*

              In Ginger Snaps, the focus is on two sisters, in their teens, so it’s puberty/the onset of menstruation that’s the red herring for ‘turning into a werewolf. It’s so so good, woman-centric, and not ultra gross out horror either-there’s some gore but it’s fine if you are ok with light to medium but not extreme horror, minimal jump scares, if I remember correctly.
              There’s also Lila the Werewolf by Peter S. Beagle (who wrote The Last Unicorn) which is about a guy who has some relationship issues with his girlfriend that turn out to… not quite be what he thought they were. It’s also good but is definitely from the male/not directly affected person’s perspective.

              I have a bit of a soft spot for fiction/media that does this kind of thing where *insert normal but stigmatized thing* is re-envisioned as a horror or fantasy trope, as well as the reverse where the horror or fantasy trope is translated into a ‘real’ world equivalent (science fictionalized vampires or what have you).

        4. SnickersKat*

          Because of you, I just read this entire book in the last 2 days instead of doing all the things I was supposed to do. So worth it! Thank you for the awesome book recommendation! I have PMDD, and this book totally made me feel seen. I’ve already recommended it to friends.

      5. Zoe Karvounopsina*

        I can’t help but feel like, as a werewolf, I would also wake up monthly in a pile of fur, looking baffled and confused.

      6. silverpie*

        « And hey! Three days out of the month I’m not much fun to be around either! »

        —Willow (Buffy the Vampire Slayer)

      8. Phony Genius*

        As I was reading this article, I was picturing a different “monster:” Jeckyl & Hyde. But a werewolf is probably better, since it’s tied to a monthly cycle.

      9. MigraineMonth*

        In the Pratchett’s Guard series, Constable Angua is their new diversity hire. Everyone assumes that it’s because she’s a woman. Spoiler: it isn’t.

        “Take Angua. She’s a w–”
        “Yes, yes, I think it’s obvious to everyone what she is.”
        “Really?”
        “Yes, we all know.”

      10. Vio*

        There’s actually been a few works of fiction that have used lycanthropy (werewolves) as a metaphor for puberty and/or menstruation. Off the top of my head the Ginger Snaps movie(s) got a fair bit of attention for the topic.

    7. Echo*

      I agree but I think the solution is really easy: the word ‘typically’. “I have a medical condition that can cause XYZ. Typically this affects me about X days each month.”

    8. Lyra Belacqua*

      Yeah, I agree–I have PMDD that’s now reasonably controlled with antidepressants (I’m still very fatigued and irritable a couple of days a month, but not suicidal), and my strategy is to track my cycles (thankfully regular) and take bad days off when possible/work from home or schedule light days when not. But I’ve been able do that in part because my jobs have been flexible enough/I had enough sick leave to do so. If I didn’t have those luxuries, I might honestly be inclined to avoid mentioning irritability etc. and try to make it sound like cramps or other physical symptoms. “Women are crazy at that time of the month!!!” is just such a damaging trope–I’d be worried about getting the double whammy of stigma against mental illness + misogyny.

      1. Perfectly Particular*

        I have PMDD, but it is getting much better as all my peri-menopause symptoms kick in. Back in the day, before I had children, one of the female doctors at my large OB/GYN practice prescribed an anti-depressant for 2 weeks/month. It helped a lot! For my next annual, I saw a different (male) doctor, and when I told him I might want to take the ant-depressant all the time because I was having trouble remembering on a 2 week schedule, he told me that birth control would solve the whole issue, and “let’s see if we can get you off the crazy-drugs”!!! I wish I could say that I stood up for myself, but really, I let him switch my birth control, told him to refill the antidepressant, and then just avoided seeing him again. (Until, plot twist – he was the on call OB for my daughter’s birth, and was freaking amazing in the delivery room) It still makes me so angry that I suffered for years, and when I finally had a solution – even my medical professional stigmatized me!

    9. Boof*

      As a medical professional, I’ve got to say actually almost all disability paperwork asks me to try to predict how many off days a person will have per time. Usually days per month. There are a lot of things I can do that beyond hormone cycles, like periodic medication, administration’s and procedures. Overall, the regularity is actually a lot more easy to work with then some thing that is wildly unpredictable.

    10. Garblesnark*

      I don’t agree with this! I handle intermittent FMLA paperwork on a semi-regular basis at work and [x] [days/hours/time unit] per [month/week/time unit] is an absolutely standard way to frame an intermittent (non-constant) medical condition. I’ve seen it for chemo, physical therapy, migraines, allergy shots, various mental health conditions, iron infusions, immune deficiency, prenatal care, postnatal care, blood pressure issues…. Remember, most chronic health conditions are dynamic, which means they are not the same every day!

    11. JSPA*

      It hides the exact diagnosis. Once there is a syndrome or acronym supplied, people google it, read about the most extreme edge cases, and wonder if (or assume that) yours is that bad.

      Additionally, different people have different problems at different times in their cycle. This level of disclosure doesn’t say, “Hey, you’ll know when I’m menstruating!” (which can feel TMI at work).

  5. GratefulForThisPost*

    Thank you so, so, so much for posting this. I have been recently diagnosed with PMDD- a journey in itself- and the issues that arise (particularly brain fog) make it so difficult to work and function. It’s also noteworthy that I don’t always realize when I’m acting irrationally, and I only find out when others mention that my reaction was outsized afterwards.

    I am a professional with elite degrees, in therapy and seeking every form of credentialed medical advice- and there genuinely aren’t known “treatments” that work consistently. I lose two weeks out of every four, but am not in a place where I can be considered for disability, even if I could afford to pursue that route. I am also struggling to figure out what my next career steps will look like as my historical roles of Program Management/ leadership are simply not options under the circumstances. I was heartbroken by the “bad boss” story last year, both because I absolutely understood that the organization couldn’t support her continuing to be abusive to her staff- but it was likely that there was no way for her to improve it.

    It’s also hard when people mock it because they think it’s the same as PMS- PMS may be bad, but it doesn’t mean having overwhelming depression and literally forgetting your best friend’s wedding because the brain fog is so intense.

    It’s so so so hard, and it feels like there’s no solution. Giving advice on coping strategies in a forum as public as this is so appreciated.

    1. PMDD Sufferer*

      Do you have remote or hybrid work as an option in your career? I transitioned to remote work in early 2022, was diagnosed with PMDD shortly thereafter, and having flexibility to ‘lean out’ on my worst symptom days has been a huge benefit. When I was in-office, if I had any 1 on 1 conversations with my boss or direct reports (about anything! Not even difficult topics!) during my PMDD phase, I would cry at the drop of a hat. Now at least I can cry alone at home without being known as ‘the crier’, or excuse myself from work for a few hours when I’m at my foggiest. Of course, I do work in a startup environment where everyone can flex their schedule as they like.

      Wishing you best of luck in your journey. I’m also in therapy, and on medication which takes the edge off my bad days (so I’m not suicidal, but I still feel like shit). Aside from those two treatments and a very understanding husband, nothing else seems to make a difference. It’s hard!

