The Thing About Suicidal Ideation When You Have PMDD.

**Content Warning** Details of suicidal thoughts may be triggering. Please read with care.

I don't wake up with a plan, and I'm not a danger to anybody—except perhaps myself? But I've been through this many times before, and so I know the risk of actual harm is minimal; and yet, the thought of ending it all in the weeks before—and during (if you're me)—my period, is never far from the front of my mind.

I know when I'm ‘on the turn’ — the phrase I use to describe the moment my hormone fluctuations become unmanageable and a dull tapping, flippant but intrusive, slams random thoughts into my brain about what it would feel like to drive into the wall, or take myself off to sea and just keep swimming until my body gives out. There are other, quicker solutions that also enter my head, but I can't bear the thought of other people having to deal with the aftermath, this is some consolation, and means not all of the horrific thoughts stick.

Occasionally, while on the cusp of my sanity, and usually in late luteal Vs early menstrual phase, these thoughts ramp up in to full blown “Get me off this fucking planet, ASAP Rocky” Or in laymen's terms: fight or flight mode is fully activated. I've never really understood the other modes: fawn and freeze. Like my ADHD brain reminds me daily, I'm an all or nothing kind of girl and so fight and flight are the only two modes that reach me during this phase.

Suicidality is common in PMDD

I've lived with premenstrual dysphoric disorder for more than two decades. A neurohormonal disorder than increases the suicide risk by almost 40%.

The frustration I feel around this stems from the fact that I've tried everything to tame it, including: implants to turn off my ovaries, exhausting the medical treatment pathway— right up to but not including surgery—I've had so much therapy I reckon I've a good shot at actually being a therapist, and I've thrown everything including the kitchen sink at it in a bid to rid me from the clutches of PMDD hell.

Unfortunately for me, nothing has worked for any significant amount of time. There's been no consistency in my recovery.

Truthfully, the only real consistency you can expect from PMDD that it always comes back. Flare ups, rages, meltdowns, followed by the recovery and then the inevitable clean up, hit me so hard I wonder how I'm still alive.

Without dancing around the subject I'm in this phase right now. I want to escape myself. For the past week I've done a terrible job at regulating my emotions while wading through the PMDD quagmire, and honestly, I'm drowning. Every time I put one foot in front of the other I sink deeper, losing parts of myself until all that's left is my ability to breathe and even that feels too much effort.

The only way I know how to protect myself when I feel like this, is to hide. I build myself a cave in my bedroom and I sink into a reality TV doomhole in an attempt to protect my family from my moods and the darkness I undoubtedly cast on their lives when I'm like this.

I hide because being in close proximity to other people feels like a physical assault. I feel battered, my senses so heightened I can burst into tears over the sound of my children playing, and vomit at smells that would, during another phase of my cycle, tickle my taste buds.

Although I often contemplate suicide during this time, it's not a medical emergency in the same way a suicide attempt is. I know this because I've been through it more than 200 times in my menstruating life. Sure, there have been attempts in the past. Research suggest approximately 34% of women with PMDD attempt suicide, but the ‘benefit’ (for want of a better word) of having lived with this disorder for so long, is that, as much as I know it takes everything I have to survive this phase, I too know this phase will pass. If I can just survive it, the days will get brighter again.

Is it fair that women with Premenstrual Disorders should have to live this way, being told they're hysterical and crying wolf because they feel like they want to end their own lives every month? Absolutely NOT. But so little about women's health is fair.

While apathy oozes from me, spilling over into all areas of my life, I have to hold on to this nugget of knowledge that PMDD is not a permanent state.

Right now, the need to get away is overwhelming. This weekend, of which we had a babysitter planned to do nice husband and wifey things, was completely wasted. My tears constant throughout and the only thing I knew how to do to make it better was to sleep it all away.

Being at war with myself every month is exhausting, there's no other better fitting explanation than: it drains the life from you.

Doing One Tiny Thing

This morning my husband woke me up, took charge (which could have easily gone either way for him) and said “come on I found a place with a view you'll like” I didn't want to get up. I felt as if I couldn't. Desperately trying to pull the cover back over my head in the oppressive heat of my bedroom, he told me to get up, that we'd pick up a coffee on route. He assured me we didn't have to do anything accept drive there just to say we made it out.

I pulled on some lounge bottoms, scraped my hair into a greasy ponytail and grabbed a blanket to sit on. We drove 46 minutes to a viewpoint just to sit there for 5 minutes and listen to the birds and the crickets, to watch the wind brush over a lake in the distance — to breathe.

It wasn't the best morning ever, we'd missed the high temps of yesterday and it was windy at the top of the viewpoint, but when I got in the car to come home, something shifted. I realised I didn't feel like I wanted to die in that moment. I wasn't scanning my brain for an escape route. It felt like the fog might finally be lifting.

Sometimes the things we’re told to do when in crisis aren't actually what we need. Eat well, do yoga, journal, go to the gym, reach out to a friend etc… they each have a place, but in the depths of true darkness, in the midst of sudden and variable hormonal changes, sometimes all we really need is to stand in the sun and take a deep breath. We don't need lengthy plans with unrealistic goals, or pressurised environments that include forced fun and us having to mask the entire time. We just need small, genuine moments of connection.

I have—if my period tracker is anything to go by—maybe a day or two more of this horrorshow before I'll get about a week's reprieve when my hormones stabilise. It terrifies me to know this feeling will be back before I know it, but it also humbles me and bolsters me to know that something as small as a drive and a view can shift my mood, not fully, but enough.

This is healing in action. It's not perfect, or linear, it's without bells and whistles or rigid plans. It's quiet. and it's malleable.

If you're living with PMDD and considering treatment options please visit IAPMD for a full list of evidence based treatments.

If you're in the midst of hell right now and feel like your only way out is to not be here anymore, go somewhere that usually calms you, just for a minute. You don't have to have it all figured out, you just have to do one small thing right now, to stay alive.

Sending love and solidarity to all of the PMDD, hormonal warriors out there, especially those whom are also neurodivergent. I see you. I am you. Hang on. 💕

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