Opening a Conversation Around PMDD, IUDs, and Mental Health

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Opening a Conversation Around PMDD, IUDs, and Mental Health

May 13, 2021
A woman stands on a rooftop at sunset and smiles.

In the late Fall 2020 I had my first wild mood swings. I’d have enough energy for a morning run, but by noon, the tiniest of obstacles could send me into a furious spiral. Other times, I could have easily spent days in bed, subsisting on a diet of only cereal. Then suddenly, I’d feel great, even though seemingly nothing in my environment had changed. 

I ignored these unpredictable mood changes for a while and avoided telling anyone what I was struggling with. It was hard for me to believe that I might need help, for several reasons. First, I come from a stoic family where feelings go unexpressed and mental health is not often discussed. This has made me a stronger person in many ways, but it also means that I struggle to talk about my mental health and find the words to express complicated emotions. 

I also have a perpetual fear of being a complainer. We all know the complainers. Those people who take everything good for granted, who never seem to be able to see the bright side. I have great friends, smart colleagues, supportive family, a roof over my head, food to eat, books to read, a bike to ride…the list goes on. As a result, I regularly find myself thinking that there’s no good reason for me to be sad or have a bad day. 

At the time of my writing this, we’ve lived with the COVID-19 pandemic for just over a year. Oddly, the pandemic backdrop made it even more difficult for me to trust my gut feeling that something was off with my mental health. After all, everyone is going through a tough time right now; I don’t know a single person who hasn’t struggled immensely this past year. “Maybe my dark mood is just COVID blues,” I thought. 

It wasn’t until I hopped on the phone with an old friend of more than 10 years that I realized something needed to change. Opening up to her about my mood swings was not only a huge relief; it highlighted for me just how much I had been pushing my mental health struggles to the back of my mind. My experience struck a familiar chord with my friend, and she was the first person to bring up pre-menstrual syndrome (PMS) and its scary-sounding cousin, premenstrual dysphoric disorder, or PMDD.  

People who menstruate might be familiar with cyclical mood changes that are standard issue with average PMS. But I had never experienced mood swings with my cycle, or if I had, they didn’t interfere with my daily life. I also don’t have one of those regular, calendar-friendly, wrap-it-up-in-a-bow menstrual cycles due to my long-time use of the lifesaving, game-changing hormonal IUD

When I say I love my birth control, I am not exaggerating. Pre-IUD, I had debilitating cramps and myriad other terrible physical symptoms every month. The IUD changed that for the better, all while keeping me baby-free. I had assumed (incorrectly) that because the IUD helped with the physical symptoms, it would alleviate any mental symptoms too. My friend encouraged me to start by talking to a primary care doctor or OB-GYN, as she had done, to find out if the mood swings could be related to my cycle. 

I was nervous to talk to the doctor. I was certain she wouldn’t believe me – after all, I was having trouble trusting myself, so how would I ever get a doctor to take me seriously? When the mood swings got even worse in February, I decided I had to try. The doctor I spoke to was super patient and listened intently as I stumbled my way through an explanation. Although she stopped short of any official diagnosis, she said that the symptoms I was experiencing were consistent with PMDD. She also explained in detail why it’s possible to have PMDD with a hormonal IUD and without a regular cycle. Because the hormonal IUD prevents pregnancy by stopping fertilization, not ovulation, you can still experience mood swings as the level of hormones present in your body rises and falls each month or so. While I had a basic understanding of the workings of my trusty IUD, I didn’t connect the dots with ovulation and mood swings until my doctor took the time to explain it to me. 

The doctor also reassured me that PMDD is both well-documented and treatable. With my mind at ease thanks to positive, open conversations with my friend and my doctor, I was able to take better control of my health. Mental health and physical health are intimately connected, and I’ve learned the importance of treating mental health issues with the same level of concern I’d give to any health problem, such as diabetes or back pain. 

There is still a lot of stigma when it comes to talking about mental illness, and by opening up to friends and family, I realized that I’ve been using this stigma to judge myself pretty harshly. Speaking openly and honestly with trusted peers, family, and health care professionals has helped me find my way through a challenging situation. I just had to be brave enough to start the conversation.