      1. PMDDnewbie*

        Solidarity, fellow commenter. I was diagnosed in early December, but am in my late 30s and my hormones have been wreaking havoc on my emotions for the past year+. The fact that every single person/body/case is different, and there are so many different avenues and variables for treatment makes it feel like an overwhelming game of Whack-a-Mole to address.
        My OB/GYN started me on a low-dose birth control pill just to regulate my cycle — part of my problem is that because my periods are so unpredictable, I don’t realize that a meltdown or days of feeling depressed is caused by PMDD until after I’ve gotten my period and then looked back at where I was in my cycle at the time those symptoms occurred. I am also looking into therapy to learn coping mechanisms for the intense mood swings. Fortunately for me, I am self-employed and WFH, but I recognize that’s not an option for everyone! PMDD is really hard and it’s not talked about enough.

    2. Magenta Sky*

      “It’s also hard when people mock it because they think it’s the same as PMS- PMS may be bad, but it doesn’t mean having overwhelming depression and literally forgetting your best friend’s wedding because the brain fog is so intense.”

      And that’s the more common presentation. My father had a half sister who had a very extreme case. For several days of the month, she would literally shoot at the neighbors, and spent most of her life in a mental hospital.

        1. Magenta Sky*

          And it was nearly a century ago, when the formal diagnosis was “crazy and dangerous.” There weren’t a lot of options.

          The world has improved in so many ways.

    3. Still alive*

      Yes, “10 years to diagnosis” makes it sound like “10 years to effective treatment” and that is absolutely not the case for me. Perimenopause took me from 2 good weeks per month to zero, and my current choices with meds are: sleep 12 hours a day and have maybe 4 hours of awake functionality, or be suicidal. Still working on it with my medical folks but I have no idea how to explain “we are going to be trying different med combinations, I need to spend six months on each one, they may make it worse, and I’ll just be cycling through them until the heat death of the universe”

      1. I forget my handle here*

        this is unsolicited advice, but one thing that has worked well for me when it comes to trying to figure out what meds work for me was pharmacogenetic testing.

        With pharmacogenetic testing, your prescriber order the test, you get a swab kit in the mail, you send it back, and they are able to assess how you metabolize many different medications. I was able to find out that there is basically one subgroup of antidepressants my body processes normally.

        just wanted to mention it as something that is cool to know it exists as something you can do that might reduce the medication merry-go-round process

        1. ThatOtherClare*

          Oh my goodness! I genuinely need this done and didn’t know it was a thing! I’ve been having troubles with a (non-PMS related) medication and at my last medical appointment my doctor basically shrugged and said “I guess you metabolise it quicker than normal maybe?”. I’m going back to him very soon and I’m going to ask him for a testing referral. Thank you so much internet stranger, you’ve quite possibly changed my life! You have my deep gratitude!

          1. Texan In Exile*

            Until recently, they weren’t even required to test drugs on female bodies. Turns out we metabolize drugs differently from boys and men! Who could have guessed?

    4. birb*

      People thinking PMS and PMDD are the same is always such a horrifying conversation.

      “Oh, I get that, too! Right before my period, I’m cranky and have cramps and I just want to lie in bed all day with a heat pack! Is that what it’s like?”

      “No, out of nowhere for a few days before my period I have a deep sincere urge to kill myself and everything is painful and sore and I suddenly have much worse arthritis than usual, and I can’t think clearly enough to focus, even if its the thing I most enjoy in the world. It goes away after a couple of days and THEN I have regular PMS symptoms.”

      It think all the newer research into cytokine storms is going to eventually help us understand why PMDD happens and maybe provide some relief.

      1. Elsewise*

        God, I had an ultrasound tech do that to me once! I went in for a pelvic ultrasound to determine if I had cysts. She asked me about my symptoms, I told her I’m in a lot of pain, have really intense mood swings and brain fog around my period, and she laughed and said “yeah, I get like that too. I always tell my husband, don’t let me make any decisions when I’m on my period!” Okay, awesome, I definitely came here to listen to your internalized misogyny and not for any medical reason.

        (For what it’s worth, I don’t have PMDD, I have endometriosis that caused some various complications. But the “uterine/menstrual health being under-researched, under-accommodated, and under-diagnosed” mood is there.)

      2. ThatOtherClare*

        You might also be interested in some of the latest research into progesterone intolerance, allopregnanolone sensitivity, and the GABA-A connection to PMDD.

        1. IneffableBastard*

          oh, that might explain why hormone pills (not all of them birth control) always made me suicidal. I got an hysterectomy recently so I still have PMDD but at least I do not have the Shining-elevator-scene periods anymore.

    5. New Mom (of 1 5/9)*

      I was terrified to go off of birth control because I definitely had undiagnosed PMDD as a teen–not sure if the idea of PMDD existed 10-15 years ago, but it would have been harder to diagnose given that my periods were so irregular. Anyways in the PMDD subreddit many people seem to have had success with calcium + magnesium + vitamin D. You didn’t ask for this, but if you’re desperate it’s worth a shot.

    6. skunk cabbage*

      I am a teacher with PMDD. Here’s what’s helped me:

      1. I get FMLA, intermittent leave. My period is a double whammy…I get migraines with puking during and PMDD the week before, so I miss a lot of work. PMDD makes me super sensitive so I cry nonstop! Very embarrassing, and sometimes I just take the day off. The intermittent FMLA means they can’t fire me for missing too much work.

      2. Find a kind and patient OBGYN who will help you find a good treatment plan. After years of med guinea pig mode, I found a combo of an anti depressant, a beta blocker, and a birth control taken continuously really dialed down all the harsh edges. I still have some symptoms but no nonstop crying, oppressive suicidal ideation, occasional psychosis, turning into an evil and cruel and paranoid version of myself, etc.
      Have faith that you can find treatment options that work if you keep looking. Here are suggestions: https://iapmd.org/treatment-options

      3. Try to find a sympathetic person or two at work who can support you when you need it. Like I have a few teachers who can cover my class during their planning if I start having a panic attack. Then I go to an office and call our work’s employee assistance program counseling hotline. If you can find ways to take a breather when things are really bad, it can help.

      4. Know that you’re not alone. I did not get a PMDD diagnosis until I was 38. But I did get misdiagnosed with a bunch of other stuff, like bipolar. Before I found my current treatment plan, it was very embarrassing to do things like cry publicly and blow up at people for no reason. It caused a lot of shame and sadness. My bosses gave me a lot of negative feedback and a lot of advice that did not help (like how clenching your butthole will stop you from crying?!? if only that worked). At the end of the day, though, I never gave up. I never lost my job. And I never killed myself, even though my brain kept telling me to! (Did you know historians think Sylvia Plath had PMDD?) Maybe it sounds sad, but I feel resilient and accomplished knowing those facts. You’re still here and trying, too.

      5. Self-compassion has also helped as a concept. The book called Self Compassion by Kristin Neff was my introduction to the concept. PMDD came with a lot of shame because I ruined so many relationships and hurt the ones I loved over and over. Mindfulness and self-compassion have helped dull the ensuing self-loathing a little.

