Helen’s Guide To PMS

Introduction:

By April 2007, the female sex hormones that I’d been prescribed had really started to take effect, in numerous ways. For me, one of the most unexpected effects was that I started to exhibit several of the symptoms of PMS – Premenstrual Syndrome. I’m not sure why I hadn’t anticipated that they would manifest themselves: with hindsight, it should have been fairly obvious that I could expect to experience PMS to some degree; after all, it’s driven by oestrogen levels and I was taking a comparatively high dosage.

To start with it was difficult to understand what was going on and, even now, over a year after surgery, and on a lower dose of oestrogen, I still experience PMS and I still find it hard to cope with. Possibly the most curious thing is the way that, after building in intensity for two or three days, the symptoms then vanish literally overnight – only for the whole process to start again some 29 days later.

Back in April 2007, I began to research the subject and to assemble what I like to call “Helen’s Guide To PMS”. Despite the seriousness of the topic, it’s a deliberately jokey title because I realise that every woman who suffers PMS will experience and manage it in a way unique to her as an individual. Therefore, to imply that I am speaking for all women would be a conceit of monumental proportions. Rather, I hope that I can talk about some of the wider, more generalised aspects of the condition in the hope of offering one trans woman’s insight into an aspect of transitioning which I don’t think I’ve seen mentioned in any Trans 101. Some of what follows is drawn from my own real life experiences and some of it is based on information found on the web.

Abstract of journal entry for Saturday 21 April 2007:
I’ve started a thread on the NuttycaTS forum. I hope it gets some positive responses…

Coping with PMS-like symptoms:

I hope this isn’t a contentious subject that gets me shot down in flames, but nevertheless, I have to ask…

About once every 4 weeks or so, I seem to exhibit several symptoms which seem to be very similar to PMS: not sleeping, feeling bloated, getting very emotional, etc. The worst of these is becoming very tearful – yesterday was very bad for me, more in terms of embarrassing myself at work, than anything. I just couldn’t stop bursting into tears. And I know that I have no reason; compared to 99.9% of the population of planet earth, I have a very privileged life and should be happy for everything that I have. And generally, I am. But even reminding myself of all that didn’t help me yesterday.

This is the fourth month now that this has happened and it doesn’t seem to get any easier with the passing of time. I find it difficult to know how to learn to “deal with it” – where do I start? – but I know I need to find a way that works for me, and soon.

So I wondered if anyone else ‘suffered’ these kind of symptoms, and if so, do you have any successful strategies for coping with them?

My office manager said I should think about going out for a cup of coffee when it happens (I’m not convinced about the practicality of that) – someone else has suggested taking a mineral/vitamin/herbal supplement (I was given the brand names Well Woman and Magnesium X) – and someone else has suggested Evening Primrose/Star Flower. Has anyone tried any of these? Did/do they work for you? Do you have any other hints/tips that I might try?

Sorry if this sounds like a dumb question, I’m trying not to make it sound like an industrial strength whinge, but it’s really preoccupying me at the moment and I’d really like to know if I’m the only one who gets this way…

Later edit: A couple of people replied with a few helpful suggestions:

• Exercise
• Evening Primrose
• Chocolate (“think of all those endorphins”)
• Pamper yourself. “You could try a nice bath, with some smellies in, and candles, maybe a book etc, or if you have someone special get them to maybe join you. Then get out the old Johnsons and get him/her to give you a nice all over massage :-)”
• Someone posted a link to quite a comprehensive article here: www.womenshealthchannel.com/pms/treatment.shtml The link is to page 4 of 5.
• And someone else pointed out a fact sheet on the Women’s Health Concern website.

Abstract of journal entry for Sunday 22 April 2007:
I’ve done a bit more research on PMS and am hoping to make this a reasonably comprehensive resource for my own future reference – as well as the last word on the subject.

…For the moment, anyway… :-)

So… As you’d expect, there’s a metric tonne of information out on the web and what follows is collated from some of those sources.

Symptoms: There are more than 100 symptoms associated with PMS and a woman’s individual symptoms can vary from month to month. The most common symptoms include:

• depression and agitation, stress or anxiety
• trouble falling asleep (insomnia)
• fluid retention and abdominal bloating
• abdominal cramps
• irritability and mood swings
• crying spells
• breast tenderness
• trouble concentrating
• skin and hair changes, worsening of existing skin disorders, and respiratory or eye problems
• appetite changes and food cravings
• social withdrawal
• body temperature increase

Causes: As is often the case, nobody really knows. Current thinking suspects that it may be linked to fluctuations in hormone levels.

