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Premenstrual Dysphoric Disorder (PMDD)

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PMDD

Definition    Return to top

Premenstrual dysphoric disorder (PMDD) is a condition marked by severe depression, irritability, and tension before menstruation. These symptoms are more severe than those seen with premenstrual syndrome (PMS).

Causes, incidence, and risk factors    Return to top

The causes of PMS and PMDD have not been identified, although social, cultural, biological, and psychological factors all appear to be involved. Researchers estimate that PMDD affects between 3% and 8% of women in their reproductive years.

Major depression is very common with PMDD, although PMDD can occur in women who do NOT have a history of major depression.

Studies have found that women who have seasonal affective disorder (SAD), a form of depression characterized by annual episodes of depression during fall or winter that improve in the spring or summer, are likely to also have PMDD.

Symptoms    Return to top

The symptoms of PMDD are similar to those of PMS, but they are generally more severe and debilitating. Symptoms occur during the last week of most menstrual cycles and usually improve within a few days after the period starts.

Five or more of the following symptoms must be present:

Feeling of sadness or hopelessness, possible suicidal thoughts

Feelings of tension or anxiety

Panic attacks

Mood swings marked by periods of teariness

Persistent irritability or anger that affects other people

Disinterest in daily activities and relationships

Trouble concentrating

Fatigue or low energy

Food cravings or binge eating

Sleep disturbances

Feeling out of control

Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

Signs and tests    Return to top

There are no physical examination findings or lab tests specific to the diagnosis of PMDD. A complete history, physical examination (including a pelvic exam), and psychiatric evaluation should be conducted to rule out other potential conditions.

Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times they are likely to occur. This information may help the health care provider diagnose PMDD and determine the appropriate treatment.

Treatment    Return to top

Women with PMDD may be helped by the following:

Regular exercise 3 to 5 times per week

Adequate rest

A balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine)

In addition, it is important to keep a diary or calendar to record the type, severity, and duration of symptoms.

Selective serotonin-reuptake inhibitors (SSRIs) are antidepressant drugs that can treat PMDD. SSRIs include fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa).

SSRIs can relieve physical symptoms, irritability, and tension. In fact, SSRIs appear to relieve PMS-related depression much faster than major depression. Women with PMDD, but without major depression, need only take SSRIs during the 14-day premenstrual period. This approach, called intermittent treatment, causes fewer side effects than when SSRIs are used to treat major depression.

Nutritional supplements -- such as vitamin B6, calcium, and magnesium -- may be recommended. Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramping and breast tenderness. Diuretics may be useful for women who experience significant weight gain due to fluid retention.

Expectations (prognosis)    Return to top

After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels.

Complications    Return to top

PMDD symptoms may become severe enough that they interfere with a woman's daily life. Women with depression may have worse symptoms during the second half of their cycle and may require medication adjustments.

As many as 10% of women who report PMS symptoms, particularly those with PMDD, have had suicidal thoughts. The incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle.

PMDD may be associated with eating disorders and smoking.

Calling your health care provider    Return to top

Call 911 immediately if you are having suicidal thoughts.

Call for an appointment with your health care provider if:

PMS symptoms do not improve with self-treatment

PMS symptoms are interfering with your daily life

Update Date: 4/8/2003

Updated by: A.D.A.M. editorial.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

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Posted

PMDD

PMS has become a household word and the brunt of many jokes. According to a recent survey, many women remain unaware of its more severe form, premenstrual dysphoric disorder or PMDD. Among 500 women recently surveyed, 8 out of 10 did not know that severe premenstrual problems have been officially classified as PMDD, nor did they know that such problems can be diagnosed and treated. Even more disturbing is that the one in 4 respondents who described their premenstrual symptoms as strong or severe were among those unaware of PMDD.

