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Category: Health
Satisfied Customers: 62411
Experience:  director at Ohio Integrative Medicine
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I am a 20 year old female who doesnt know what to do anymore.

Customer Question

I am a 20 year old female who doesn't know what to do anymore. Ever since I hit puberty at just 10 years old, I have had hormonal rage issues. At first, it wasn't too often, but it has increased to once every month about 4 years ago. About 3 to 5 days before my period, I'll just be going about my business, I'll get a hot feeling on my neck, a depressed feeling or an impending sense of doom, then I'll just explode. I'll start screaming, cussing, throwing anything I can, hitting or hurting myself, screaming at others, breaking anything I can, and hyperventilating.

These episodes will last anywhere from 2 to 10 minutes and will pretty much make me feel suicidal for the rest of the day which could go on to several weeks. I've tried so hard to become more of a positive person to make sure that it's not depression causing this, and it's not. It is directly related to my menstrual cycle.

I have very heavy, painful periods. Every period, I will go about 2 days of being in a constant fetal position crying from the pain with no help from pain medication. The last time I had a cervical pap smear, they said it was incredibly tender and I bled all over the table. They said it was not cervical cancer but the cells were atypical. They didn't feel it was necessary to investigate that more. I also have no libido, nor have I had any libido in my entire life.

I am overweight so the doctors checked my thyroid levels, hormone levels, blood sugars, triglycerides, cholesterol, vitamin levels and all tests came back normal. I have spent 10 years trying to find out what is wrong with me and I don't know what else to do, everyone keeps telling me that I'm completely normal but my life is ruined every single month. I can't take this anymore!

The doctors did think that I might have had PMDD but Yaz did nothing for me except make me nauseous every minute of every day and I still had rage issues. I'm thinking that I might have a pituitary tumor that is throwing my reproductive system off or maybe some sort of PCOS which I heard would make your periods lighter or make you miss them. My periods are heavy, regular, and last about 8 to 9 days.

I'm not sure if any of you can help me, but I'm not sure what else to do. I can't deal with living this way every month anymore. It's been ten years and I feel like I have no chance at a normal life. I can't get a job because of this because I have flipped out on customers in previous jobs.
Submitted: 4 years ago.
Category: Health
Expert:  DrThomasMd replied 4 years ago.
Since this is still cyclic with the period you should try other treatments
What stands out is no therapy
CBT or cognitive behavioral therapy is indicated in this situation, done by PhD clinical psychologists.

Pharmacologic treatment for PMDD begins with an SSRI medication which you have not had [zoloft, celexa, venlafaxine, etc.]

Low dose alprazolam is a second line treatment.

i would suggest that a psychiatrist who uses these meds daily would be able to make a good selection.
Customer: replied 4 years ago.
I appreciate your answer but cognitive behavior therapy? Doesn't that indicate that I would have some sort of emotional problems or mental stress that I need to work out? These attacks of mine have absolutely nothing to do with situational stress. They happen out of the blue with absolutely no provocation. You could literally ask me what time of day it is and I could flip out if it was time for me to have an episode.

I guess my point was that I'm thinking that all of my problems are connected. Treating a symptom with medications such as zoloft of the alprozolam might help the rage but I want to be able to treat the source. I want to be able to figure out what is causing all of my problems but I have no direction to go by. Do I need to see some sort of specialist like an endocrinologist? I have no medical insurance so I'd need to know what sort of specialist to pursue before I just jump into it blindfolded.

Also, I should have noted that my mother goes through the same problems I have. She has very heavy, painful periods, goes through rage episodes connected to her cycle, and has had no libido in her entire life.
Expert:  DrThomasMd replied 4 years ago.
Unless you have a thyroid problem [easy to tell if TSH is not between .3 and 3], or other physical problem, then the specialists are as I have stated.
CBT has a large evidence base for helping with such disorders, in addition to the medication effects.

An endocrinologist might help with looking at all the hormones..but my understanding was that this had been done....

Your regular doctor can easily screen you with a TSH, T4, am cortisol level, and estrogen panel.
Category: Health
Satisfied Customers: 62411
Experience: director at Ohio Integrative Medicine
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Expert:  DrThomasMd replied 4 years ago.
You are in the reply box but don't see a reply
Customer: replied 4 years ago.
I just don't think that I should treat the symptoms without questioning the cause. What could be causing my brain to just rage out like that? It can't be doing it all on its own. And what about my other problems? It all just seems like too much of a coincidence for it to just be treated by anti-anxiety medication. Also, my mother has the exact same problems that I do. What indicates CBT that also takes everything else into account?

I was thinking about an endocrinologist because I figured they could take a look at my brain. Maybe I'm just pulling at straws with that theory, but I still maintain that there has to be a cause for this.
Expert:  DrThomasMd replied 4 years ago.
The cause is not known in conventional medicine.

The treatment of neurotransmitters and hormones together as a "cause" is done with the medicines I have mentioned.

An endocrinologist would certainly rule out a hormonal problem, but no a neurological or neurotransmitter problem. Which again is treated with an SSRI.

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