Women with low levels of serotonin have been found to be particularly sensitive to levels of the hormone progesterone, which, it is thought, may lead to symptoms of PMS.

I’m remembering the research into Ecstacy use which suggested that prolonged/heavy use might significantly reduce serotonin levels as well as the brain’s capability to produce it.

Diagnosis and PMS Diary: Before I talk about techniques for dealing with PMS, I should mention its diagnosis. For one thing, there is no recognised way of diagnosing PMS. A fundamental problem is that there’s a huge overlap with the symptoms of depression and the main distinguishing factor between the two conditions is the fact that PMS is cyclical, ie: it comes round at regular intervals. One can have blood tests and urine tests to confirm that the symptoms aren’t something else, but, if one believes that one is suffering PMS, keeping a diary is pretty much essential to be able to confirm the cyclical aspect and therefore be able to diagnose it with any certainty.

I myself have kept a record which dates back to my first experience of PMS in 2007. From that data, I’ve been able to work out that my cycle is about 29 days on average. Initially I would get PMS at around the time of the New Moon, but since surgery I seem to have resynchronised to around the time of the Full Moon.

Edited To Add – Saturday 10 November 2007:

2007 History: The January 2007 occurrence is not very well recorded in my journal, but in hindsight, I’m now convinced that it was the first appearance of the symptoms – about 3 months after starting to take feminising hormones – oestrogen – and 3 months is generally accepted as about the time that the hormones take to start kicking in. If January 2007 was my first experience of PMS, then I wouldn’t have recorded it as such because I wouldn’t have known that that’s what it was. Also, it just might be that the symptoms weren’t as pronounced then.

At the time, I put my tearfulness down to being stressed out about visiting and ‘coming out’ to Mum and Dad, and undoubtedly that intensity of emotions was part of it. I must also remember that, on that day, I had sessions with my gender counsellor and speech therapist, as well as having a blood test: quite a stressful day. I’m smiling to myself as I type this: knowing what I know now, if I ever find myself with a schedule that full when I’m expecting PMS, I’ll definitely take a duvet day, and to hell with everyone!

And twice (February and March 2007) the PMS seems to have coincided with bad bursts of dysphoria, triggered by not shaving in advance of electrolysis.

Moon phases: As I mentioned earlier, initially my PMS was tied quite closely to the New Moon; it disappeared for a good six months after surgery, but it’s returned with a vengeance these last few months – and curiously, it’s now synchronising with the Full Moon. Which is why now is an appropriate time for me to post this: I’ve just had an extremely stressful couple of days which seems to have brought my expected PMS forward by a day, to today (Sunday) – and the Full Moon is in two days – on Tuesday.

For 2007, by November, I’d experienced two bouts of PMS peaking on the New Moon, three 2 days before, two 1 day before, one 1 day after, one 3 days after and one 4 days after. So, although it’s hard to say there was definitely a link, that bad ol’ moon, she sure as hell looked suspicious, always hangin’ around at about that time…

Treatment: There are almost as many suggestions for treatment as there are symptoms. But a few do seem to appear over and over, some of them might even be worth trying. Although I don’t think I’ll be trying synthetic testosterone or an intra-uterine system – and I’m already using oestrogen patches…

For many women, simple changes to diet and lifestyle, stress reduction, aerobic exercise, reducing or eliminating alcohol, caffeine, refined sugar, salt, dairy products, and animal fats may be beneficial. Smoking doesn’t help (well, duh!). Some studies show that drinking tea and increasing carbohydrate intake is helpful. (Carbohydrates increase the level of serotonin). A diet sheet is available from the National Association for Premenstrual Syndrome (NAPS) – but they want money and I’m a cheapskate.

Other (non-hormonal) treatments include: Vitamin B6, calcium supplements, magnesium, Evening primrose oil (EPO), diuretics (water tablets) for ankle swelling, and even antidepressants.

Links: These websites were really informative:

• www.bbc.co.uk/health/womens_health/reproductive_pms.shtml
• www.netdoctor.co.uk/diseases/facts/pms.htm
• http://en.wikipedia.org/wiki/Premenstrual_stress_syndrome
• www.womenshealthchannel.com/pms/treatment.shtml
• www.womens-health-concern.org/

Yeah and?

It seems that we each find our own ways of coping; as best I can tell, the information I’ve collated here seems to be a reasonable representation of a broad average of symptoms and treatments. Of course, when talking about half the population it’s not a good idea to generalise, but I hope I’ve included enough details here to offer some useful starting points for any trans woman who’s starting to experience PMS and is wondering – as I was – just what is happening here…