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How to Navigate Relationships with Premenstrual Dysphoric Disorder (PMDD)

[Trigger Warning: Article makes mention of mental health crises and suicidal ideation.]

Relationships are hard. Premenstrual Dysphoric Disorder (PMDD) makes them harder.
You have the best intentions to do it differently this cycle yet somehow, every cycle, you feel UNHINGED. No matter how hard you try, you unleash the luteal beast every damn month.
Or perhaps it's the swirling existential questions like:
  • Is this person right for me?
  • Do I even deserve them?
  • Should we get divorced?
If PMDD is creating pain and turmoil in your partnership, read on for how to communicate effectively all month long so you feel more understood and your partner feels less attacked.

Why does PMDD create conflict in relationships, especially with my partner?

With PMDD, it's common to feel like one person the first half of your cycle and a completely different person the second half. 
Let's start by connecting the dots between what's happening inside our brains in response to the hormone fluctuations, and how that impacts the nervous system:
In menstrual cycle awareness circles, estrogen is sometimes called the "veil of accomodation." We naturally feel more warm and fuzzy towards our loved ones. When estrogen is on the rise, so are our feel-good brain chemicals like serotonin and dopamine. This makes it easier to "play nice with others."
When hormones start to decline, folks with PMDD are sensitive to the hormonal shift. It’s like the rug is getting pulled out from underneath us… and all that was swept under there is front and center stage… in our face to see. 
Due to the hormone and brain changes, we naturally become less accommodating. Even if we tend to be people pleasers, we become more boundaried and potentially more resentful if those boundaries are not being respected or our needs aren’t being met.
We have less emotional and biological resilience to the stress in our lives. Stress hormones actually increase during the luteal phase and we're less resilient to that stress due to the hormonal and brain chemistry changes.
This all adds up to feeling more tension within ourselves and in our relationships, with a lowered tolerance to stress and less access to the coping skills that typically help us during other times of the month.
So why do our partners can the brunt of these dsyregulated emotions? Often times, our partners trigger our deepest trauma wounds since we look to them to help meet our deepest needs of safety, belonging, and love.

Can your relationship survive PMDD?

If my relationship survived, so can yours.*
(*As long as both partners are respectful and safe. If you're in an abusive relationship, please seek professional help.)
I'll tell you a little bit about our story. My husband and I met during the worst PMDD episode of my life.
We met salsa dancing. Sparks flew... all that good stuff. In fact, we became "official" on Valentine's day at a concert to this song: "Te Amo Para Siempre."
The rest is history... well, not really.
And a few months later I fell into a deep dark depression. I was experiencing suicidal ideation that it felt like it would hijack my brain and the next day was like a haze... "Did that really just happen?" Coming out of the aftermath and conflict, an apology didn't seem like enough.
I ended up taking medical leave for 6 months or so. I spent my days in intensive outpatient therapy.
He stood by me through it all. He even came to family therapy a handful of times. And he's the type of guy that "doesn't believe in therapy."  I tell you all of this to emphasize that we didn't "make it" because we're an exceptionally emotionally evolved couple doing all the right things. Nope.
Sitting here today, I can't believe I'm putting this on the internet and that helping others find relief is now my life's work.
Here's the important part. Our relationship didn't survive because he is exceptionally patient (he's honestly not). And it's not because he knew just the right way to support me (he had no idea).
It is so so common to assume one or both of these things:
  1. We (the person with PMDD) are broken and need to change, otherwise we are unworthy of love.
  2. They (the PMDD partner) needs to change and be more emotionally evolved to support us in just the right way.
The thing is: Neither are true.
Looking back, we "made it" and are married today, 9 years later with 4 children (and two Frenchies) for 3 reasons.
  1. He accepted that it wasn't his job to rescue me or fix me. (This helped give me the space to help myself and seek professional support.)
  2. I released all blame that it wasn't my fault or his, and that it was my symptoms talking... and then got outside help.
  3. I learned how to identify & meet my needs and state my needs directly to him (because he certainly couln't read my mind).
This didn't happen overnight, that's for sure.
It was a choice we had to make and remake every day. That choice allowed me the SPACE & TIME to figure out my path to finding relief. We'll talk about that a bit more below.

Why do I want to break up with my partner every month, during my PMDD symptoms?

