Gyno Girl Presents: Sex, Drugs & Hormones PMDD and Perimenopause: Symptoms, Diagnosis, and Treatment
What happens when your family stages an intervention because they've been avoiding you 10 days every month?
I'm sharing the story of a patient who had a complete breakdown at Christmas dinner. She snapped at her husband, her kids, her mom, her in-laws—everyone. A few hours later, her family told her: "We love you, but for 10 days every month, we actively avoid you."
She came to me asking: Am I bipolar? Am I manic? What's happening to me?
This is PMDD premenstrual dysphoric disorder. And when it collides with perimenopause, it becomes a perfect storm. This is not just PMS. This isn't you being dramatic. It's a real biochemical thing happening in your brain an abnormal response to normal hormonal changes.
I discuss the science of PMDD: how GABA receptors respond to progesterone metabolites, why some brains are change sensitive, and why the hormonal volatility of perimenopause (erratic estrogen, declining progesterone, unpredictable timing) makes everything exponentially worse. I explain treatment options from luteal-phase SSRIs to Yaz to Duavee for refractory cases, and why tracking your symptoms for at least two cycles is critical for diagnosis.
Highlights:
- Why "I feel like I'm watching myself burn down my life and can't stop it" is the hallmark of PMDD.
- The DRSP tracking tool: why you need 2 cycles to diagnose PMDD properly.
- Why Vitex (chasteberry) might help mood swings and breast pain.
- What Duavee is and why it works for women who can't tolerate progestins.
- Why Dr. Tammy Rowan calls PMDD a progesterone sensitivity issue.
- Ulipristal: the emergency contraception drug being studied for PMDD.
If you've ever felt like your brain gets hijacked on a schedule, if you've felt completely out of control, this episode is for you. Track your symptoms. Find a clinician who takes cyclic mood symptoms seriously. You don't have to live like this. Please share this episode with someone you know might be experiencing this or a clinician you think would benefit from it.
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GSM Collective
The GSM Collective - Chicago Boutique concierge gynecology practice Led by Dr. Sameena Rahman, specialist in sexual medicine & menopause Unrushed appointments in a beautiful, private setting Personalized care for women's health, hormones, and pelvic floor issues Multiple membership options available Ready for personalized women's healthcare? Visit our Chicago office today.