This Undue Burden

There is an unopened pill bottle that hasn’t seen the light of day, or yellow apartment lighting, since it first got stuffed into the trademark brown paper prescription bag from CVS pharmacy. 

“It’s worrying that you’ve been experiencing this on your own for a year and haven’t come in earlier,” the gynecologist expresses, with a look of something between disappointment and pity. I don’t tell her about the time a different gynecologist gasped from in between my legs as I lay staring at the grey speckled drop ceiling tiles, clutching my stabbing-pain lower abdomen. That day, we both discovered that my IUD had fallen out of place. There’s another, more unplaceable kind of pain that happens when you’re forced into vulnerability due to a lack of knowledge about something so intimate. I felt that, too. 

I didn’t tell her about the time the gynecologist before that failed to warn me how painful IUD insertion was, meaning I failed to plan ahead and ask someone for a ride, and was forced to take two buses and a subway home. Nor about the time another gynecologist inserted the subzero speculum into my vagina with zero warning, triggering SA memories. Nor all the other times I left crying from gynecologists’ offices all over the city. Creating my own wayward constellation of sites of trauma. 

All I could get out in response was a tearful nod. The doctor proceeded to tell me about my array of options. Two in total. I could either take a birth control pill daily at a low enough dosage that it wouldn’t serve as contraception—which seemed illogical given that there was already a copper letter T in my uterus (yes, I had one reinserted after the first mishap)—or get on an antidepressant. Oh, and I had to decide right then and there. 

So, I paid to get prescribed a medication that sits untouched in a corner of my home. Out of the glorious pregnancy prevention menu options, I had chosen the Paragard IUD because it was non-hormonal. Although researchers are still unsure of the exact causes of Premenstrual Dysphoric Disorder (PMDD), they believe it is caused by (depending what website you read it on) a “negative,” “abnormal,” or on the kinder and more people-centric webpages, “very sensitive,” response to ‘normal’ hormone level changes brought about by the monthly menstrual cycle. Back in 2021, the NIH released an article titled, “To Normalize is to Impose a Requirement on an Existence.” We are required to go about our daily lives uninterrupted, even as we undergo physically and emotionally taxing bodily changes because they are deemed normal; menstruating bodies are forced to work their 9-5s, sit through classes as their uterine lining seemingly vengefully sheds, and perhaps worst of all, socialize while holding back grimaces and doing the mental math of how many days are left in their cycle.

With PMDD, I am required to move through the world as if I didn’t just leave my body in a dissociative fog in a desperate effort to distance myself from the foreign version of me I become the days right before my period. Each month, it’s not so much a wanting to forget as it is a wanting to believe I’ll be able to see it coming and stop it in its tracks before it gets a hold on me. You don’t know you’re in it until you are. The rage enters like a poisonous gas and I wish I knew how to craft a gas mask for my partner, or at the very least a warning sign. The irritability is a thousand fire ants crawling on my skin that I can’t swat away. The depression is a plunge into the darkest, most soundless depths of the sea. Soundless because I can’t hear myself spiral, let alone think. Soundless because it is one of the only times in my life I can’t find the right words to save me. 

Growing up in an immigrant household meant many things, but chief of all was a great level of suspicion and wariness of Western medicine. I felt most healed when my grandparents practiced their indigenous cleansing rituals on me. At the slightest stomach ache, my grandfather was rubbing an egg across my body and enveloping me in smoke, uttering hushed prayers as he did so. We’re hundreds of miles apart now. I try to do limpias on my own but the protection only lasts so long before the stresses, anxieties, and responsibilities of working two jobs, being in school, being a good partner, and so much more take back over my mind. And body. Stigmatization and medical mistrust run rampant in plenty communities of colour, understandably so given the history of forced experimentation, unconsented operations, and other forms of discrimination. I understand all too well the reasons behind my internal turmoil over whether or not to take this antidepressant, but understanding isn’t always sufficient remedy. The diagnosis alone has helped me immensely in terms of feeling the slightest bit seen and affirmed in my experience. A true remedy, however, would be providing accommodations in school and workplaces for menstruating bodies, and in a way that doesn’t lead to backlash or punitive measures. Instead, upon submitting a request for work accommodations based on PMDD falling under ADA protections, I was told that I would only receive accommodations “if the request does not create an undue burden on other staff/the organization.” 