    7. Thankful I am old now*

      Undiagnosed my entire menstruating life.
      Two good weeks a month.
      Forgot my best friend’s child’s baptism.
      Had no idea what brain fog was-
      Got through graduate school working ahead.
      Debilitating cramps for three days at least with physical discomfort the 3 days before.
      Was told by a gyn who was a woman that if I was a feminist I wouldn’t have cramps.
      Was told by a gyn that I was overreacting ( nausea, diarrhea, migraines, and doubled over in pain, rivers of fluid)
      Was told by a male supervisor when I said I had to go home early that exercise can help with that.
      birth control pills helped some but not all and had there own side effects.
      You can guess my age- I never knew that there were pills you could take to eliminate your menstrual cycle.
      My supervisor diagnosed peri menopause.
      It is an evil world that you can have hot flashes AND your period at the same time.
      The hysterectomy was the best thing that ever happened to me.

      1. buddleia*

        >Was told by a gyn who was a woman that if I was a feminist I wouldn’t have cramps.

        WTF!!!!

        I’m so sorry you went through all of that and finally had a hysterectomy.

  6. helio*

    Really interesting read! I have PMDD that is (now) well managed with medication, as well as addressing my ADHD (apparently if you have ADHD you are much more likely to have PMDD!). I feel for my younger self who did not have any clue what was going on to clue in why, while life seemed more difficult for her than everyone else, it seemed impossible for one week a month. I agree with not disclosing the exact diagnosis- disorders that impact women more prominently than others are still so wildly dismissed. While we hope that who we work with are not misogynistic, sometimes people have some old fashioned ideas that they don’t realize they hold until a situation brings them to light.

    1. Holly*

      I have (diagnosed) ADHD and as-yet-undiagnosed PMDD (I’ve had tests for every other condition it could be, and cant currently afford the last screens.

      It’s very difficult. I lose one – two weeks every month due to the PMDD, and one other is spent desperately trying to catch up which is difficult to due my ADHD. I maybe have like 7 – 9 good days in a month in the summer, assuming the heat doesn’t give me a migraine, and like 2 in the winter.

      Currently running on zero due to cPTSD rearing its head on an anniversary this month.

      I guess I just want to tell people – it’s not normal to have periods wreck your life. If everyone in your maternal line has issues, that actually means its even less normal, no matter what they you! PMDD runs in families, and it’s one of the ‘fun’ things that can lay dormant for years until its triggered by trauma.

      I know PMDD is a new thing, but if you don’t have it, please don’t dismiss those of us that do. I’ve had way too many people dismiss mine as being an ordinary period and it makes it feel even worse to be medically gaslit and dismissed when you’re already struggling with suicidal ideation.

  7. Essentially Cheesy*

    I think everyone, universally, needs to get rid of the notion that we all need to be raring to go and our best selves every work day, no matter what. Everyone has down days and we all need our employers to be flexible and compassionate.

    I do think that we need to all work on environments where we can discuss these things without getting too squeamish about them, possibly without being too overly gross about them. It’s a hard balance to find.

  8. BellyButton*

    in 2018 I started a low dose of anti-depressants. SSRIs can help with PMS and PMDD. I was shocked at how the lowest dose helped reduce the cramping more than I ever dreamed possible. I still have cramps, but not as severe. My mood swings are also so much better. It may not be a solution for everyone but it has helped me so much.

    Working from home also helped a lot. Sitting and wearing dress clothes made cramping so much worse. Being able to sit in a recliner, stretched out, with a heating pad is so much more comfortable.

    1. LivingTheDream*

      I also have PMDD, and my antidepressants are managing it great for me at the moment, which I’m so thankful for. However, I had to go through a LOT of medications to here. One of my favorite aspects of WFH is that I’m not afraid to try new medications. If I do have a bad side effect, I’m already at home. That flexibility has been a huge help for me.

    2. DeskApple*

      I tried Sertraline but was so nauseous, could you share what you tried and the dosage? My cramping is brutal

      1. The Unspeakable Queen Lisa*

        Just FYI, you may not be able to take SSRIs. My hubby was on them a few years ago for anxiety – he tried literally all of them and their relatives and they all left him so nauseated and headachy he had to lie down for hours every evening between runs to the bathroom. Then he found a non-SSRI that “only” gave him crippling headaches that meant he had to lie in a dark room for hours every evening. He eventually learned to manage his anxiety and was able to quit the meds, but they really wrecked his quality of life for a few years.

        Maybe that’s a trade off you’re willing to make, but it may be that these don’t work with your body chemistry.

        P.S. Sour things can help take the edge off the nausea. He was going through half a bag of Lemonheads a day!

      2. BellyButton*

        It took me about 5 anti-depressants to find the right one. My psychiatrist said that is about average for most people. The first one I noticed a difference with was zoloft at 25mg, but I couldn’t eat and it made me a zombie. I have now been on duloxetine for a 4 years and it is working.

        2. Warrior13*

          PMDDer on duloxetine for 5ish years too! I also added wellbutrin earlier this year and I feel the best I’ve felt in years, if not ever. I am also someone that can tolerate a combination pill, so I take Yasmin continuously.

          I primarily have things under control, but its taken about 6 years to get here. I now work fully remote with only 3-4 days of travel 3 times a year. I just had a meltdown last Friday after a super stressful event on Wednesday caused breakthrough symptoms and I started spotting. Its my first one at this job and it was over the phone, but I’m still super embarrassed. But this article made me feel so seen!!

        3. Minimal Pear*

          I was on duloxetine for something completely different (nerve pain) but just want to note that if you try it, you might want to keep an eye on the quality of your sleep. It really messed up my sleep but it was very subtle/snuck up on me so I was feeling terrible for a while before I noticed. Nothing against the med in general, I just wish someone had warned me!

      3. MBRec*

        I’m on Slynd (which is a type of BC) and on 5mg of Lexapro. We’re about to titrate up but it’s been life changing, and the response was immediate.

      4. Keymaster in absentia*

        I could never get on with any of the modern antidepressants so I’m on a much older tricyclic. It’s not advised anymore (has a high risk of heart issues) but I’m staying on it because it works.

      5. I forget my handle here*

        I want to mention, one thing that can reduce the medication merry-go-round is pharmacogenetic testing.

        With pharmacogenetic testing, your prescriber order the test, you get a swab kit in the mail, you send it back, and they are able to assess how you metabolize many different medications. I was able to find out that there is basically one subgroup of antidepressants my body processes normally.

        just wanted to mention it as something that is cool to know it exists as something you can do that might reduce the medication merry-go-round process

    3. coffeeeecup*

      I take an SSRI and I find it takes a bit of the edge off the PMDD but not enough. I think it’s a hormonal thing that probably needs a relevant treatment for some people, but in the absence of knowing what that might be, the SSRI is better than nothing!

  9. OrigCassandra*

    I have to deal with the patienceless-ragemonster variant of PMDD. I manage it by calendaring so I know when I’m liable to ragemonster at somebody — if I warn myself not to in advance, I can usually shut my inner ragemonster down. Trickier now that I’m barreling toward menopause, but it still helps.

    Usually. I have definitely had a few moments I’m not proud of.

