Defeating the Stone Man: PMDD, menstruation, and healing

In Uncategorized by Adrienne K.13 Comments

smokies

“The power Cherokees attributed to menstruating women is illustrated by the myth “The Stone Man.” The Stone Man was a cannibal with a skin of solid rock and an appetite for Indian hunters. When a hunter spotted Stone Man heading for a village, he hurried to the medicine man, who stationed seven menstruating women in the cannibal’s path. The Stone Man grew progressively weaker as he passed the women and collapsed when he came to the last one. The medicine man drove seven sourwood stakes through the Stone Man’s heart, and the people built a large fire on top of him. While he was burning, the Stone Man taught the people songs for hunting and medicine for various illnesses. When the fire died down, the people found red paint, which they believed brought success. Through the power of menstruating women, therefore, great tragedy was averted and good fortune brought to the people.” (30)

I was reading Cherokee Women by Theda Purdue, and I got to the passage quoted above. I smiled, thinking about a line of menstruating women stopping Stone Man, picturing something like this GIF:

IMG_2080

But in reading through the section in her book about traditional beliefs around menstruation, and the misinterpretation of those beliefs, made me start thinking more deeply about my own relationship with my body, my hormones, and their power. Power is something that can be both negative and positive—evil can be powerful, but good can also be powerful. And in my struggles I’ve seen plenty of both.

This has been a piece that has been nearly impossible to write, but I write because I’ve seen how little women (and all people who menstruate) openly talk about these issues, and how stigmatized talking about moontimes and monthly bleeding has become in Indian Country.

So I write this by way of explanation, to the many missed deadlines, unanswered emails, unanswered texts, broken plans, the resentful subtweets and facebook posts from colleagues and friends. I’m sorry.

For the past 8 years, and even more intensely for the last two, I’ve been dealing with Premenstrual Dysmorphic Disorder (PMDD), or as I describe it to others, PMS from hell.

There’s a stereotype in our culture about the PMSing woman, raging for donuts, crying over Sarah McLaughlin humane society commercials, throwing hairbrushes at unsuspecting partners. It’s used to demean and diminish women, to paint us as weak, unstable, and crazy. PMS is a punchline, not a real medical condition, and it keeps us from talking about it.

I can’t remember when it first started. But I remember sitting on a bench my first year of grad school, on the phone with my mom, bawling about how I was never going to make it through my doctoral program, how I was going to fail statistics, how I was failing Indian Country, how no one would ever love me—and her gently asking, “Honey, what week are you in your cycle?”

For most of my adult life, I’ve been ruled by my hormones, devastated two weeks a month by surges of progesterone and plunges of estrogen, relegated to bed, crippled by depression one week and left with a pounding heart and anxiety the next.

I learned to hide it well. I knew to schedule nights out with friends during my “good weeks” and make excuses for not going out my “bad weeks.” I knew that my email inbox would get out of control for two weeks, that I would miss deadlines, that I would be paralyzed by fear and feelings of being completely and totally overwhelmed–but that in 14 days, I could start to get it all back. But it meant that I was always behind, and playing catch up from the last round, and could never quite keep my head above water. I took on a lot of commitments outside of school, so I often got away with apologies of just being so “busy.”

The state of my house was always the sign of where I was in my cycle. Weeks three and four, dishes piled in the sink, my recycling overflowed, my laundry towered out of the hamper, my bed went unmade. The simplest tasks required hours of self coaxing, of forcing myself out of bed to take a shower, only to return to bed for three more hours afterward. I often felt those weeks like I was wading through wet sand, that lifting my legs and arms required an amount of effort I couldn’t even fathom. I would hear my voice in meetings on campus, and it would quiver and shake with emotion, like at any second I would break down in tears. And I often did. It didn’t help that my chosen career path as an academic means constant self doubt and scrutiny under the best of conditions–but the hormones just drummed the narrative even more deeply.

My brain would bring up every stupid thing I’d ever done, every guy who didn’t like me back or broke up with me, every extra cookie I ate, and just replay it in a loop. Reminders, over and over again, about how awful I was at life and grad school and love.