PMDD_month.pdf

pmdd_use_scoring.pdf

Aoibh likes this

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Posted (edited)

Oh it is so wonderful to finally find a forum for this disorder. I have PMDD. I really did'nt know what it was and did not know it had a name but I knew I had a problem and that this was just not normal. I was aware enough to firgure out it was related some how the my monthly period. It really became a source of concern when my daughter was born. I noticed that when that time of the month came around I would get so angry so easy. I found myself wishing my daughter was some where else. I did not and could not deal with the daily chores of taking care of her. It always seemed to hit during the 2 week before my period and then I felt much better after my period. But, lordy the guilt I would feel. So I told my ob-gyn what was going on and I had kept records of my behavior and how I felt, the depression and I would just go in complete isolation from everyone during that time. He said that I had PMDD Premenstral Dysphoric Disorder. I was giving a choice of and everyday med or just at that time. I chose the everyday med Zoloft (50 mg) and what a differece I have been taking it for almost a year now. I still have episodes but I am more aware of what is happening now. I am of sounder mind set to understard what going on with my body. I am going to talk to my doctor and see if we can increase the meds a little bit. And hopefully that will take care of it all. I will keep you informed on what happens to me.

I hope to find others on this forum that can identify with me and be able to discuss this disorder with me, just having some one to talk to about it helps so much. If you have not suffered with it there is just truely no understanding..... not like some one who can totally feel what you have felt.

Thanks for listiening. IT really means a lot to have a place to go and just express how you feel.

Edited by Marie

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Posted

A new study published this month suggests that the duration of treatment for a severe form of premenstrual syndrome called premenstrual dysphoric disorder (PMDD) is important for determining whether a person will relapse or not. The researchers also found that symptom severity at the onset of treatment is a good predictor of relapse.

According to the researchers, approximately half of the patients who demonstrated improvement experienced relapse within 6 to 8 months after discontinuing treatment with the antidepressant drug, sertraline (Zoloft).

Overall, longer treatment was marginally better in preventing relapse.

But both the rate of relapse and time to relapse were highly associated with symptom severity at baseline. Patients with severe symptoms at baseline were significantly more likely to experience relapse after discontinuing the drug. These patients also experienced relapse after a shorter period, and were significantly more likely to experience relapse during extended drug treatment compared with patients in the lower symptom severity group.

Patients with lower symptom severity at baseline were less likely to experience relapse regardless of treatment duration, and the time to relapse was significantly longer.

According to the researchers, premenstrual syndrome (PMS) continues to be one of the most common health problems reported by women of reproductive age. The morbidity of PMS is due to the severity of the symptoms, the resulting impairment of work, personal relationships, and activities, and its chronic nature over many years of menstrual cycling.

Treatment of the severe form of PMS, termed premenstrual dysphoric disorder (PMDD), with serotonergic reuptake inhibitors (SSRIs) has consistently demonstrated efficacy, and the U.S. Food and Drug Administration has approved the use of sertraline hydrochloride, fluoxetine hydrochloride, and paroxetine hydrochloride for this indication.

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Posted

About half of women whose symptoms of severe premenstrual syndrome are relieved by the antidepressant sertraline (Zoloft) appear to experience relapse within six to eight months after stopping medication.

The finding is reported in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Women with more severe symptoms and those who took the drug for a shorter period of time may be more likely to relapse.

Premenstrual syndrome (PMS) is one of the most common health problems reported by women of reproductive age, according to background information in the article. Several antidepressant medications, including sertraline hydrochloride, have been approved to treat the most severe form of PMS (known as premenstrual dysphoric disorder, or PMDD).

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Posted

thank you for all this information. i was recently prescribed 50mg of zoloft to take the week before and week during my menstrual cycle. i couldn't handle the side effects from 50mg so i am now taking 25mg and it's better. does you have any experience with withdrawals when only taking 2 weeks out of the month? I would appreciate any feedback.

thanks

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Posted

i understand what you're feeling..i've always been aware of having bad PMS for yrs...but presumed that every woman suffered the same symptoms and just had to put up with it...after i suffered depression I noticed that my PMS was worse after coming off meds....my attendance at work was poor at this time of month and decided i needed to sort this out....so i went to the doc...and I have been put on an AD....i take it 2 weeks before period...seems to lessen the symptoms....but its meant to take a few months to completely work?

hope you get the right level of meds for you and feel better all the time......i know it can feel like being jekyll and hyde!