    1. BellyButton*

      Yes! I use an app, and when I start noticing I am feeling irrational or weepy I look at it, and I am always 3 days out from my usual start date. I can then warn my BF. “I am needy, whiny, irrational, and I also want to kill you for breathing.”

    2. Lime green Pacer*

      I have some kind of environmental allergy that periodically gives me major headaches, fatigue, and extreme irritability. So I’m finding the discussion about dealing with the “rage monster” side of my own condition very interesting.

  10. HannahS*

    If anyone is wondering where the data on the rates of attempted suicide came from, I found this study:

    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03851-0

    The study itself is interesting and important, and also has significant limitations (largely due to selection bias and self-report,) which the authors acknowledge. Definitely an understudied and undertaught area–the management of many conditions related to menstruation/pregnancy/lactation/menopause remain poorly taught in medical school and residency, even in specialties where it comes up a LOT.

    1. DeskApple*

      thank you for linking this. I only knew endometriosis was bad in my family but come to find out most women has post partum psychosis and now there is research suggesting a link between that and PMDD too

  11. DeskApple*

    I feel so seen! PMDD can also make individuals really susceptible to self harm and can make you take criticism too personally because of the hormone imbalance. HRT saved me and made me realize I wasn’t stupid and didn’t deserve to hate myself each month. Most importantly that
    any failures didn’t mean I didn’t deserve to live (that’s how serious PMDD is). AaM taught me how to be objective with criticism and approach it like a consultant and that helped so much. I feel like I unlocked the person I always wished I could be by accepting my limitations and also accepting I deserved treatment. Thanks for addressing this!

  12. ZSD*

    For anyone else who wondered: I looked it up, and the luteal phase is apparently the phase of your cycle before you start menstruating.

    1. Zap R.*

      We definitely learned the stages in Grade 9 health class but we spent like a day on them and the entire rest of the semester on teen pregnancy (but not abortions), the dangers of smoking (it gives you psoriasis and therefore makes you ugly), and how if we tried drugs even once we’d end up doing sex work on the Downtown East Side of Vancouver.

      Oddly, I did not grow up anywhere near Vancouver.

  13. Advocate*

    Endometriosis afflicts 10% of girls and women. It can damage vital organs, cause infertility, chronic pain, and lead to permanent disability. These diseases are career killers. They sideline smart, talented women and cost our economy billions $ in productivity. Yet research into gynecologic diseases like Endometriosis and PMDD are deeply underfunded by the National Institutes of Health (NIH). Ob/Gyn funding represents less that one percent of all funding. To be clear, that is a category of vital health that affects more than half the population. Get mad, fellow ladies. Vote accordingly. https://www.cnbc.com/2016/05/19/this-neglected-disease-is-a-hidden-drain-on-womens-success.html

    1. Zap R.*

      We definitely learned the stages in Grade 9 health class but we spent like a day on them and the entire rest of the semester on teen pregnancy (but not abortions), the dangers of smoking (it gives you psoriasis and therefore makes you ugly), and how if we tried drugs even once we’d end up doing sex work on the Downtown East Side of Vancouver.

      Oddly, I did not grow up anywhere near Vancouver.

      2. 2QS*

        I did, and this just made me burst out laughing. It’s terrible, but that’s more sex ed than I got in Grade 9, or all of high school, in B.C. way back in the day.

    2. Texan In Exile*

      “There is five times more research into erectile dysfunction, which affects 19% of men, than into premenstrual syndrome, which affects 90% of women.”

      From The Guardian (link to follow)

    3. H.Regalis*

      I have cysts on my ovaries that bleed on a regular basis but follow no pattern I have ever bene able to discern. It’s fucked up my teeth, my hair, and makes me super tired because I’m losing a significant amount of blood on the days it happens. I’ve had this problem for almost twenty years, been to plenty of doctors, and I still haven’t found a good solution.

      Past doctors: Well, we can’t figure out what’s causing this, so it can’t be that bad, because otherwise we would have a solution for you ¯\_(ツ)_/¯
      Me: (╯°□°)╯︵ ┻━┻

      Health problems affecting uteruses and vaginas are the poor relations of the medical world. It sucks and I hate it.

      1. Advocate*

        Sounds like intrauterine fibroids or adenomyosis. Please see a female surgical gynecologist — an M.D. (not O.D.) — whose primary practice is not obstetrics.

        1. Broadway Duchess*

          You wouldn’t see an OD (optometrist) for menstrual issues in any event unless your eyes are somehow affected. If you meant a DO (osteopath), please know that osteopathic training is virtually identical to the allopathic training MDs receive, so a gynecologist who is a DO is not less than one who is an MD. Naturopath, on the other hand…

          1. Advocate*

            Of course I meant D.O., as you condescendingly corrected me. The fact remains that D.O.s are *not* M.D.s.

            1. Boof*

              DO’s are practically mds; we both have to go through the same residency programs where really the brunt of clinical learning takes place. They have a slightly different type of medical school that focuses a little more on osteopathic stuff. That being said definitely see someone who specializes in it rather than, say, family medicine or a midlevel

      2. Anon4MedicalStuff*

        I have exactly the same problem, including the weight loss/malnutrition from large amounts of blood loss. And my doctors are exactly the same!

        “If It WaS a BiG dEaL wE’d HaVe A tReAtMeNt FoR iT sO sToP mAkInG a FuSs”

        Faaaaaargh

        If men got giant bleeding cysts on their gonads they wouldn’t have to wait until they were the size of a cricket ball before being allowed to request that they be removed.

        1. H.Regalis*

          I feel you. It sucks and is beyond frustrating. You go into the doctor and they’re like ¯\_(ツ)_/¯, and if you mention trying OTC stuff or home remedies (did that on social media once—never again), then inevitably somebody’s like, “OMG, go to the doctor, duh! Stop doing all that new-age, snake oil bullshit! You’re so fucking ignorant that you probably deserve what’s happening to you.”

  14. WantonSeedStitch*

    I just want to give you a shout-out for the inclusive way you talked about a menstruation-related condition here, Alison! You didn’t write with the assumption that anyone who menstruates is a woman. While I am a woman myself, I know enough people who menstruate who *aren’t* that I really appreciate this.

    2. Too Many Birds*

      Totally. And that many women (trans and cis!) do *not* menstruate for a variety of reasons.

  15. Not an expert*

    Not the same, but possibly related is Perimenopause. If you are person who menstruates, are in your 30s or 40s, and have noticed new symptoms of anything like brain fog, rage, unusual hair loss, weight gain (even though your diet and exercise is the same), temperature regulation weirdness, sleep problems, then it might be perimenopause related. I’ll have to do some digging for a more exhaustive list of symptoms, but as I understand it, there are a lot, and they can vary wildly from person to person.

    This is (hopefully) a growing field of study that is so far pointing to symptoms starting much earlier (as early as 8-10 years before official menopause) than previously thought.

