“I’m sorry. I’m just PMSing.”

This phrase became a staple in my life since I was 17. Soon, however, my premenstrual symptoms became a problem too big to fix with apologies.

When I noticed the worsening premenstrual symptoms, ‘Dr. Google’ was my go-to resource. There, I discovered two things: first, something was wrong; second, I had anything from cancer to a bad lifestyle. Months later, I went to the OB/GYN for the first time and learned my symptoms could be put into a four-letter acronym: PMDD, premenstrual dysphoric disorder.

PMDD is a severe form of PMS and found in about 8% of premenopausal, menstruating women (1,5,6). Thought PMS was a joke? The effect of PMDD is measured in disability-adjusted life years (DALY). Someone who has PMDD, lasting between 14–51 years old, will lose around 3.835 years of their life to this disability (7). This number is equivalent to that of major depression and posttraumatic stress syndrome (1). Seriously. PMS, and it’s bigger, badder sister PMDD, are nothing to laugh at.

So what does PMDD feel like? Clinically, 11 symptoms are associated with PMDD (4):

1. Depressed mood or hopelessness
2. Anxiety or tension
3. Unstable, rapidly changing emotions
4. Irritability or anger
5. Decreased interest in usual activities
6. Concentration difficulties
7. Lack of energy
8. Change in appetite
9. Change in sleep patterns
10. Feeling overwhelmed or out of control.
11. Various physical symptoms (3)

PMDD requires at least 5 of the 11 symptoms, which must also interfere with usual activities (4). These symptoms also must not be heightening another disorder (4).

For me, PMDD comes as debilitating anxiety and sudden irritability. Intense cramping and back pain as well as severe nausea. Inability to concentrate on simple tasks. Unusual amounts of self-deprecating thoughts and crying over trivial things. The sensation of sudden weight gain. And, the most central factor: feeling out of control.

These symptoms didn’t happen all at once. As I got older, my symptoms became worse. I was nineteen when I finally realized I needed to talk to a doctor.

After the PMDD diagnosis, my doctor offered three solutions: develop coping mechanisms to deal with my premenstrual mood; take antidepressants ten days before my predicted period; or go on hormonal birth control.

At this stage of my life, “dealing with it” was not an option. Being in university already seemed like enough stress. Taking antidepressants for short periods of time didn’t seem like a great idea either. Constantly readjusting to the medicine every cycle meant “re-doing” the side effects. Even taking antidepressants regularly wouldn’t be ideal. I was (and am) not depressed, so why take something that I didn’t need?

The only option left was birth control. I wasn’t sure how I felt about taking hormones to regulate mine. Being the neutral option, however, the pill was my only medical solution.

The only option? PMDD, even PMS, has no known causes. Potential contributors are anything from reproductive hormones to genetic factors to stress (2). There are a few nonmedical treatments suitable for PMS, such as diet and exercise, and dietary supplements. Dietary and herbal supplements have also shown small premenstrual physical benefits (2). Psychotherapy is another option to develop coping mechanisms. Until more medical research is done, the current medical PMDD options are the only options.

After I started taking birth control, my symptoms lessened but would occasionally appear. My premenstrual symptoms appeared to be worse depending on my stress levels. Compared to birth control, antidepressants are better at assuaging the symptoms of PMDD (2). Researchers even speculate that taking hormones is more of a placebo effect (2). If I believe I’m doing something that should help, it will.

That being said, I’m still happy with my decision to go on the pill rather than antidepressants. Regulating my hormones does help with my symptoms, even if it is all in my head.

So now what?

Having PMDD isn’t an excuse, but it does make for a good story. Talking about some of my PMDD memories has become easy, at times funny, with friends and family. I am learning how to explain my diagnosis to people in ways that they understand. By teaching others, I was learning personal acceptance, confidence and growth.

In the end, it will take time to find the cause of PMS and PMDD. A viable medical solution will hopefully be found for future generations of PMDD after more research is done. Until that time, here are my suggestions: eat right; exercise; and talk about what you’re feeling. You will find the support you need, even if the support comes in a 28 day pill pack. You will feel better in a matter of days. You are more than your symptoms. PMS and PMDD don’t need an apology; they need research, a solution and a voice.