But then, my period would start, and I’d experience what I called in my head “the click”–suddenly I saw my apartment for the mess it was, horrified by the piles of dishes and unmade sheets, I saw the unanswered text messages and emails, the take out containers, the deadlines that had blown past, and I frantically would jump into recovery mode. Tasks that seemed insurmountable the week before were handled in minutes, writing that I couldn’t attempt because my brain told me I wasn’t good enough was started, finished, and handed in. But it was awful, because I knew I only had two weeks before it would start again. Sometimes the anticipation of what I knew was around the corner would be enough to make me cry and crawl in bed even during the good weeks.

On top of the mental symptoms I had horrible physical symptoms as well: water retention that could make me swing up nearly 10 lbs a month, back pain, nausea, stomach issues, acne, sore, painful breasts, and more. At a friend’s wedding I fainted for the first time in my life, and woke up flat on my back on the deck to a sea of my friend’s worried faces. The next day, my period arrived.

I had seen various nurse practitioners and doctors through my years in graduate school and tried to relay to them the extent of my struggles. I never felt heard. I was put on hormonal birth control more than once, but found that I felt like week three and four all cycle, rather than just half. When I told my doctor how the pills made me feel, I was told that I needed to “wait it out” and that in 3-6 months things could even out. There was no way I could have survived that long. The impression I always got from the doctors was that I was somehow being unreasonable. That PMS was something all women dealt with, and it couldn’t possibly be the paralyzing mess I made it out to be. The doctors would shrug and say that maybe I should try exercising? Or not eating so much sugar? Maybe cut back on the coffee too.

I did try exercising. I tried a lot of things. But mostly I tried to cope. I had stopped trying to find a relationship at some point, convinced that no one would or could date someone who disappeared for half the month. But I still I wrote, instagrammed, and tweeted. I carefully and fastidiously curated my online life so no one would know how sad I was, and how much I was struggling.

I moved to Arizona to write my dissertation, and for the first time I felt I had the space and time to try and get a handle on my health. I exercised religiously, carefully watched what I ate, going so far as to count macronutrients, weigh my food, and record how I was feeling each day based on the percentage of fat, carbs, and protein I was consuming. I also downloaded an app which revolutionized my relationship with my body, called Hormone Horoscope. It’s a bright bubblegum pink thing, full of Teen magazine peppy “you go girl!” language that makes me roll my eyes, but it was life changing. The app tracks your cycle, and each day offers a “horoscope,” letting you know what your hormones are doing and how that might be affecting how you feel. There is also a “make today better” section and a “fun fact”–both of which pull in what the scientific research says about that particular phase of your cycle. For example, day 19, right toward the end of week 3:

You may get a serious case of the blahs today and find it difficult to muster enthusiasm about anything, like a project you’re working on, great news you heard, or a cutie who’s taking you out on a romantic date. That’s progesterone’s fault. As this sedating hormone climbs, it saps your pep and excitement…

It goes on, encouraging you to push through if you find yourself not being able to find the words you need (also progesterone’s fault) or letting you know that the hormone also can make you crave sweet foods and want to buy things to beautify your house (damn you, progesterone!).

Having that knowledge in my pocket changed the way I was able to cope with my symptoms. Each time when I would feel something–overwhelming sadness, exhaustion, lower back pain, you name it–I would check the app and see if it was related to my hormones. More often than not, it was, and this knowledge gave me the strength to take power back over my body, realizing that this was something truly biological, that my feelings were real. I learned the way hormone cycles worked, and began to be able to picture the graph in my head—knowing where I was, what hormone was rising, which was falling, and how that was affecting my day to day.

189983-480x360-Menstrual-cycle-chart

Once I started feeling a bit better, I upped the level of control on the factors I could. I kept exercising, completely cut out processed foods and added sugar, limited my caffeine intake during week four to cut down on the anxiety and insomnia, cut out any alcohol use during my luteal phase (the second two weeks of my cycle), and I began taking calcium, vitamin B6, fish oil, and tumeric supplements. Through it all I fastidiously tracked it all in a notebook, along with all my symptoms and how I was feeling each day.