    Note: I am not an expert

    1. DeskApple*

      I think the helpful difference to note is that PMDD is the 10-14 days before your period and is regular as well. But all of it (phases of menopause included) are all so wildly understudied it baffles the senses. I’m so glad for social media which gives great clinicians a platform to educate

      1. Still alive*

        Agreed! It is related in the sense that peri can make existing PMDD much worse though, because if you’ve been coping by tracking your cycle that coping mechanism can be removed, and also the number of symptomatic days can increase.

      3. WellRed*

        It doesn’t say it’s the same. I also found myself reading the post, being super grateful I don’t suffer from PMDD and sympathetic to those who do. And also being reminded of how challenging life is since starting what I assume is perimenopause (and originally worried was early dementia). It’s not a contest.

      4. Advocate*

        I don’t think it’s helpful to discount anyone’s experience. This isn’t a competition. Peri-menopause and menopause can absolutely be disabling for a lot of women, especially if compounded with any other estrogenic or autoimmune diseases or processes.

    3. Cruciatus*

      I’m currently fighting what is probably hormone related insomnia likely due to perimenopause. It’s exhausting never sleeping! Fortunately my department is pretty chill, but I know I’m very lucky to be able to WFH suddenly if I need to. (And if anyone can give me hope this will get better I’m all ears! It’s been a month and nothing my doctor has done has fixed it!)

    4. Advocate*

      And on that note, please read “Women Have Been Misled About Menopause” nyti.ms/3WRpCQ1 (gift link)

    6. Fives*

      I was finally diagnosed with this in October and getting put on the patch has been absolutely life-changing for me. I’ve been trying to figure out what was wrong with me for years. I kept pushing because I knew something was wrong. I hadn’t realized how bad I felt until I felt… OK.

  16. Keymaster the absent*

    With the highly stigmatised and very serious mental disorders like this and additionally any kind of psychosis/detachment from reality it really comes down to how well you can act ‘normal’ as a percentage of working life.

    The odd brain fog incident is fine. Rage/anger/shouting you can maybe get away with once or twice a year by saying it’s a medical problem if it’s not too severe a reaction. Depends on the firm.

    But I absolutely wouldn’t disclose a serious mental issue to a company HR or management. Did it once and got burnt beyond belief (people being too scared to even talk to me afterward). I do have a few hard earned tactics that if I start to feel the anger/fear/irrational stress come on I can get myself out of the situation and go sit outside for a while alone. The brain fog is very real too and that is harder to deal with paradoxically – because it limits the thinking you can’t recall the coping strategies!

    This is a very good article and I’m really impressed how Alison blended a genuine concern for people with these conditions with a realisitic view of the workplace.

  17. BritSouthAfricanAmericanHybrid*

    Oh my goodness, thank you for posting this! About 14 years ago we almost lost our daughter to suicide because of PMDD. The therapists and doctors insisted she was bi-polar or schizophrenic, even though she did not tick all their boxes. We knew it was something else. But it was a frightening time. She heard voices, she threatened to kill people at school (nothing like having the police and CPS at your door as a result), she self-harmed on several occasions, and it was terrifying. But then, I saw a pattern and put two and two together. The ONLY reason we even knew about PMDD was because of a late-night TV commercial we saw. She saw an excellent OB/Gyn who worked with her and got her on some great birth control and other meds and she is doing really well.

    Today she is married and mom to 5 kids. Her husband is awesome and takes over all parenting for 2-3 days every few months when she is overwhelmed (having kids actually helped her symptoms, but that is not the solution for everyone, obviously!) When she did work full-time she really tried to ensure she was ahead of things, and then if she had a bad day or two, she could just cruise through the day on auto-pilot.

    I do think employers need to be made aware of PMDD, no matter how rare it is.

  18. Quinalla*

    Thank you so much for posting this, I don’t have PMDD but was only knew a tiny bit about it and great to learn more. It is interesting as the symptoms sound very similar to perimenopause symptoms which I am experiencing (brain fog and rage are both very common)! It makes sense though that they would be similar since peri so many of your hormone levels are dropping, it’s similar to that part of the cycle. I pre-ordered the book as I want to learn more, thanks again!

  19. PMDD Meh*

    Thanks for including this topic! My wife has really been struggling with this, perimenopause seems to have completely obliterated her ability to cope 2-3 days a month. She tried an SSRI but had a severe reaction to it that may have been serotonin syndrome. Doctors are reluctant to try HRT because she’s still fairly young (45). She ended up quitting her job because she just couldn’t function well and her boss (female mid-50s) was entirely unhelpful about trying to manage things and frequently made it worse by being a very reactive manager.

    1. higheredadmin*

      This is a common complaint for perimenopause – that doctors will tell you that having it in your 40s is too young, so HRT is denied. I would suggest your wife keeps trying doctors (if possible) until she finds someone willing to help.

    2. Perimenopause if Different*

      With all of the mentions here of Perimenopause I’m putting in a quick plug for Dr. Jen Gunter’s book The Menopause Manifesto.
      I’m a pelvic floor physical therapist knee deep in perimenopause/menopause education with the people I take care of. Please tell your wives, sisters, daughters etc… to push for the care they deserve and take references with them to talk to their medical providers (North American Menopause Society or similar organizations from other countries are great places to start because they tick the “evidence based practice” boxes). I see far too often that primary care providers try to start with anti-depressants, or localized hormone methods, or decide to treat all of the other medical things that come with perimenopause (e.g., elevated cholesterol, brain fog, mood changes, sleep problems, and on and on…) rather than addressing the GIANT COMMON ELEPHANT IN THE ROOM. None of that is consistent with established standard of care for perimenopause, rather it is a symptom of gatekeepers working with limited information. It is infuriating to see as a provider and even more so when I am the patient having to fight for my own care.

    3. Keymaster in absentia*

      My best friend is around 45 and having a very rough time with peri menopause. They also tried her on an SSRI but it didn’t work.

      Now she’s on HRT and an older tricyclic antidepressant and the difference is remarkable. No more rage fits, no more forgetting where she was driving to. 45 definitely isn’t too young for HRT.

  20. Feeling Like a Monster*

    This is timely! I have noticed massive mood swings in the past few months that I’m tracking now for medical assistance. My issue is more along perimenopause, but it’s definitely disrupting and completely out of my character.
    I would never had thought to reach out for a reasonable accommodation!

    1. SheLooksFamiliar*

      Just to show biology is not the same for everyone…I was extremely PMSy with wild mood swings and other symptoms that make me wonder now if I had PMDD. My doctor never mentioned it then, I just ate Snickers bars and potato chips – Sure! Why not? – and tried to avoid people when I felt The Feels. Work friends told me I didn’t come unglued but I’m sure I had some bad moments.

      Once perimenopause started, I got massive migraines but my moods stabilized. I was so calm and easygoing, I didn’t even feel extreme moods. Except for the horrible hot flashes, no one could tell I was menopausal.

      No one and nothing ever prepares you for the hot flashes. Pure misery.

  21. brownstag*

    I feel like mentioning “days per month” is as good as saying it’s because of menstruation. I would modify the script to say “occasionally”

    1. autom*

      Agreed, especially if you’re in a workplace that is squeamish about that stuff (which is many of them).

    2. nnn*

      “Occasionally” would make me think 2-3 times a year, not multiple days a month. I don’t think that’s setting expectations well.

