PMDD and Work: One Patient’s Story

Jan 18, 2021

Like many PMDD sufferers, I developed my severe Premenstrual Dysphoric Disorder after weaning my first child from breastfeeding. I had two children in quick succession and was able to access back to back maternity leave without returning to work.

After exhausting my allocation of extended maternity leave I was faced with a huge dilemma. I could return to work as a classroom teacher and retain my permanent position, which I had held for the past 18 years – or I could quit.


“I knew that I couldn’t possibly carry out my role.”


I knew that I couldn’t possibly carry out my role caring for 30 eight year olds, planning and implementing their learning programs, plus catch-up on the four years of policy, departmental and technological changes that had occurred since I was last in the classroom, while I continued to live with PMDD. The thought of getting myself off to work prepared for the day as well as making sure my own children were on time and ready to go, as well as making sure the family was clothed, fed and happy, had me verging on panic.

Some days my symptoms of depression and fatigue left me unable to shower and days when the anxiety, irritability and intense feelings of anger would consume me were not appropriate emotions to be taking into any workplace – let alone a high pressure environment with sensitive and vulnerable children who deserved the best level of care and guidance. I couldn’t imagine how I would cope with a room of robust and noisy little people demanding attention when I was experiencing misophonia and sensory overload. I couldn’t possibly teach math or mark papers when my brain fog reduced my cognitive function so severely on a regular basis. So, I resigned myself to the fact that I would be unable to return to work.


“I resigned myself to the fact that I would be unable to return to work.”


This did not sit well with me at all. Prior to my PMDD diagnosis I was a high functioning, high achieving individual. I had performed well at high school scoring in the top ten percent of the state in my high school certificate. I had a university degree and was a ‘targeted graduate’, gaining permanent full time employment with a local school as soon as I finished my qualifications. I had worked hard at my school to become a respected teacher amongst the school community, taking on extra duties and organisational roles and had relieved as an Assistant Principal on a couple of occasions. I had developed good working relationships with my colleagues and had found a new niche of interest in working with children who were deaf or hearing impaired. My future seemed bright in this new role and I successfully gained my Masters degree with High distinction and planned a future in an itinerant role with aspirations to one day becoming the regional assistant principal hearing.


“When I realised I could not return to work all I could think was – what a waste!”


When I realised I could not return to work all I could think was – what a waste! What had I become? I had spent so much of my life getting to this point in my career and to throw it away at this point made me deeply resentful of my diagnosis. I spent hours searching for information to help me find a better way out of this mess I was now in and I found a video on the IAPMD website about PMDD and the workplace. I learned that there were resources to help people navigate these issues and that employees have a right to access sick leave for their PMDD when they are unfit for work and that full disclosure of the condition is not mandatory.

This helped me in my decision to request a medical certificate from my doctor stating that I had a severe and chronic health condition that made me unfit to work at least for the next year until I had been through and recovered from surgery. It did not disclose the name of the condition and it was accepted by my employer. I was able to access a full year of sick leave, retaining my right of return, without ever having to explain what PMDD is to my employer.


“I had cringed at the thought of having to disclose my PMDD to my employer.”


I had cringed at the thought of having to disclose my PMDD to my employer due to the stigma of mental health and gynaecological health conditions and didn’t feel comfortable doing so. When I met with my boss I felt confident knowing that I didn’t have to disclose my condition if I didn’t want to and respectfully declined when he asked me about it. I had knowledge and support from my doctor on my side and I was willing to make an example of myself for the rights of others had my request been denied.

I had decided that I needed to move forward through the treatment options over the coming year with a total hysterectomy and bilateral oophorectomy with hormone replacement therapy, as my final option, if I was to ever hope to return to a normal working life. Little did I know what a long and tumultuous journey getting to that point would be. It is almost September and it is unlikely that I will have the operation before November, leaving my future for returning to work next year somewhat uncertain.


“Getting the hormone replacement therapy right has been way more difficult than I thought.”


I did not realise that the precursor to surgery, the ovarian suppression, also known as chemical menopause, would be such an upheaval. It’s a good thing I did not return to work as my journey over the past nine months has seen me plunged into a state of menopause with severe and debilitating depression, uncontrollable crying, feeling overwhelmed and several periods of intense suicidal ideation. Getting the hormone replacement therapy right has been way more difficult than I thought. When you are sensitive to hormonal fluctuations and you start messing around with hormone levels and different methods of administration it can be a horrific roller coaster of symptoms and emotions.


“Work is such a huge part of our identity and sense of self worth.”


But there is a light at the end of the tunnel. I now have my HRT under control and my surgery consultation is impending. It has been quite a journey for my family and I and I hope that one day this will all be behind me so that I can return to work and resume a normal life. Had my employer not supported me in this, or rejected my access to sick leave, I believe the blow would have absolutely crushed me. Work is such a huge part of our identity and sense of self worth that when someone takes that away from you, you can feel worthless and like everything you’ve worked so hard to achieve has all been a waste of time. I believe I still have a lot to give my workplace and my community. I have skills and experience that should be used – when I am well again.

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