Oh it is so wonderful to finally find a forum for this disorder. I have PMDD. I really did'nt know what it was and did not know it had a name but I knew I had a problem and that this was just not normal. I was aware enough to firgure out it was related some how the my monthly period. It really became a source of concern when my daughter was born. I noticed that when that time of the month came around I would get so angry so easy. I found myself wishing my daughter was some where else. I did not and could not deal with the daily chores of taking care of her. It always seemed to hit during the 2 week before my period and then I felt much better after my period. But, lordy the guilt I would feel. So I told my ob-gyn what was going on and I had kept records of my behavior and how I felt, the depression and I would just go in complete isolation from everyone during that time. He said that I had PMDD Premenstral Dysphoric Disorder. I was giving a choice of and everyday med or just at that time. I chose the everyday med Zoloft (50 mg) and what a differece I have been taking it for almost a year now. I still have episodes but I am more aware of what is happening now. I am of sounder mind set to understard what going on with my body. I am going to talk to my doctor and see if we can increase the meds a little bit. And hopefully that will take care of it all. I will keep you informed on what happens to me.

I hope to find others on this forum that can identify with me and be able to discuss this disorder with me, just having some one to talk to about it helps so much. If you have not suffered with it there is just truely no understanding..... not like some one who can totally feel what you have felt.

Thanks for listiening. IT really means a lot to have a place to go and just express how you feel.

[/quot

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Posted

It was quite a relief to finally be able to put a name to what I had been suffering since I started my periods at 11. I always just thought that all women felt *this* bad! How wrong was I! Basically I'm only truly depressed for half the month!

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Posted

I'm 32 y. I just accepte I got PMDD.

I guess I've suffered since I got my first period at 15y.

SInce about a year I'm on anti-depressiv (SSRI) medication when my depression got way way to deep...

I'm just so tired of stil falling down in depression - not as bad as before - but do get depressive up til my period each month, even if I am on medication. I'm stil staying home from work, almost each month, not one week as before - but at least 2 days... It's not acceptable.

My medication takes the wurth "sadnes" away - but I get careless and only stay in bed in my sleepy-depressed mood.

Any one got advise?

Should i try another medication?

Do i just have to accept it?

Thanks for advice!

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Posted (edited)

I think I have this, just before I'm due on (I am on the combined pill) I feel depressed, even suicidal. I get heart palpitations too. My stomach boats and I gain weight, I get angry over pointless things and find myself in tears over nothing. It's very stressful, and makes me ill, I find I stay in the house when this happens. It greatly impacts on ny relationships with people and I feel stupid and embarrassed. Does anyone know if you can get help for this in England?

Edited by marzipan

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Posted

Im a sufferer of PMDD since about 16. Im now 24 and still suffer from it monthly. Ive been on the pill and although it helped somewhat, the cons outweighed the pros. I lost my sex drive, I was irritable, and gained weight. Since off it (two months now) my pmdd has been out of control. I assume its because my hormones are adjusting but this month is by far the worst. Its affecting my fiances and i's relationship and today I feel purely SICK. Im already on zoloft and unfortunately thats no additional help. I have an rx for Ativan that I take in severe cases of anxiety and have just now taken one in hopes it'll help how Im feeling.

Does anyone have any input on the use of anti-anxiety pills to help pmdd?

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Posted

Hi Bflyxs

Here is a link to a topic that may be helpful:

Trace

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Posted (edited)

I'm 42 and have pmdd...the older I get the worse it has gotten. I can be "superwoman" three weeks out of the month and do it all, but the week before my period starts I become less patient, moody, over all just really hard to live with...I don't even want to be around myself. I recognize I'm being like this but seem to have no control over it. I've also noticed that if I drink alcoholic beverages this week it has a totally different effect on me vs the other three weeks of the month, seems to hit me harder and faster.

So long story short, my doc prescribed 20mg/daily of prozac..started 5 days ago- I have some concerns/questions if anyone has experienced this or can help.