    4. Thistle Pie*

      There are other ways to phrase it, but things like treatments for various conditions can also affect people X days per month, and that’s even more common than PMDD.

    5. Retired Vulcan Raises 1 Grey Eyebrow*

      Yes, I’d avoid saying anything about monthly symptoms if you’re a woman. We have to live in the work world as it is, not as we’d like it to be.
      If you say “occasionally”, then it would probably take several months before a manager notices it’s monthly and hopefully by then your work on all the other days will have proved your worth as an employee.

  22. higheredadmin*

    I have used the following language for my hormone issues: “I have a health condition that is under control with medication; however, at set intervals we have to review and reset and I can get pretty off until everything gets balanced again.” This is very true for anything hormonal – you get it organized and then boom, hormones shift around again and back to the drawing board. PMDD is just another example of women’s health conditions being under-researched, under-treated and under-diagnosed, and our societal view that women’s suffering is just a part of being a woman as opposed to medical conditions that we should be trying to help people with.

  23. Rachel*

    If I am on the receiving end of a meltdown at work, how can I distinguish between a medical condition with this as a symptom and antisocial, manipulative behavior?

    More to the point, how can I do this without asking somebody to disclose their medical condition?

    1. Keymaster in absentia*

      You treat it the same way. ‘I won’t be talked to like this’ and leave the room if possible.

      You don’t have to put up with being raged at just because someone has a mental condition. And speaking as one with a serious illness it’s actually less beneficial for us to be shielded from the consequences of our actions.

      You don’t have to know what’s behind it. If the person apologises later, says they’ve got a problem and are getting help then that’s okay to move on from. If they say they’ve got a problem and you’ve just got to live with it then that’s not a reasonable answer.

      And if they don’t apologise they’re a git.

      1. Rachel*

        “They are a git”

        I mean, okay, but what if that git is my boss who has power over me? What if that git is my co-worker and I am a captive audience to their meltdowns?

        How many meltdowns and apology cycles should I go through before I quit?

        1. Ask a Manager* Post author

          The answer is the same whether there’s a medical condition in play or not (and there are many terrible bosses who explode at people with no medical issue causing it). You don’t need to put up with people being abusive at work. If your employer doesn’t care to intervene, that may mean your only option is to quit. But no one here is saying that PMDD gives colleagues license to mistreat you, nor would that be considered a reasonable accommodation (you’ll see that the accommodations discussed in the book excerpt are things like the flexibility to work from home or to avoid scheduling meetings on certain days).

          1. Rachel*

            I would really like to discuss this further.

            You are saying that people should handle meltdowns with apology, which initiates the meltdown/apology cycle of abuse.

            You are also saying nobody needs to put up with abuse.

            Which one is it?

            1. Ask a Manager* Post author

              No one has suggested that a regular pattern of meltdowns at work is okay or an acceptable accommodation.

              To be clear, no one should have a meltdown at work. That said, some people do lose their cool at work — whether from PMDD or stress or a bad reaction to a medication or going through something in their personal life or all sorts of other reasons. If it happens, you should acknowledge it wasn’t okay and apologize, not try to pretend it didn’t happen. If it happens more than once, an employer should not tolerate that; that’s not a reasonable accommodation in most cases, particularly if it’s directed at someone else.

    2. Boof*

      Honestly, the person, and if not them, then you should address that the behavior was not OK. Even if there’s a reason for the behavior, even as a “and “good” reason, the behavior still has to be gotten under control. And everyone should acknowledge that. I don’t think it’s fair to for some coworkers to keep working with someone who has regular meltdowns no matter the reason.

    3. name of the day*

      as someone who has had outbursts at work bc of pmdd, that’s on the person outbursting. i don’t and shouldn’t expect anyone to be ok with being spoken to in that way! an accommodation for pmdd would be something like “work from home” not “get to yell at people with no consequences”!

    5. Annie*

      If you only have the data point of one outburst, you basically can’t. If you have a behavioral history of at least a few months, and there’s a pattern, it MIGHT be medical.

      Another complicating factor: Antisocial, manipulative behavior can be a symptom of a medical issue.

      As others have pointed out, however, the exact origin of the outburst (medical or not) doesn’t impact what the best approach to one would be.

  25. Jam Today*

    I don’t know that it rises to the level of what some of the other women here are reporting, but I have noticed that it is worsening with age; my primary symptom is an all-consuming rage, like pacing around my house having shouting imaginary arguments with people (I live alone, fortunately) that lasts for some number of days, and then disappears like it never happened.

    It took me a LONG time to figure out the pattern. I asked my PCP about it and her suggestion was meditation and I’m like lady, the absolute last thing I need is to be living in my own head *more* than I already am. Suffice it to say, I am so far lucky that I have been aware enough of it to keep myself from having a moment of explosive anger on a work call, but I have had a couple of close shaves and white-knuckling it is increasingly challenging.

    1. Keymaster in absentia*

      Yeah, I hate medical professionals prescribing meditation or mindfulness for mental disorders because they can actually do more harm than good. I have a serious mental illness and chronic pain – I don’t want to be aware of my body or mind!

      The fight to get decent treatment is very real and I’m sorry you’re going through it. It’s so sadly common for anything female-related to be waved off by the doctors.

      (Took 25 years for them to actually yank my uterus out)

    2. higheredadmin*

      I would suggest you look into hormonal patterns in perimenopause. Estrogen and progesterone don’t just all neatly stop in a staged progression – they are all over the place at different times and to what you are saying often out of balance. The rage is a common effect of this (paired with the realization that your body is going through something huge and the medical advice is to basically calm down and lump it.) I would suggest that you look into estrogen dominance and progesterone dominance.

      1. Jam Today*

        Oh for sure, I’m certain that’s it, and I’m going to ask for a referral to (or must seek out on my own) a physician who specializes in menopause. I’m not there yet, but trending in that direction with many of the common symptoms (and some unusual ones — my hair went from pin-straight to 2b-c wavy in a year and a half). I have some complicating factors that some physicians believe preclude HRT but man, listen: I do not want to grow a beard, lose my bones, or go crazy. I need to find something that will work.

  26. JTP*

    Thank you for posting about this topic. I have PMDD, have had it since I was a teenager, and didn’t get diagnosed until I was 33.

    1. JTP*

      And to add: that was more than ten years ago, and I’m still trying to find a combo of meds that works for me, my regular major depressive disorder, seasonal depression, and ADHD (my brain is all effed up). Hormones are out of the question because I have a clotting disorder.

      1. I forget my handle here*

        If you are trying to find what medications are most helpful, one thing that reduced the medication merry-go-round for me was pharmacogenetic testing.

        With pharmacogenetic testing, your prescriber order the test, you get a swab kit in the mail, you send it back, and they are able to assess how you metabolize many different medications. I was able to find out that there is basically one subgroup of antidepressants my body processes normally, and a bunch that will never be worth trying.

        just wanted to mention it as something that is cool to know it exists as something you can do that might reduce the medication merry-go-round process

  27. Duckles*

    I feel like the stats cannot possibly be right— even in the low end that would mean one in sixty women has attempted suicide which seems vastly too high.