I read everything I could get my hands on about PMDD during that year. I scoured the internet, I used my academic library access to read medical journals, used my statistical training to interpret the results and see what was worth trying. The problem is, the literature and research is scant. Most of the studies were not double-blind randomized studies (the gold standard of research), most of the studies were small, with less than 100 participants, and most of the results were mixed. Even though it’s estimated that upwards of 10% of people who menstruate suffer from PMDD, meaning millions of people, there are very few resources put toward figuring out the causes, or solutions other than managing and controlling symptoms. The reality is, everyone experiences PMDD differently. So it’s hard to find a solution that works for everyone.

Through my control, I felt good. Not great, but managed. I lost a lot of weight, I found myself happier and able to write. The problem was, most of my mental capacity was taken up by controlling my body. The second I would deviate from the perfect plan–a night out to eat with friends, a couple beers at the local bar watching a game, a missed run or set of vitamins–the symptoms would come roaring back. But I felt like at least I could manage better.

Once I moved back to the East Coast to start my postdoc, things spiraled out of control. Gone was the support network and routine I had in Arizona, gone was the sunshine and ability to be outside, gone were the days spent surrounded by other Native people, and in their place was loneliness, a cold, long, dark winter, and crushing imposter syndrome. The negative self talk during my luteal phase began to be reinforced by my experiences–I was getting rejections from conferences and academic journals, I had very few friends, wasn’t getting any calls or invites to go out, the couple of guys I went on dates with weren’t interested in pursuing anything with me, and the academic jobs I had worked so hard for were rejecting me left and right. I would find myself unable to concentrate on anything of substance, so I would scroll facebook for hours and hours on my phone, feeling worse and worse about myself with each engagement announcement, each wedding photo, each friend having a baby.

Mixed in were incredible, amazing things–opportunities to speak at universities and museums across the country, colleagues who supported me from afar, a beautiful new apartment, my family and friends who cared so deeply about my success and well being, and constant messages in my inbox telling me my blog was making a difference, my work mattered, and thanking me for sharing about my experiences. But I couldn’t see it, my brain wouldn’t let me.

It wasn’t until I finally got a job, an incredible, wonderful, amazing job, that I finally got to a place where I could begin to deal on a real medical level with what was happening to me. I was in a position where I was lucky enough to have great medical insurance and financial stability, two factors I know many, many folks do not have access to, so I’m aware of my privilege. I found a personal trainer, knowing that if I was paying for sessions and had them on my calendar I’d be forced to go. I started meditating, and practicing gratitude, both using smartphone apps (links at the end of the post), and I quit facebook. Most importantly, I found an acupuncturist, recommended by a colleague, who got me to a place with my cycles that I hadn’t ever experienced. She was the first person who listened intently to all my symptoms, knew exactly what I was talking about, and felt confident that she could help. On top of it, she is also Indigenous, so understood where I was coming from on a cultural and personal level as well. Through our sessions together, I felt a weight lifting that hadn’t even realized was there, until it was gone. My physical symptoms improved dramatically, and the anxiety all but disappeared. The depression lingered, but improved.

After two cycles of acupuncture that continued to help me feel like myself again, I started researching what else I could do. Just down the hill from my house was a Women’s Health Collective with a behavioral medicine division, and right on the website was a description that said they specialized in PMDD. It still took me months to make the call. I was scared, and afraid to admit that I really needed help. Once I finally did, I met with a psychiatrist and a therapist, who listened and nodded and knew exactly what I was talking about when I described my symptoms. They didn’t dismiss me, and they validated everything I was feeling. Despite my initial hesitancies with taking medication, I started taking an antidepressant for half the month. When I told the doctor I felt like I could manage without it, she said—“yes, you’re managing, but it honestly doesn’t have to be this hard.My mom reminded me about her 2nd graders with ADD whose parents say no to meds, and how hard their little brains have to work just to function in a classroom. “It’s biology honey,” she told me, “your brain just works differently, and why not try it? You can always stop.” I went and filled the prescription that day—though I had to read through Tracy Clayton’s beautiful Buzzfeed essay a couple times first.

