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"The most bizarre part is that as soon as I start bleeding it goes away," the artist and PMDD sufferer Charley Feltham told me over email from Cornwall. "Literally 30 minutes or an hour later and I feel totally normal again. Like I've been in a fog for a week and then I just step out." For the week or ten days before her period, however, Charley loses herself entirely. "Smells are stronger, sounds are louder, things that don't bother me normally become a major issue, I'm clumsy and accident prone, totally exhausted and emotional. As I get closer to my period all of that intensifies and gets coupled with an extreme self-loathing, sometimes even suicidal thoughts. I look in the mirror and my whole face looks different, distorted and not myself. It sounds bonkers; it feels bonkers."But it is a flavor of "bonkers" that is all too familiar to about 5 percent of menstruating women. In fact, the rate may be even higher than that—the National Association for Premenstrual Syndrome quotes 5 to 8 percent with the caveat that it's likely to be underreported, especially by women from ethnic minorities. And if you think that the reason we know so little about PMDD is because relatively few people have it, remember that only 6 percent of the adult population in the UK suffers from diabetes. And we've all heard about that.The monthly cycle of those all-important reproductive hormones, released at different stages into the baby-making system, seem to affect the way signals pass through our brains.
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In his treatment guidelines for PMS, Nick Panay writes that, "When treating women with PMS, newer contraceptive pill types may represent effective treatment for PMS and should be considered as one of the first-line pharmaceutical interventions." If the combined pill is a first step in the fight against PMS and PMDD, then it is not the only possibility. There is increasing evidence that serotonin may play a key role in PMS and PMDD, and so a number of SSRIs (a type of antidepressants that increase the level of the neurotransmitter, serotonin) have been used in its treatment, with better results than a comparative placebo.The other option—the elephant in the womb, as it were—is a hysterectomy. But while for some women that is a serious consideration, many others would prefer to run the gamut of lifestyle changes, cognitive behavioural therapy, progesterone treatments, and antidepressants first. Because, as is so often the case, good diet, exercise, reducing stress, not bingeing on carbohydrates, caffeine, or alcohol can all help to reduce the effects of PMS and PMDD.Sadly, we are fleshy monkeys living in a social world and sometimes mental health issues arise from the confluence of external and biological triggers.
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