    1. different seudonym*

      It says “It can mean wild mood swings, rage, anxiety, depression, and lethargy during the second half of the person’s menstrual cycle, and about a third of people with PMDD have attempted suicide. Yet on average it takes 10 years to get a diagnosis, and many people have never even heard of it.”

      Perhaps this means one-third of people **with a diagnosis in hand** have made attempts?

      1. Warrior Princess Xena*

        I have never heard of it and I thought I was pretty well-read on various disorders like endometriosis and PCOS; apparently I need to do more research! I’d agree that “with a diagnosis in hand” would make the most sense – assuming that PMDD can affect 5-8% of ~50% of the population, that would bring us to about 1/125, which seems high when compared with some of the estimates I’m seeing for self-reports. But this is the sort of data that it can be very hard to get an accurate read on, and I don’t doubt the misery PMDD can inflict!

    3. Bunny Lake Is Found*

      Attempted suicide can cover a lot of ground–like taking medication and alcohol you know could be dangerous in combination and just being in too much physical and mental pain too care if it the mix could lead to your death, you are just so desperate for sleep or any way to just be without pain. It doesn’t need to be “I want to die so I am taking X actions to accomplish it.”

    4. The Unspeakable Queen Lisa*

      Based on what metric? You don’t even name any counterpoints, you’re just like, “Nah, doesn’t sound right.” How would you know? If someone attempted, would they tell you?

      1 in 60 women attempting suicide does not, unfortunately, sound too high to me. Much less “vastly” too high. You really sound like you’re basing it on your own life and just assuming everyone is like you.

      1. Lexi Vipond*

        But for one specific reason, which presumably lies behind only some attempts? Even if it was half of all attempts, which seems unlikely to me, that would be 1 in 30 women making an attempt for any reason – and presumably 1 in 10 men, since men commit suicide at 3x the rate of women.

        (About 1 in 10000 people actually die of suicide each year, and the attempt rate is supposed to be 10-25x higher. But I have no idea how you turn that into a lifetime rate.)

        1. Magenta Sky*

          PubMedCentral has a paper that says 10-20 million people per year attempt suicide world wide. That’s a tad less than on in 500.

          (Successful) global suicide rates are estimated to be 18/100,000 for males and 11/100,000 for females.

  28. Amber Rose*

    Well now. I’ve suddenly got some food for thought about why I hate my body, my life and everything in the entire world during shark week.

    I spent many of my teen years feeling like it was normal to be in so much pain from cramps that I’d run high fevers. BC eventually made that tolerable from a physical standpoint but the mental one has only got worse as I age. -_-

  29. BecauseHigherEd*

    Just went and read a sample on Amazon. What I read was great and I’m looking forward to going through the whole thing, but BIG TRIGGER WARNING for anyone who chooses to read it (mental health, self-harm, suicidal ideation).

  30. starrai*

    When it comes to disclosure, what about when you are applying to jobs? I’ve been job hunting lately, and in the Disabilities disclosure field, often you can opt not to disclose at that time. Because I have probable things that I want to get definitively diagnosed before I claim anything, I’ve been been doing the “not at this time” selection, but I’m still worried unconscious bias will read that as “most definitely will need accommodations” and will not move my application forward. (Which would be illegal, of course, but there’s no way for me to know that’s actually happening.)

    Anyway, I’m interested to hear how people with disabilities, particularly less visible ones, navigate the application process before even getting hired.

    1. JTP*

      This didn’t nest properly the first time, trying again.

      I don’t think the hiring managers see your answers to those questions (sex/gender, veteran status, disability). Those are aggregated and reported to the EEOC.

      1. starrai*

        Agreed that the hiring managers probably don’t! But the initial HR screeners do, right? Those are the ones I’m worried about acting on their unconscious biases.

  31. Lizcase*

    I’ve never been diagnosed with PMDD, but the difference between having a cycle every month (only regular due to birth control pills) and one every 3 months (BC shot) was eye-opening. I had no idea how much my moods were changing with my cycle. I suddenly stopped having fights with my then boyfriend every month. I stopped having constant issues at work. it suddenly felt like everything was stable rather than living on a rollercoaster.

    after having a child, I went back to the hormone shots (more frequently than for bc) because honestly they keep me sane. i still have issues when I’m due for my shot but it feels like regular PMS, not uncontrollable rage.
    I don’t like the person I am when my hormones aren’t regulated.

  32. JTP*

    I don’t think the hiring managers see your answers to those questions (sex/gender, veteran status, disability). Those are aggregated and reported to the EEOC.

  33. cz*

    Thankfully I am now past it, but this brings back memories. I’m sorry for anyone going through this!!!

  34. ijustworkhere*

    I’m curious about this disorder because I believe my mother had it (and I’m in my 60s). She became an unrecognizable person for several days a month. It was extremely painful and I still haven’t fully gotten over her rages and deep depressions even after years of therapy. A red faced, screaming angry woman will still trigger a full on flight/fight/freeze response and it’s all I can do to not react.

    She had a hysterectomy when I was a teenager and it was like another mother showed up at my house. She told me she felt like she had woken up from a long nightmare. Her personality completely changed and she never acted like that again.

    I cannot imagine the difficulty a person who suffers from this disorder would have in the workplace and I honestly don’t know how an employer accommodates it if it’s as bad as what I saw in my mother. .

    1. Advocate*

      If what your mother was dealing with necessitated a hysterectomy, then it’s very likely she was trying to cope with another painful pelvic illness on top of whatever hormonal fluctuations were happening.

      1. LadyVet*

        Eh, it’s possible that it was PMDD, that her doctors didn’t fully get it but could tell it was connected to her lady organs, and since she had at least one kid she was done using those.

  36. Warrior Princess Xena*

    I do not to my knowledge have PMDD but I have a different longstanding medical condition that always invariably flairs up with my cycle and it makes the first few days a misery; I inevitably end up with disrupted sleep, tremendous oversensitivity to all stimulus, and a general low level of pain that makes it hard to focus. But I can opt to work from home where I don’t have to have my professional face on at all times and can do things like have a hotpack and especially comfortable clothes, all of which helps! It doesn’t always have to be a “big” accommodation to have a tremendous effect on your quality of life, and I encourage people to push for them.

  37. name of the day*

    i’m on my second day of my period so this is the first day in almost 2 weeks that i’m starting to feel a bit better. pmdd started after my cycle returned postpartum and before i clocked the pattern it made my life hell. i damaged working relationships because i simultaneously couldn’t think straight and also was ready to fight at the slightest perceived… anything lol. it was a bad combination to say the least.

    i have had SUCH a hard time getting an obgyn to take me seriously, it was surprising how little help they’ve been. i left my last appointment feeling like “what has to happen for me to get help? do i need to lose my job? get divorced? do i need to (GOD FORBID!! THIS IS JUST IN THEORY!!) hurt myself or somebody else?” it’s so discouraging to be told “well you’re doing everything you can to manage it :)” but for 10 days a month i’m in hell so am i really managing?

    all that being said (i am still coming out of the fog apparently lol), i HAVE been able to manage it a lot better after doing some research, and testing out some different supplements. i also pretty much shut everything down but the bare necessities and i schedule my work around it as much as i can. solidarity with others suffering- it’s the worst.