As a Native woman and a Native scholar, as I suffered through this month after month I thought about our western taboos around menstruation, and how they traditionally aren’t matched in Indigenous communities. In American society, menstruation is talked about in hushed tones among women, tampons and pads are hidden deep in pockets or in shirtsleeves, every teen’s embarrassing moment includes that time they bled through an outfit or got their period in an unexpected place. A first period isn’t traditionally celebrated in mainstream American culture, which isn’t the case in Indigenous communities. Many of our tribes celebrate this important transition to adulthood for young women with ceremonies. Even so, today, periods and bleeding women are treated as “unclean” in many of our communities, which to me feels like a complete misuse of our traditional teachings. Women on their “moons” aren’t unclean, they are powerful. We are having our own ceremony, and don’t need to go through the same ceremony that the men must. I think about the StoneMan, and how the medicine man knew the way to stop him was with women on their moon. We are powerful, and we need to remember that.

But within these traditional teachings. I didn’t know where I fit. Instead of feeling powerful, I felt betrayed by that medicine, out of balance rather than in a rhythm. So I tried to think about it as finding that balance, not controlling my power, but bringing it back into its natural place where it can do the good work it is designed to do. Maybe it means that my medicine is strong—I just needed some help to nudge it in the right direction.

I’m only on my second cycle of therapy and medication, but already I know that it will never be that bad again. I joked with my therapist that I felt like the Claritin allergy commercial where the world becomes “Claritin clear”–things were bright, I was smiling and laughing easily during my luteal phase, I literally was stopping to pet dogs, smell flowers, and coo at babies. Now we’ve begun the process of working on all of the negative messages I’d internalized through all these years, unpacking my fears around academic writing and going on dates, replacing negative behaviors and thoughts with positive ones, calling my weeks by their number rather than “good weeks” and “bad weeks.” My therapist has been helping me to see all of the amazing things I was able to accomplish in the last few years despite my struggles, how proactive I was with my health, what a support network I have in my family and friends, how many positive coping mechanisms I had come up with to help me continue to be a functional adult even when feeling awful, and how deeply in tune I am with my body now.

So I write all this to say—this is where I had been going two weeks a month. This is where the blog posts went, the emails went, the text messages went. I was fighting the StoneMan. But I feel that he’s finally been defeated, and in his place is the medicine and strength the giant left in his death.

Thank you for sticking with me, for your support even when you didn’t know what was going on. This blog has always been a respite, a source of strength, and a place to talk about the things that are hard to talk about–so I hope this post can be a continuation of that. I also write all this to encourage anyone else who is struggling to seek out help, and to try and move past some of the stigma we have about talking about menstruation and mental health. I’m going to leave a list of a few of the resources and things that have helped me here, with the hope that they might help others as well. But truly, Wado, thank you, for giving me a community, support, and space while all of this was going on.

Apps (I have an iphone, but I think most of these have android equivalents):

Hormone Horoscope (Free!): Let’s you program in your cycle and length, and each day tells you what’s going on with your body. Yes, it’s really pink, yes it’s written like Teen magazine, but the data is real and it’s a really good summary of the scientific research for each stage of your cycle. It’s really validating to know your symptoms aren’t in your head, and to be able to blame them on a specific biological process.

Period tracker (Free!): You have to tell it you’re “trying to conceive” even if you’re not, otherwise it won’t let you track your ovulation, which is weird. But it lets you track physical symptoms, mental feelings (using cute emojis), has a journal entry function, and let’s you look back at past cycles to identify patterns. This app is invaluable for me. I use it every single day.

Gaiam Meditation Studio ($3.99): Love this app. There are so many meditations, broken up by “collection”—everything from stress relief, anxiety, sleep, breaking a bad mood, gratitude, you name it. They range from 4 to 12 minutes, so it’s a low commitment and you can pair a few for a quick session.

5 Minute Journal ($4.99): Yes a little pricey, but worth it. Gratitude has been really important for me lately, and helps me to find joy even when I’m feeling down. This app is super easy and quick (hence the name), it gives you a reminder in the morning and at night to jot down things you’re grateful for, how you’ll make the day better, and amazing things that happened that day. You also upload a daily picture, and scanning back through is a great reminder of all the good things going on. Some days I’m thankful for a burrito and my bed, but even so, it reminds me that overall things are awesome.

