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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.

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