Usually when I start noticing my period-related symptoms, it isn’t a sign that my period is just around the corner. Instead I prepare myself for up to a week of intensifying ailments, including horribly low moods, intense fatigue, and cramps. I have PMDD, or premenstrual dysphoric disorder, meaning that these symptoms aren’t minor inconveniences or distractions. At times, the fatigue and emotional turmoil of my hormones can get so bad it leads me to be completely unproductive for days at a time. This isn’t new to me; as a teenager I sometimes had to take time off from school and spend entire days in bed because of my horrible period symptoms.
Despite the fact that PMDD still goes relatively undiagnosed, studies show 5% to 8% of women suffer from the disorder, and 45.2% of women report that their symptoms require them to take days off. But the misconceptions around PMDD can make it difficult for those suffering (and the people they work with) to understand the steps that need to be taken.
“Part of the problem is that it has taken a while for PMDD to achieve status as a clinical diagnosis,” says Dr. Tiffany Pham, an OB-GYN and medical adviser at Flo health. Pham notes that the American Psychological Association only listed it as a diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013, and the World Health Organization didn’t classify it as such until 2016.
She adds that PMDD can be debilitating and can seriously affect productivity, which in turn for many people can affect upward mobility. Nutritional therapist Sandra Cohen, who often helps clients manage their PMDD symptoms, says managing work can also be difficult due to the taboos around menstrual health and symptoms. “Because of the taboos around this, it’s very hard to say ‘I have PMDD and I need 24 or 48 hours off,’” she says.
While being self-employed can help with some of these challenges—such as not having to disclose personal medical information to get necessary accommodations—it presents its own challenges. When I started working as a freelancer, needing to take the day off became coupled with worrying about my deadlines, and being unable to pitch or be productive meant I was cutting into my commissions for the coming week. Being my own boss isn’t always easy, and as much as I love the flexibility and creativity, the additional pressure of managing my own deadlines and workload becomes increasingly difficult during the days when my PMDD symptoms are peaking.
“When you’re self-employed, your financial stability is based on your ability to be productive,” Pham says. “So if you’re affected five to ten days of the month, that’s almost a third of the month you’re not able to produce. This can be more difficult when you are your own boss because you may not have any other support.”
For business coach Nina Roldan, worsening PMDD symptoms over the past four years led her to rethink her job, as she used to work in project management at large events, which often meant being on her feet from 6 a.m. to 10 p.m. “In my twenties that was still manageable,” she says. “But as I’ve gotten older, my PMDD has gotten worse, so I really needed to see what kind of lifestyle I wanted to have and what skill set I had. About two years ago, I retrained as a business coach.”
Roldan also needed to make lifestyle- and schedule-related changes after her anxiety symptoms escalated. She blocks off time on her calendar when she knows her symptoms will be at their worst, and finds ways to be productive in a different way near the end of her cycle. For her, that meant finishing admin-related tasks and not assigning herself any creative tasks near the time when she knows her symptoms will be worse. She also works on her pitches and the social aspect of her work near the start of her cycle, when she’s feeling more energetic.
What Roldan does may not work for everyone, but slowing down and listening to your body is key, Pham says. She also suggests regular exercise, cognitive behavioral therapy, and working with instead of against your symptoms, which she says means listening to your body and doing tasks that don’t make you feel worse, even scheduling time off if needed.
For me, it’s meant tracking my symptoms and knowing that I need to have slower days. I’ll work on my assigned deadlines ahead of time in order to not have last-minute pressure for when my symptoms do show up, and I adjust my diet as needed. (Lemon ginger tea goes a long way in helping some of my symptoms.)
Awareness and support for PMDD and menstrual health in general still has a long way to go, and can leave individuals feeling even more lonely in their work journeys. But building a lifestyle that supports your health and empowers you to take care of yourself is a good place to start.