1. Day two into taking it I started my menstrual cycle (10 days early) cramps, bloating, back pain- has continued for three days, normally I only experience the heavy effects of my cycle on the second day-- :stare: and my cycle usually only lasts 5 days

2. So far I'm not feeling better...I'm tired (sleeping way to much) :yawn: and have no motivation and feel numb....I'm not moody because I feel like I don't give a **it -about anything....I'm busy..work, kids....like everyone-- I don't have time to be tired- I'm hoping this will wear off because I like being active :EmoticonDogRun:

3. I'm hungry and have craving like right before you start your cycle-- :verysad3:

I'm hoping if I stick with the meds it will get better but honestly I don't like feeling numb or tired and this period thing is just irritating.. the busier I am usually the happier I am.. and right now I'm feeling very "blue" and frustrated :boredsmiley:

Thanks in advance for your replies..this really is annoying and I'm thinking of stopping and just "coping" with the one crappy week out of the month vs crappy every day.

Kimber

Edited by AquaViolet
TOS

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Posted

Hi Kimber,

I am 47 and have just been diagnosed with PMDD in the last two years. I was getting treatment for depression when my psychologist mentioned PMDD. I'd never heard of it before. I take Celexa and it has made a big difference since I went to a higher dose, 40 mg. It does take a month or more to take effect, so please don't give up on it yet.

I was also diagnosed with breast cancer last year and after a lumpectomy I was given chemo and radiation. This put me into instant menopause and I noticed my PMDD symptoms improved a bit. Then I was put on Tamoxifen and a miracle happened! After about a month my constant "edgy" feeling evaporated and I have been able to feel normal for the first time in my life.

I read somewhere that Tamoxifen has been studied for PMDD, but there are concerns about putting non-cancer patients on a cancer drug. It feels like I've been allegic to my own estrogen since puberty and this estrogen-blocking drug is treating that allergy.

I hope you are doing okay. It is nice to find this forum and talk with others with PMDD.

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Posted

I too suffer from pmdd and also major depression. I finally got diognosed about a month ago and got on meds(citalopram & trazodone). I finally decided that I just couldn't get better on my own( I've been trying for just about 25 years now). I also got tired of only having about 4 days out of the month be happy ones and the last two weeks being just miserable.

The meds have helped tremendously and the down days are more tolerable

Also for me doing something active each morning wether its walking the dog or going to the gym help me to not get "stuck".

It feels great to come here and get so much info and support from others with the same illness.

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Posted

Wow! I can't believe there's a sub forum devoted to PMDD!!
Out of all of my dx'es I hate my PMDD the most. I have tried every natural and rx therapy there is. All it's done is made me addicted to benzo's.
Sorry, the one rx I haven't yet tried is Lupron to put me into chemical menopause. I have seen a surgeon to ask about having my ovaries removed to stop the monthly madness, but even though my family is complete, they won't do it.

I can't introduce any hormones to my body or it freaks out. The worst thing about PMDD is that a lot of Psych's don't understand it or just dismiss it and they'll often say you need to see your Gyno, GP, Endo about it. When you see those professionals, they say it's a psychological condition and you need to see a psych about it!
And other people just don't 'get it'. They compare it to their PMS and think you're being a drama queen. I only have one friend who 'gets it' and can actually see it creeping up.

Since my latest and thorough dx'es with a new psych I was put on Seroquel for my BP2. It's helped a little bit with the PMDD. I'm not quite as physically and emotionally out of control. (I'm also on Effexor and Valium. Have been on AD's for over a decade which never helped me with the PMDD)

If I had've seen this thread yesterday I would have said it was the first month that I hadn't thought about or actually SI'ed. But the thoughts have been there today on day 28 of my cycle.....no action though.

One thing that has never made sense to me or any medical professional is the really bad cramping I get. I don't have any endometriosis or anything else that often causes severe pain, but this pain is so severe that the only thing that has ever relieved it completely was oxycontin.....which I can't be taking regularly. (it was a one off thing) Does anypne else get severe cramping along with the mood issues?