 

Other resources:

When Taking Anxiety Medication is a Revolutionary Act (Tracy Clayton, Buzzfeed)

Beginners Guide to Starting Therapy (Buzzfeed)

Another Round episode on finding a therapist (I have some major love for Tracy and Heben and the ways they normalize talking about meds, therapy, and self care)

Diagnosing PMDD (includes this chart below, as well as treatment options and info about the biological factors at play):

Research Criteria for Premenstrual Dysphoric Disorder

A. In most menstrual cycles during the past year, five (or more) of the following symptoms were present for most of the time during the last week of the luteal phase, began to remit within a few days after the onset of the follicular phase, and were absent in the week postmenses, with at least one of the symptoms being either (1), (2), (3), or (4):

  1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
  2. Marked anxiety, tension, feelings of being “keyed up” or “on edge”
  3. Marked affective lability (e.g., feeling suddenly sad or tearful or increased sensitivity to rejection)
  4. Persistent and marked anger or irritability or increased interpersonal conflicts
  5. Decreased interest in usual activities (e.g., work, school, friends, hobbies)
  6. Subjective sense of difficulty in concentrating
  7. Lethargy, easy fatigability, or marked lack of energy
  8. Marked change in appetite, overeating, or specific food cravings
  9. Hypersomnia or insomnia
  10. A subjective sense of being overwhelmed or out of control
  11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of “bloating,” or weight gain

B. The disturbance markedly interferes with work or school or with usual social activities and relationships with others (e.g., avoidance of social activities, decreased productivity and efficiency at work or school).

C. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although it may be superimposed on any of these disorders).

D. Criteria A, B, and C must be confirmed by prospective daily ratings during at least two consecutive symptomatic cycles. (The diagnosis may be made provisionally prior to this confirmation.)

Disclaimer: Obviously I’m not a medical professional, and this is my experience and what has worked for me. I really encourage everyone to seek out a care team and start working on what’s best for them!

  • http://www.splitfeathers.blogspot.com Lara Trace Hentz

    I love you for writing this and sharing this. WaDo!

  • herthoughts

    I’m not a biologist, but I don’t think other female mammals are given this challenge to the high degree we are. Add to that the challenge of giving birth to babies with heads way larger and rounder than other mammals, and one can conclude that we are very tough chicks. When one thinks about menstruation historically, until relatively recently women were pregnant most of their adult lives, and didn’t endure this on a monthly basis as we do today. As a store clerk said to me the other day when I asked her if she was having a hot flash, “I’ll take this any day over having the monthly cycle”. I said “Amen”.

  • Emily

    Thank you for writing about this!

  • Coty Savard

    I feel like I could written this, thank you so much sharing. Uploading all the application!

  • Beatrice Beardsworth

    Wow…your experience was very similar to mine. I never realized how severe my pmdd was until after the birth of my twins and that started me on a journey to find relief from the emotional pain of depression and anxiety from pmdd that was taking over my life. I, too, experienced the feeling of not being taken seriously by (male) doctors. I exercised religiously and monitored my food and my feelings but that experience of being too overwhelmed to make any progress in my life, even with the smallest of tasks, was all encompassing. I began to notice, exactly like you said, that iwould have two weeks on and two weeks off…eventually, my two weeks off would be so destructive that my two good weeks would be spent rushing to try to fix everything. I finally saw a counselor and discussed taking antidepressants but ended up taking a 3 week cycle of hormonal birth control, which eliminated my period. There are pros and cons but the relief from the anxiety was powerful and immediate. I am in awe at the weight under which I was operating for so long…like no wonder I couldn’t get my life together! Thank you for sharing your experience!

  • sparrow925

    So impressed with all the work you put in to getting all the gears working together! <3 Add my hug to the piles of love here. Thank you for all the academic work that you do as well, I really value your insight on this blog.

    Wanted to point you to a period app you might not have checked out? "Clue" is my period app of choice, as a scientist I'm in love with it — very clean and professional, clean design without looking like something from 17 Magazine, good info cited from academic journals, lets you track everything (with an account so you can change phones), and you can even download your own data to do your own stats with! They do big data studies as well, since this is an area that, as you say, big studies haven't been done with yet.

    • Adrienne_K

      Oh my gosh, I just downloaded Clue and it’s fantastic! It does so many things I wish the others did. And the thought of being able to do stats with my own data…nerd heaven! Thanks so much, I’m going to actually edit the post to include it as another option for folks.

