Hormones make me seriously depressed
THERE are days when presenter Sarah Mulindwa simply can’t get out of bed.
“I don’t want to reply to messages, I’m anxious, irritable and genuinely feel like I have nothing to wake up for,” says the 33-year-old.
But the sexual health nurse specialist who presents E4’s The Sex Clinic isn’t suffering from clinical depression. Her symptoms are caused by a severe form of premenstrual tension known as premenstrual dysphoric disorder (PMDD) which is thought to affect as many as one in 20 women.
“I got my first period just after I turned 14 and developed the symptoms that you associate with premenstrual syndrome (PMS) like hot flashes and mood swings,” she says.
“But your mother and friends all tell you it’s what to expect, so it becomes normal and you learn to deal with it.”
It wasn’t until Sarah was in her midtwenties that she noticed that her hormones were starting to significantly impact her once a month. “I realised Sarah on TV’S The Sex Clinic that I was actually getting severely depressed at certain times – that I wanted to be by myself and stay in bed all day. It was like I was walking around with a cloud over my head.
“We all know about PMS but PMDD is a completely different ballgame – it’s a lot more severe and completely takes over. It affects up to five per cent of women of childbearing age every month – that’s a lot of women, but most people haven’t heard of it. We need to start to talking about it.”
Once Sarah’s period starts, she is instantly back to her usual, optimistic, chilled-out self, but in the days running up to it, even everyday tasks become a struggle. “At work, normally I’m friendly and approachable but I become very irritable – and then that upsets me because I’m being a cow, essentially. I miss deadlines and really have to push myself to carry on.”
It also contributed to the end of one six-year relationship. “While we had other issues, my PMDD really aggravated the usual ups and downs that couples have, amplifying things that might not really have been a big deal,” she admits. “It definitely caused
■ Premenstrual dysphoric disorder (PMDD) is thought to affect around one in 20 women. A very severe form of premenstrual syndrome, it causes emotional and physical symptoms for up to a fortnight before menstruation.
■ PMDD can make it difficult to work, socialise and maintain relationships. Symptoms include mood swings, anxiety, lack of concentration, sleep problems, depression and, in severe cases, even suicidal feelings.
arguments about small things that probably wouldn’t have been a problem a week earlier or later. It really affected things between us.”
Sarah was 26 years old before she decided to seek medical advice.
“I realised that once a month I wasn’t
■ While the exact cause is unclear, it is thought PMDD may be associated with increased sensitivity to the normal hormonal changes that occur during the menstrual cycle, potentially linked to inherited genetic variations.
■ PMDD is commonly defined as an endocrine disorder (ie it is hormonerelated), but because it has many emotional symptoms it is also listed as a mental health condition.
■ For more information go to mind. org.uk/pmdd
in control of my emotions, so I decided it was time to see my GP,” she says.
Unfortunately, the appointment wasn’t as helpful as she might have hoped. “The doctor recommended trying evening primrose oil and offered me antidepressants, but I chose not to go down that route,” she says. “It’s easy to just prescribe something like that without thinking, but because I’m a nurse I knew my issue wasn’t anxiety or depression. My symptoms are completely related to my menstrual cycle and my hormones, so I need help to balance them, not simply try to mask the problem.”
That’s why Sarah, who works part-time as a fashion editor as well as a nurse, has been researching contraceptives on the market that might improve her monthly cycle.
“Contraceptives are by far the most effective treatment for controlling hormones currently available, so I need to try all my options,” she says.
“Over the years I’ve taken Microgynon, a contraceptive pill, but that made things even worse. Then I tried a Mirena coil, which was inserted three years ago, but that hasn’t improved anything at all. I’m going to have a hormone implant next as I’ve heard that might be helpful.”
Knowing she has PMDD hasn’t made the monthly mood swings any easier for Sarah to live with. “If I have 12 cycles in a year, eight or nine will definitely bring on my PMDD about a week before my period comes.
“But unless you have experienced it, you really wouldn’t understand it. You genuinely feel depressed and that you want to lock yourself away.
“Sometimes I’m OK at spotting that my hormones are the cause of how I’m feeling, but that tends to be on a ‘good’ month, when the symptoms are mild. Identifying it for yourself doesn’t make the emotions go away, but when you realise, you can rationalise it all, so it becomes a bit easier to live with.
“At other times it can be so severe that I can’t make that connection.
“I was living with my brother Kevin for a time and it got to the point that he would tell me my period was coming before I even knew myself.”
There’s no predicting how each cycle will pan out either. “This month was particularly bad as it lasted almost 10 days and I felt hugely stressed,” she says.
“I run my sexual health clinic on a Monday and someone asked me to do something 10 minutes after I should have left. I just started crying and was completely inconsolable. It was such a small trigger and normally wouldn’t have phased me at all, but it led to me letting out so much pent up emotion. It can be so embarrassing.
“When I’m myself, I’m calm and it’s hard to get me stressed, but before my period is due I find everything so much harder. Then once my period starts everything is normal. It’s just an emotional rollercoaster.”
■■The Sex Clinic is available to watch on All 4.
Sometimes I spot that my hormones are the cause of how I’m feeling, but when it’s bad I don’t make a connection