The pain makes my mood even worse....and the bloating is ridiculous! I actually have PMDD clothes so people don't ask me when the baby is due .LOL

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Posted

I was put on birth control pretty much right when I started menstruating at 14 to help with cramps. They were unbelievably bad. I stayed on it until February of this year, when I was 21. I had to get off it because apparently taking anything with estrogen when you have migraines with auras is a bad idea as it ups your chances of stroke. Since going off birth control, I have had horrible PMDD. I couldn't understand why I got suicidal once a month! About a week before my period, I get into a deep deep depression and get very irritable and angry. Sometimes I feel suicidal. I haven't found a good way to cope with it, as all of the SSRIs I have tried (and I've tried a lot) make me very ill.

Does anyone have suggestions for natural alternatives? Or even other medications that aren't in the SSRI family that have helped you? I'm very tentative about trying anything new because the SSRIs just make me SO SICK but I also don't want to go through any more months wishing I would die. :(

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Posted (edited)

Hi everyone, I have been a pmdd Sufferer all my life. I finally got help for it at 53 (when my periods are winding down actually) at this point it has turned into regular depression, but I also seem to have extremely bad bouts of anger in combination with depression. I also have Asperger's which also has tantrums and inability to relate to other people as symptoms.

Having had no medical intervention, and never having any doctor who brought it up, I have lost several jobs over the years due to this, one after working there for 10 years because a new manager did not know how to deal with me, and have not really gotten into the habit of keeping friends, realizing at some point I will get angry and show this awful side of myself.

So, in effect it has affected all aspects of my life. I have really never met a man who would deal with my anger issues, or any other issues, really. I've never had children. I have never done a lot of things that a "real woman" ought to do.

I have a combination of depression, PMDD, and Asperger's syndrome.

I am now on low level Prozac, and can only work part time because I can't stand to be around people a lot. (I enjoy my job). I can work a day (8 hours) but need a day off between work days. On these days I work as an artist and make things to sell at galleries. So I still work-- and am not trying to "beat the system" or anything.

Edited by Animalier

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Posted

Hi I would really recommend Agnus Castus - it's a natural remedy in capsule form from health food shops. It has helped with my PMDD. My doctor suggested it, I have not been on anything else - I think I will take it more regularly as some months I do take it too late and the symptoms come again [suicidal thoughts, very overwhelmed, small tasks impossible, crying, even felt like shoplifting last month which was a new one for me!!]

Hope this helps someone. xc

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Posted

Hi All,  Im new here and I have been looking for support with my 'Pmdd' I have just started taking fluoxetine just 12 days ago and I was wondering if anybody has had success with it, there are some great reviews about pmdd being treated with fluoxetine but I was hoping to get some replies here.

 

Thanks

K70

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Posted

Hi All,  Im new here and I have been looking for support with my 'Pmdd' I have just started taking fluoxetine just 12 days ago and I was wondering if anybody has had success with it, there are some great reviews about pmdd being treated with fluoxetine but I was hoping to get some replies here.

 

Thanks

K70

 

Hi Kayte. Unfortunately I have little experience with Prozac (I was on it at a young age before the horrid PMDD symptoms set it), but wanted to welcome you to the site and link you to the Fluoxetine/Prozac forum here:

 

http://www.depressionforums.org/forums/forum/52-prozac-fluoxetine/

 

Maybe ladies who are on  fluoxetine can be more helpful than me. I hope you feel better soon! I'm in the brunt of my symptoms now, and it's truly awful.

 

(((Hugs)))

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Posted

Not sure how active the forum is but I just wanted to tell you i don't under full the effects of PMDD and never will ,since ill never have to go through it, but i DO know how hard it is to live with. My wife has been suffering from PMDD for the past 7 years. There are no doctors near us the understand or treat PMDD. We have tried several medications and last night she even mentioned have a total hysterectomy. She mentioned suicide a few times, feels that she is the worse mother in the word because she is not able to do stuff with our children. People truly do not understand what these women have to live through. If may be so bold to ask, id like to share a post she sent to her friends in an effort to make them understand a bit and also to help her a little.

 

From my wife to her friends.

 

"Well...looks like we are going to Houston. Massive migraine today leaving me unable to move. Time for some very serious action. I can't live this way any longer. I spent the day crying uncontrollably and passed out from exhaustion and pain. We're looking for a specialist in Houston, phone calls tomorrow if I'm up to it. Upon further research I found true PMDD only effects 3-8% of all women still in reproductive years. I've seen and called all the OB's in our area over the last 15 years. They are clueless, older, and not current on the disease or treatment. It is NOT a mental disorder but a very real physical problem so shrinks can't help..they have zero education specializing in OB/GYN but general MD's pass patients off to them leading nowhere.

