I reached for my pack of tissues, hissing at myself when I realized that the pack was empty.
I opened my eyes and stared around me. My bed was a mess. Scattered all around me were rumples of tissue paper soaked up with my tears. My head felt as though huge stones hidden in my skull were thumping steadily against each other, resulting in one of the most torturous headaches of my life, and my eyes were badly swollen.
If someone came into my room at that moment and asked me what the matter was, I doubt I would have been able to explain categorically to the person what the problem was.
My head felt as though huge stones hidden in my skull were thumping steadily against each other, resulting in one of the most torturous headaches of my life, and my eyes were badly swollen.
All I could possibly have said is that it seemed like a wave of bad energy had come over me when I woke up that morning, that it felt like something was drawing darkness out of me, bringing to the surface, secrets that I had safely buried in a part of my soul that I thought was way out of reach, that my mind was suddenly overwhelmed with memories from all my bad days, my mistakes, my traumatic experiences, all the pain I had survived over the years, that my head was filled with questions. Questions about who I was, what I wanted, what I was living for, why I was living.
I got up from my bed and glanced at the reflection of myself in the mirror. My face was a mess. I looked away, suddenly feeling appalled by the young woman staring back at me, suddenly wishing she was existing in a different place, a different time, a different body, and for a minute there, wishing she was not existing at all.
I am not always like this. I endeavor to keep myself mentally healthy most of the time. I keep myself busy with school, with my writing, with my music, and of recent, with my dance lessons. I keep my mind productively occupied and my body healthy.
But there are those times when something dark invades my personal space and takes over my mind. It usually lasts for about four, five days, roughly about one week. Within that period of time, I withdraw to myself, I avoid people, I spend most of the hours on my bed, staring up at the ceiling. I’d pick up my tablet and try to do some reading, some writing. It never works. So I give up. I would turn off the lights, bury myself under layers of blankets, and soak my pillow with tears till I fall asleep.
The hours would drag by, drowsily, heavily, till the day of salvation comes, the first day of my period.
The hours would drag by, drowsily, heavily, till the day of salvation comes, the first day of my period. As the blood starts to flow between my legs, and the physical ache that accompanies my menstrual period takes over me, the ache that had consumed my heart for the past few days would gradually begin to ease away, and slowly, but surely, my smile, my lightheartedness, would return.
I would look around my room, stupefied by the mess I had made. I would pick up my tablet and check my calendar and I’d be mad at myself for the load of work that I had piled up in the past one week, all the missed appointments and classes, all the missed calls, and I’d run my hands to through my hair, whispering to myself, “what on earth came over me?”
Then the darkness would be gone, my heart completely free of all the ache that had plagued it the past few days, and I would return to my normal, busy, healthy self; until the plagues returned, usually a week or so before my menstrual period, and I’d find myself plunged into those recesses of darkness once again.
Upon sharing these series of experiences with my doctor a few weeks ago, I learnt that what I had been suffering from is called premenstrual dysphoric disorder (PMDD), a severe form of the more common premenstrual syndrome (PMS). The first emotion I remember feeling the moment my doctor shared this diagnosis with me is a kind of strange fear. I remember my heart thumping loudly in my chest and my palms getting wet with sweat. I had never been diagnosed with any serious health condition before and being diagnosed with something that had the word “Disorder” in it was new and scary. Briefly, at that moment, I really felt like something was wrong with me. However, with my doctor’s encouraging and comforting words, I gradually began to get a grasp of this condition and to understand that it is not something to be terrified of.
The first emotion I remember feeling the moment my doctor shared this diagnosis with me is a kind of strange fear. I remember my heart thumping loudly in my chest and my palms getting wet with sweat.
While the symptoms of PMDD and those of clinical depression are very similar, one major difference between these two conditions is that the symptoms of PMDD usually follow the menstrual cycle, manifesting typically one or two weeks before the menstrual period. They generally start to get better when the period starts and will have completely disappeared by the time the period is over. To be diagnosed with PMDD, a female must not just display the symptoms of depression, but she must only experience these symptoms during the premenstrual portion of her menstrual cycle and must see relief for at least a few days or weeks during the cycle.
The cause of PMDD has not been exactly defined but recent research suggests that PMDD is associated with exacerbated sensitivity to normal hormonal changes that occur during the menstrual cycle: The menstrual cycle is associated with fluctuations in the level of hormones such as estrogen and progesterone. These fluctuations may affect chemicals in the brain such as serotonin which in turn, affects mood. While these hormonal changes occur in all women, some women are more sensitive to them and this increased sensitivity may play a role in increasing their susceptibility to PMS and PMDD. Some research has also shown that genetics might play a role, as well as stressful or traumatic past events.