  • Cireena Simcox

    And now for something completely different….
    I work @rth_brighton – a Regency Town House in the UK. Because of all the whispers & silence surrounding menstruation through history we’re having an event called “Women.Period” on Sept 16th.The historiography is going well, but am looking now for legends, stories, nomenclature (I personally find ‘surfing the crimson tide’ hilarious!).I see you refer to it as ‘moons’?
    Have nothing at all re native North Americans. I would like to use your Stone Man legend – but any others would be great. Would also like to know how, historically, native North Americans traditionally absorbed the flow?
    And if any of your readers have any family stories or know of other legends would welcome those, too.
    Hey, I need all the help I can get here!
    cheers, Cireena (@poob2016)

  • http://bandia.net Kathryn NicDhàna

    Oh honey! *hugs you* So many of us have been there. Probably most of us, really. Thank you for having the guts to speak out. To fight that Stone Man. Your work is crucial, and there are a bunch of us out here ready to line up and fight him with you.

    Even when the hormones have been kicking your ass, you have continued to be a leading and necessary voice in these struggles. Especially during times when others either won’t take the risk of speaking out, or are just too sick of it. The fact that you have kept up the fight despite your personal struggles just makes me respect and love you all the more.

    We’ve all got our embarrassing overload of things we haven’t gotten to, and tasks we feel inadequate to, and ways in which we wish we’ve done better. I so know what you’re saying, and I also know there’s a way through. Thank you for trusting us with your story. There are young women who will get help now because of you. Like so many times before, you have made life possible and better for others out here. Never doubt that. <3 <3 <3

  • John Breitenbach

    Good on you Adrienne! I know that too many times we idealize women by saying that they “can handle anything” without really giving them any other option, but your story is a great example of strength through vulnerability.

  • Brockland A.T.

    Iodine helps with PMS.

    Most people are iodine deficient in North America, especially those who live inland and don’t get enough iodine naturally from their diet. Iodized salt helps but is not enough for optimal health.

    http://clearwoman.com/pms-premenstrual-syndrome/

    The link also mentions the importance of supplements of iodine in atomic and ionic form.

  • Rachel

    Thank you for sharing this, Dr. Keene <3. I haven't struggled with PMS but my physical symptoms are atrocious on the first day. My family doctor thankfully is willing to prescribe the painkillers i need to handle it, but if I don't take it I get crippling cramps on the first day, to the point of vomiting and blacking out if I try to walk.

    I've also had to deal with depression (though unrelated to my menstrual cycle). I moved to southern California for graduate school, and I spent two years there. I did really well academically, enjoyed my classes, and got along well with my professors and classmates….and it was the most miserable I've ever been in my life. I was away from all of my friends and family, and being starved of that affection and support network was killing me. I also hated the climate…I'm sort of weird this way, but I love cooler weather and four seasons with snowy winters and overcast skies, and there it was bright and sunny and hot all the time and it drove me nuts (seriously, if there's an opposite of Seasonal Affective Disorder, I probably have it).
    At the end of my second year I determined that I would not be able to make it through a third year without putting myself in the hospital, so I pulled the plug and moved back to where my friends live (I'm going back in another year to finish up, as I think I've healed enough psychologically to handle the rest of it now, but MAN). I think our ambitious and individualistic culture fails to take into account needing a close social network, so while I'm not Native (I'm about as white as they come), I do understand being deeply unhappy because of being away from the ones you love, even though you're doing the lauded thing by pursuing a career you thought you'd enjoy.

    Going back to periods…I've felt a lot of grief and anger over various facets of my reproductive system, part of which is the aforementioned pain, but I've always appreciated what my mom did for me when I first got my period. My mom put together a Women's Ceremony for me, inviting the women from her women's group and my grandmother over, and they each gave me a symbolic gift related to me reaching womanhood, and I remember us all dancing, and the memory of it still makes me a little teary-eyed, because my period (and my sexuality in general) has been nothing but a source of pain and frustration in my life….but this one thing, this one event at least was good, because I know my mom wanted it to be a positive, joyous experience for me, and I'll always be grateful for that.

    So thanks again, for carving out this little space to talk about it, and for sharing with us <3