I did find some new information..the only known link clinically is the brain misreading hormone synapses relating to the ovaries. Problem is, a full hysterectomy is not a cure. I joined multiple support groups and dozens who chose that had zero results, facing recovery from surgery plus the pain this crap causes. That's scary.

Mike's been so great, any normal person would of left long ago. Many women with this end up alone, divorced, etc because it's like living with Dr Jeckyl. It ruins your life.

I cannot stress how much my friends support means to me. You guys - some days keep me grounded, make me laugh, it may seem petty to you but the world to me. I thought this was getting better, it's not. I thought I could control it, I most certainly cannot. It's ruining my life and I refuse to be a prisoner any longer. I'm watching my children live without me...that hurts and bad.

I miss the real me. 22 years ago I was the happiest person you'd ever meet. My coworkers used to laugh, they'd never seen me get mad even once laughing if I mentioned being angry " You? Moe..mad? Yeah right!". Crazy right? No...I was truly a happy soul. I was in college creating artwork nonstop, thriving. My apartment was thee hot spot every weekend. I mean we had great times, went to 10 concerts a summer, played Frisbee golf, went to the beach, you name it. I love life..I really do. I miss life and being with people. Most of all I miss laughing.

Here's the rub. None of this stuff started until I had Bryce and Dani. I can't tell you the conflict that has caused in my mind. I love my kids to death, I went through hell and testing by a Dr. we almost sued and 7 years of infertility to have them. But at the same time I feel like I'm the worst mom ever. It's like I'm in living hell simply because we wanted children together. That rips a hole in me. It's not fair. I didn't ask for fame and fortune, just a family. A family I'm now absent from many many days because of PMDD. The guilt alone feels like a boulder sitting on me.

I'm very afraid. The only treatment is a barrage of trying all new anti depressants, or surgery or both. Meds will take months, possibly years to get right. It takes a month just to start working IF it works, then you must be weaned off like a junkie or your body will go unto withdrawal if it didn't plus all the nasty side effects. That goes for each separate drug...rinse and repeat.

I did a checklist that said you must have 5 symptoms to really be considered to have PMDD. I not only had all 12 but some not mentioned and 3 or 4 were severe. Insomnia and migraines being the worst. I've had demerol and ambien and still stayed awake over 24 hours. At onset I sometimes start having anxiety attacks because I know not only is unbearable pain coming but my body is going to torture me by keeping me awake for 1-2 days straight. It's scary what your brain can accomplish against your will using your body as a weapon.

Dear brain...I'm not happy and want my life back. I want to live life, not just be a spectator.

I shared this in hopes that it helps. That it helps me reach out, that it helps all of you know this isn't me. And most importantly, awareness. Not one doctor in the triangle treats this. If you know a woman who may be suffering and doesn't know why, share my post please! Suicide is a real issue with this. PMDD was a defense on Law and Order over 8 years ago, for M*****. I at least know what's going on..imagine those that don't who go undiagnosed and untreated.Ok time to lay down. Thank you ever so much for reading all that. It seems when we don't understand we label people. I don't want to be labelled, I want compassion and help. I'd like to think the world still has some of that left in it."

 

 

I have been a paramedic for nearly 20 years and i now teach paramedicine at a local college and there is nothing worse that not being able to help the one person that you love with all your heart and will never give up on no matter how long. i just wand to thank you guys for allowing me to post here. PMDD doesn't just effect women who suffer with it but also their loved ones and especially the people who are trying to help. Again thank you. You ladies are loving, caring, great mothers, brave, and most importantly STRONG. My heart goes out to you guys and you families. We know this isn't you and that's why we will ALWAY love you and Always stand behind you to catch you if should happen to ever fall.

Thanks again for letting me get this off my chest. It has been a rough past 4 days and this morning was the worse in a long time.

 

Mike Manley (devoted husband to PMDD sufferer) 

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