The luteal phase has a way of stirring up and highlighting everything that's WRONG and needs to change in our lives. I call it the luteal "truth serum" But sometimes that "truth" gets muddy.
When our minds are hijacked by our brain's response to the hormone fluctuations, it's hard to decipher: What's the truth? And what's PMDD?
Hard truth moment:
  • Your emotions and needs matter. Don't gaslight your own emotions saying, "It's just PMDD."
  • Your partner needs respectful communication of those needs. They're not your punching bag.
  • You can communicate your needs respectfully, from a regulated place, with support and practice.
The strategy below takes practice and won't be perfect, but it's totally worth.
So what can you do instead? When you feel irritability rising or rage that's about to boil over, rather than unleashing on your partner, try this instead.
Step 1: Write it Out. "Rage on the Page"
Set a timer for 5 minutes and allow yourself to feel whatever you're feeling. Write it all down, uncensored, without trying to separate fact from fiction. Set it aside for later, then self-soothe to tend to your nervous system. Instead, ask your partner for what you need. Is it time alone? Is it just sitting next to each other without talking? Is it space from the kids? Express that small short-term need and leave the hard, big conversations for after the bleed.
Step 2: Return to your Letter, after your period bleed.
Once symptoms have lifted, read the letter on your own. What are the nuggest of truth? The truth equals the things that till feel true and important, even now in a regulated state, in a different and less symptomatic phase of your cycle. This helps you honor your needs and emotions without buying into the distorted spin that your PMDD brain put on your thoughts during luteal.
Step 3: Have the conversation.
Take the truth you've deciphered from your letter and translate it for your partner in this format:
  • [Observation] When I observe...
  • [Emotion] I feel...
  • [Unmet need] I need...
  • [Request] Would you be willing to...?
That talking format stems from an approach called Nonviolent communication. Couples Communication expert Ali Miller did a guest expert talk inside PMDD Revealed. The above is just a snapshot of the gold she shared with us inside our community.
Most importantly, after there's a rupture in communication or an all-out fight, REPAIR is the most important piece. First, forgive yourself. It's so common to feel shame after conflict due to PMDD symptoms.
Once things settle down, sit down for an agreed upon amount of time and ask each other, "How was that for you?" Be open to hearing about the impact for them as well.
Overall, this strategy helps you explore your needs and honor your emotions, without invalidating yourself because it's happening during your PMDD symptoms. It also protects your partner and relationship from having the hard conversations during a time when it's extra hard to stay regulated.

"What do I do if my partner is thinking of leaving me due to PMDD?"

Have you ever wondered, "Are they going to leave me because my symptoms are so severe?" Or has your partner expressed that they are thinking of leaving because this is all too hard?
Ouch. That cuts deep.
I have had countless people reach out to me urgently because their partner is thinking of leaving them "unless they figure out this PMDD thing.
When you feel like you will be abandoned at your darkest hour, it can trigger deep wounds like:
  • I am unlovable.
  • They deserve someone better.
  • I'll always be alone.
From a nervous system perspective, we can see that both people are responding from a place of survival. For you, the person with PMDD, it's from a primal need for love and acceptance. For them, their "flight" nervous system response is likely kicking in.
However, it's not easy to find your path to healing in a PRESSURE COOKER. These 3 things can help.
  1. SAFETY: Each person needs to feel safe to have their nervous system response. Consider working with a couples therapist skilled in a trauma-informed somatic response. Working with a professional can help you learn how to skillfully communicate needs and co-regulate.
  2. SPACE: Make a clear request for the space and time you need to explore your treatment options. It's difficult to make decisions and take action when you're feeling pressure to find relief and feel better right away. Create a plan with a timeline to breathe some space into your treatment exploration and take the pressure off.
  3. STRATEGY: Let your partner in on your next steps for your treatment plan. Taking empowered strategic action helps both of you feel a sense of agency. It also allows your partner to support you in a healthy way, calming their potential need to want to problem solve and "fix you."

Next Steps: What's your strategy?

We're not relationship experts. What I'm sharing comes from my own lived experience along with the collective wisdom of the hundreds of folks with PMDD that we've supported.
We are experts in STRATEGY. We work together with you to create a data-driven strategy to reduce symptoms and find relief so that you can reclaim your life and live out your purpose. 
If you're ready to experience our special sauce of root-cause functional medicine combined with community & cyclical awareness, click here to set up a 1-on-1 chat to decode your PMDD pattern and map out a path to relief.
DISCLAIMER: All information is meant for education only and is not intended for the diagnosis or treatment of disease, nor does it serve as a substitute for medical treatment or advice. You should seek the advice of a physician with any questions or concerns regarding personal medical conditions.

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