  38. SGPB*

    I was a long-time sufferer of PMDD. It was so extreme that I regularly experienced psychosis and was admitted to the psych ward several times before I was ever diagnosed. Having a birth control implant helped my symptoms a lot for about 10 years, but eventually, I became resistant and the symptoms began to flare again. After a year of advocating for myself in therapy, at the psych, and at my gyn, I was finally able to have my ovaries surgically removed. I am going through surgical menopause at age 38, however, I am the happiest I have ever been. The surgery saved my life. If you have extreme PMDD symptoms, please know that this is an option.

  39. Dorothy Zpornak*

    Ugh, I’ve been noticing that I’m a lot more emotionally reactive, struggling with executive function in ways I didn’t previously, fatigued, and experiencing more extreme symptoms of anxiety, all of which are affecting my work, and I mentioned it to my therapist and she said, maybe it’s perimenopause. So I’m hating her right now since I just turned 42, but terrified that she’s right and this is just going to be my life for the next 20 yrs.

  40. Lorelai*

    After many years of being highly emotional at work and about work and stressed and taking it out on people, I started an antidepressant. It turned my life around. I realize this isn’t an option for a lot of people, but it may be worth a discussion with your doctor. Why suffer needlessly?

    1. LadyVet*

      It sounds like you had “regular” depression, and it’s wonderful that you found a solution.

      This particular thread is about people with PMDD, which, unfortunately, carries even more stigma and is understood even less because it’s connected to menstruation.

    2. Keymaster in absentia*

      PMDD isn’t depression, although in some cases antidepressants can help with some of the symptoms. But it’s a real ‘hit or miss’ trial with medications and that’s even if you can find a doctor who believes in it!

      Trial and error testing with mental medications is rough, especially if they start bringing in antipsychotics. It’s additional suffering that is not for everyone.

  41. Lifeafterburnout*

    Last year I finally got a full hysterectomy and finally got rid of my emotional deregulators (aka ovaries). I could feel the difference of not having them from the moment I woke up after the surgery.
    No HRT, I’m only going through menopause once. hot flushes suck, but I’d rather have them than my ovaries back.

    I wish I’d been more assertive 12 years ago in seeking a resolution, but couldn’t due to simply trying to deal with the symptons to get enough clear headspace to work/live etc.

    pfft to the manager who told me I’d never get promoted due to my emotional irregularities. pffft to the gynacologist who refused to investigate surgery because he saw no reason to because i was “too young” and could still bear a child.

    I know now, that a lot of my problems have come from those two little deregulators.

    1. SGPB*

      I could have written this exact post! My gyn kept saying “you need those hormones for your bones and your heart” and I kept telling her they won’t matter if I don’t survive. She did finally cave and did the surgery once I got letters from 2 psychiatrists and my therapist.

    2. SGPB*

      I could have written this exact post. My obgyn kept telling me that I “need these hormones for bones and heart” so she wouldn’t do surgery. But she wouldn’t be saying that if I had a physical illness like a tumor, she was only saying that because it was a mental/hormonal illness, which is think is hugely indicative of the problem of doctors treating physical illness as more “real.” She did finally cave and give me surgery but I had to get letters from my psychiatrists and my therapist. It took a year of advocating for myself but thank god I did because it saved my life. I also wish I had it done in my 20’s but at least it’s finally over!!!

  42. Nonny mouse*

    Thank you for opening this topic up for discussion, Allison! My PMDD became noticeable about three months into a new, highly-visible, high-stress job in a male dominated organization. I had to lead a meeting with senior stakeholders and I simply could not process anything anyone was saying while also coping with a really horrific mood crash. It was awful. I ended up disclosing to my manager, a woman a few years younger than me, and thank god she was sympathetic and understanding. She told me to just quietly take a sick day in the future if I felt that way, and if it started becoming a few days a month, we could take about making formal accommodations. But a few months ago our team was reorganized and now I report to a man who seems to have limited socio-emotional intelligence, and there’s no way I would feel comfortable disclosing to him. I mentioned that I’m managing chronic health problems (which I am). Things have more or less improved since that first terrible swing, but I still don’t know how to extricate myself if another bad PMDD spell hits during a critical time when I have to be “on.”

  43. ThatOtherClare*

    The latest research is indicating that a key feature of PMS/PMDD is the way some people’s brains react to allopregnanolone (allo), which is a hormone all bodies make out of progesterone. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066446/

    High progesterone in the late cycle leads to high allo. There is some research indicating that inhibiting the chemical that converts progesterone to allo (5-alpha reductase) can lower allo levels and reduce PMDD symptoms. https://www.nature.com/articles/npp2015246

    “Yeah, and?”, you say, “I can’t just grab a bottle of dutasteride and try this for myself. How is this applicable in the real world?”

    Curcumin, a compound extracted from turmeric, is a strong 5-alpha reductase inhibitor. You can just buy turmeric, or you can buy circumin extract as a supplement.

    Personally, turmeric doesn’t do anything for my brain fog or physical symptoms, but it completely eliminates my rage and paranoia symptoms within hours. So no cure all, but still very useful. I intend to see a doctor to talk about trying the real deal and I recommend others do the same. But if you’re desperate turmeric is a viable stopgap with scientific backing.

    Thank you for listening to your local little old medicine woman and have a nice day.

  44. coffeeeecup*

    Thank you so much for this – I have it and I still haven’t found a great way to manage it at work. I hate it so much. I don’t rage at anyone so it doesn’t affect my relationships with colleagues, and I’m good at knowing when to step back when the depression gets too much, but I still find it exhausting. It seems to be getting earlier in the month as I get older, too, so I feel I’m saddled with it for a longer time than necessary.

    I’m not sure about saying I’m working with my doctor to deal with it – my doctor has no idea how to deal with it, and I find many people still don’t. If we had more education about the situation more broadly, people might start to realise it isn’t always easily manageable.

  45. Keyboard Cat*

    Question about the phrasing: “I’m working with my doctor to get it under control but in the meanwhile I’d like to ask for [accommodation].” As a manager, would you expect an employee who used this phrasing to eventually improve and be able to stop using that accommodation? For me, I don’t expect my brain fog and pain will ever be “under control” anymore than they currently are with me white knuckling it. Realistically they might get worse. My doctor has basically said to just deal with it, unless the suicidal ideation gets bad again.

  46. LaMi*

    I appreciate this. I have PMDD and I am a manager. I know that my reactions are unwarranted when I am experiencing symptoms, but the worst part is that at the time, they seem – well, not reasonable, but in proportion to the situation.

    I am working with my doctor and things are better, but it’s not an issue with a cure. My colleagues and subordinates recognize that things are better, but it’s still embarrassing and I realize that it creates a toxic workplace. I have lost employees over it. Careful cycle tracking, increased anti-anxieties at the appropriate time, and when possible, a WFH day at the height of it has helped.

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