Living with the mood disturbances brought by PMDD is seriously challenging. It can be immensely tumultuous to have about two to three weeks of a serene mental space, then to suddenly experience four days of psychological breakdown, when it feels like my whole system is crashing, and I seem to lose all sense of drive and purpose. It is tedious to gather myself up again when the dark clouds finally begin to lift and serenity gradually returns. But learning about my body in the past few months has been really helpful.
I consciously make an effort so that the darkness does not take over me like it used to do. Rather than retreat to my bed and allow myself to wallow in thoughts of pain, sadness, and hopelessness, I find a list of fine comedy movies with which to occupy my mind and I try to take long walks. The walks are really helpful! I made a choice, with the support of my doctor, of course, not to use medications to manage my PMDD for the moment for fear of possible dependence on such lifestyle drugs, so my treatment consists of aerobic exercises and frequent meals that are especially rich in carbohydrates.
As a Yoruba girl from Kwara state, Nigeria, things like menstrual pain, PMS, or any sort of unconventional pain or discomfort experienced by women and young people, in general, are often regarded as unimportant. One major factor that I feel could have influenced this school of thought is that Africans, Nigerians especially, are built for survival. We do not really believe in the concept of pain or physical discomfort, because we are conditioned to bear it all, including pain, until the last minute when it results in a catastrophic end such as death or a more serious, and decapitating health condition. Many times around here, people just drop dead and die, or someone suddenly experiences a major mental breakdown; only then people begin to think back and painfully recount the subtle signs of pain and discomfort the person has been showing that had been discarded as something that would pass away with time. We see it as a luxury to give attention to “small things” like menstrual pain or an emotional meltdown, something for the “rich people” because we are survivors, focused on surviving, not thriving, and we naturally believe that those things will fade with the passing of time, so our initial reaction to things like pain, discomfort or weakness is to ignore or deny its existence and to "just keep moving".
We do not really believe in the concept of pain or physical discomfort, because we are conditioned to bear it all, including pain, until the last minute when it results in a catastrophic end such as death or a more serious, and decapitating health condition.
I remember talking about one of my episodes to one of my male friends when I was depressed and emotionally down. There was a hidden chuckle in his voice all through our conversation. He was of the opinion that I was making the story up or at most, just exaggerating the entire ordeal in order to get his attention or get a few things from him. I ended up feeling terrible, regretting that I had attempted to open up to him. A few of my female friends tend to be a bit more understanding and supportive, but the concept of being diagnosed with PMDD is still strange to most of them. Many of them are of this school of thought: "Don't we all menstruate?" Generally, the entire concept of mental health and depression, in particular, is something we still struggle to grasp as real in this part of the world. Many people still do not believe that depression and similar conditions are real health issues that people go through, at least not until they read a suicide note. The few people that have really supported me are those who are also dealing with one mental health challenge or the other.
In a society like this, women learn to bear their sufferings, be it physical, emotional, or mental alone, for fear of being mocked, judged, or labelled as weak. But I have learnt that having at least one person that I can open up to about the changes I am experiencing in my body, like a mature and open-minded medical professional, goes a long way in helping me keep my head above the waters. Being a medical student myself is a huge privilege for me as well. It has given me the opportunity to learn about the human body and the things our bodies go through on a more intricate level, one I might never have had access to outside of medical school. What I have learnt in school about the female body has really helped me appreciate on a deeper level, the things we go through as women, from puberty to menstruation, to pregnancy, to childbirth, to menopause. It is all a wonderful, complex, and all-consuming process that really takes its toll on the female body.
As a medical student, I have learnt that pain is real, the small things people complain about are valid results of actions and reactions going on in their bodies, and these actions and reactions, no matter how small, require attention. My professional training and lived experience makes me better able to relate to people’s struggles, be it physical or mental, and better able to offer help and advice to them. Being a medical student also really affected my approach to my diagnosis. I knew that regardless of the seemingly big name of PMDD, it was just a reaction born out of certain changes and uniqueness in my body, that it was not something to be terrified about or to be ashamed of, rather it is something I just had to learn to walk through as I understand my body more and fully grasp what works for me.
Be it a mental health problem or an endocrine disorder, what matters ultimately, is that I understand how my body works, how PMDD affects me, and that I learn to properly manage its effects on my life.
I still ask myself many times if PMDD is a mental disorder or something else entirely. Conventionally, PMDD is a hormone-related disorder, hence it is categorized as an endocrine disorder. However, in addition to the physical symptoms, people with PMDD also experience diversities of mental symptoms, such as depression and suicidal feelings. Consequently, it was recently classified as a mental disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). But does it really matter what it is officially labelled as? Be it a mental health problem or an endocrine disorder, what matters ultimately, is that I understand how my body works, how PMDD affects me, and that I learn to properly manage its effects on my life.
My goal is to maintain a thriving whole health: physically, mentally, psychologically, and emotionally, one cycle at a time.