It is a miracle that I am still here, navigating life, carrying the undue burden of a dysphoric disorder. I don’t use the word “miracle” lightly, for the suicidal ideation and depression that come with PMDD are debilitating and all-consuming in a way I never thought my well of emotions could ever be. I know the antidepressants are perhaps the best choice, but they still sit in their brown paper bag for now, for just a bit longer, I’m telling myself. The gynecologist mentioned that PMDD isn’t permanent, that perhaps it’s reared its head because this particular stage of my life has an inordinate amount of external stresses pushing down on me. I’m holding out hope because it’s what I’ve always held onto, and because I know I’m worth it. I’m worth hoping better for.

Ayling Zulema Dominguez is a poet, mixed media community artist, and youth arts educator from

Bronx, NY. Their writing and artistry are rooted in radical love and an anticolonial poetics, asking

readers and viewers to come close, both in physical touch and in heart. Their writing dares to ask,

“Who are we at our most free?” Their peoples are from Mexico and Dominican Republic.

Ashley's PMDD Story

I have recently read that on average women with PMDD are misdiagnosed for 12 years! Sadly, this was the case for me and I was diagnosed with another mental health condition. It was only as I got older (and more desperate) that I started doing my research and came across PMDD. I couldn't believe it, all the symptoms matched! I bought a period tracker immediately and was even more shocked when noticing the same patterns at the same time, month after month. I felt completely let down by the NHS - unfortunately, this wouldn't be the first or last time I felt this way. Since then, PMDD has felt like a minefield, with doctors often not knowing, understanding, or believing what PMDD is. Eventually, after months of being ignored and dismissed in my "hell weeks," I decided to use savings to go and see someone privately. In an ideal world, I wouldn't have had to but it was one of the best things I ever did for myself! The specialist I saw was so different from any other health professional I had seen, he believed me! He listened and most importantly he understood! Leaving that room, I felt lighter, I knew I wasn't crazy and couldn't help how I felt every month. And better yet, I left with a plan in place - which is what I'd been begging for for months with the NHS.

I left that day with Yasmin contraceptives and vitamin b6 alongside an anti-depressant. I was so hopeful this would be the end of all my problems! I stuck to taking the pills every day but unfortunately, the symptoms didn't go away, I was bleeding constantly and became exhausted. After 3 months we could definitely say that this wasn't the treatment plan for me.

Chemical menopause was something he mentioned to me on my first appointment as a way of trialing whether it was definitely PMDD. As it stops all hormone fluctuations, PMDD symptoms will disappear. Although this sounded amazing, I was so nervous as I am only 32 and it is a really big decision to have to make. One night during "hell week" I looked at my children, my job, and my life and I didn't want to miss any more of it than I had to. Before chemical menopause, I was missing half a month every month, literally half of my life due to these "hell weeks". I decided enough was enough, I had to try it. So that's what I did, I was injected with Prostap and am currently in month one of this. Right now, I would normally be on day 15 of my cycle and would be feeling sluggish, snappy, tired, and starting to feel sad... I feel none of these things... I haven't had any nasty side effects yet; I am a bit hotter, especially at night and I do have headaches but that is so much better than the alternative! Fingers crossed this is the right path for me

Ashley @my.pmdd.and.menopause.journey

I am 32 and have 2 beautiful (and hyper) children. I work in a school and love my job! I enjoy

swimming, going to the gym, reading, and an occasional night out with friends. PMDD makes all of my

“likes” seem unbearable but I refuse to give up on living a full life.

Amy's Story

My name is Amy. I am 29 and a PMDD warrior.

My Journey began when I started my period at the age of 13. I started to become very emotional and I seemed to have no control or emotional regulation.

Throughout my teenage years and early twenties I was very erratic. I would be severely depressed and then really high and happy. I was tested for Bipolar and BPD and diagnosed with BPD.

I then went through Dialectical Behaviour therapy, Psychotherapy and many other forms of therapy but nothing seemed to change my ups and down. Until 3 years ago my mum started to notice that my ‘episodes’ were always just before my period.

I am very lucky to have an amazing best friend and therapist who also supported me and tracked my cycle with me. Then another friend showed me an article in a magazine about a girl with PMDD and I just knew that was what I had.

Over the next year I began to track myself and really noticed that I would spiral badly in my luteal (PMS) phase. I went to the doctor and they put me on Yasmin, a contraceptive pill to help my moods level out. Unfortunately, the pill started to clot my blood within a few months, so I had to come off of it. Coming off of it was very difficult and caused me to have more extreme anxiety than I had ever felt.

I had gone from no tablets to being on blood thinners, Anxiety medication, stomach liners and given an inhaler as I was struggling to breath because my blood was thickening. I then got a UTI infection and felt I was overwhelmed with all these medications. So, after a week I trusted my body and refused to take anything else. Within another week I began to feel physically better and started my mission to look at how to holistically heal my body and mind.

I have always been a firm believer that my body can come back to homeostasis but I am not naïve to think that this is an easy task. It takes a lot of time and energy.

Whilst I was doing this, my therapist referred me to a Hormone Clinic in London.

I began to read into cycle syncing, researching herbal remedies, vitamins and minerals and tracking everything within my luteal phase.

I notice my most debilitating symptoms were extreme fatigue, paranoia, anxiety and suicidal thoughts. I also noticed I struggled to feel any level of connection to anything around me as I went from day 4 to 1.

So I began to observe my thoughts, lucky for myself I had travelled a lot over the years and stayed in Buddhist temples and silent retreats so I know how to observe my thoughts and meditate already.

I started to see that the fatigue would cause brain fog, leading to feelings of shame. The shame would cause me to feel paranoid that people didn’t like me, that they thought I was lazy and useless. These feelings would lead to me having suicidal thoughts, like i should just give up, I’ll never change, life is to hard.

So I began to look up the best herbal remedies for extreme fatigue and brain fog.

I started to look at my cycle as a test each luteal phase was the practical and then other phases I would observe what had happened in depth. This was not easy, I would cry a lot, I was very scared of my ability to change and spiral but I knew I had to change it.

I tested for vitamin and mineral deficiencies and found nothing wrong. Then I found Primrose Oil and B6 tablets and began to take them in my luteal phase as well as Cod Liver Oil and Magnesium. The combination of these 3 seemed to alleviate the fatigue and anxiety about 70 %. Which was amazing and allowed me to work on the other symptoms: paranoia and suicidal thoughts.

By this point, I had finally heard back from the Hormone Clinic who unfortunately refused me because I refused to take any more medication. I will say, I am not against medication but it doesn’t seem to work well for my body. I was angry but I knew I needed to and wanted to figure this out within myself, working this out in a holistic way.

My next step was building a daily morning routine to support my mental health and self love.

I was now 28 and I was very aware this wasn’t my fault, this was a mental health condition, however, having spent my life in chaos due to my emotions. I thought processes and self belief were really low. I was ashamed of myself. I had struggled to keep jobs down for years because I was ill and wouldn’t be able to get out of bed at certain times of the month and I didn’t know how to explain myself.

My romantic relationships were really difficult too and honestly consistency had felt near to impossible but I always loved exercise, writing and meditation. So, I created a morning plan, to get up at 6am, work out, have a cold shower, do meditation, write a gratitude list and journal. Each part of this plan was strategically placed for a certain symptom.

I worked out to motivational music to get my head into self belief, I had a cold shower to help my anxiety and support my ability to endure discomfort (because my emotions can felt extremely intense and very uncomfortable). I meditated to focus my mind, I wrote a gratitude list to remind me of the simple good in the world so when I am feeling suicidal I can remember and I journaled to connect to God because I believe God can sustain me when I can’t.

I started this the day I came on my period to build momentum and I saw a profound difference!

I love nutrition too so then began to focus on food a bit more. I don’t like to stress this too much because food has been a big disorder for me. But I try to eat as good as I can and not allow myself to feel guilt for comfort food. Then, lastly, I started doing somatic therapy/tantric Yoga. Which has taken me to a new level. Each woman is different but I have a lot of trauma which is activated again and again in my luteal phase. Meaning I needed to move the trauma through my body which I have been doing and still do weekly and sometimes daily. I cry when I need to without placing a story behind it. I scream when I need to without placing a story behind it. I dance and flow the emotions through my body, because emotions are just energy in motion and I have learnt not to be afraid of them.

The more I did this and connected to my body the more powerful my feminine energy became. I started to notice that in my luteal phase, I would see visions and dreams and get very strong wisdom and intuition that would lead me to support other women.

I began to read into the divine feminine and it became clear that the menstrual cycle is not a burden but a superpower unutilised. Then 6 months ago I officially got diagnosed with PMDD and got offered tablets again. I refused and told the doctor about all I had learnt, unfortunately it wasn’t taken well and this was when I decided I wanted to do this for work. Now I support women like myself to find their intuitive toolbox and power.

I do still feel very emotional a lot in my luteal phase, I still do feel fatigued, anxiety, paranoid and sometimes suicidal BUT I have learnt, for the most part how to listen to my body through the flow of my cycle and now I see these feelings and thoughts as signals rather then problems. I accept my diagnoses and have learnt to work with it rather than fight against it. And I am no longer ashamed of it.

Amy run's the @femininerhythm she is a Wellness coach, Tantric Yoga teacher and Moon Ceremony facilitator. Amy has suffered with PMDD since age 13 and her mission is to support and empower women with her testimony and professional experience.