Emma Cardell was living in Japan when, concerned about an increasing "rollercoaster" of emotions she had been monitoring through a period app, she first reached out to an online counsellor.
Ms Cardell was subsequently diagnosed with premenstrual dysphoric disorder (PMDD).
It is a severe form of premenstrual syndrome (PMS) affecting millions of women worldwide and causing extreme mood shifts in the lead up to menstruation.
"The worst for me was the relentless insomnia that would stretch out further, the worse my symptoms were," Ms Cardell said.
"Imagine not sleeping for two months.
"I could only work max [maximum] twice a week and could not work in the week to two weeks before each period," Ms Cardell said.
"I was having to fake being normal at work and in life … I had constant battles with my partner and couldn't make nor maintain friendships."
In severe cases, PMDD can lead to suicidal ideation
Symptoms typically occur in the week or two before to menstruation and may include severe depression, irritability, mood swings, anxiety, fatigue, changes in appetite, and physical symptoms such as bloating or breast tenderness.
"Once menstruation begins, it's almost like a switch, and women feel 'normal' again," Dr Natasha Vavrek, a specialist women's GP, said.
In severe cases, PMDD can lead to suicidal ideation or behaviours.
"While not all individuals with PMDD will experience suicidal thoughts or actions, research does suggest that there may be an increased risk of suicidal ideation and suicide attempts among those with PMDD compared to the general population," Dr Vavrek said.
"PMDD awareness is suicide prevention," Ms Cardell said.
"The thing about it is that your amygdala can literally snap from 1 to 100 in an instant, and anything can be a trigger … I used to just fly off the chart."
The amygdala is a small, almond-shaped structure located deep within the brain's temporal lobe, on both sides of the brain.
"The amygdala plays a central role in the processing and regulation of emotions, particularly fear and aggression," Dr Vavrek said.
"Studies have shown that women with PMDD may have abnormal activity in brain regions involved in emotion processing, including the amygdala.
"For example, some research suggests that individuals with PMDD may have heightened amygdala reactivity to negative emotional stimuli during the luteal phase of the menstrual cycle [the phase just before menstruation], when PMDD symptoms typically occur."
Many people don't know the psychiatric disorder exists
Women's Health Tasmania deputy chief executive Lucinda Shannon said it can be hard for people with PMDD to find support.
"There are a few barriers, and one is that people don't know that it exists … [and] there's a lot of silence about what a healthy menstrual cycle looks and feels like.
"Instead, we hear sexist jokes about being 'moody' [which] encourages folk to just soldier on, when really, the symptoms of PMDD can be really distressing and require support and compassion."
In fact, PMDD is considered a psychiatric depressive disorder.
Women's Health Tasmania runs The Good Period Workshop where anyone with a period can talk about their experience, including experiences related to PMDD.
"The workshops were co-designed by a group of women," Ms Shannon said.
"We're careful about how we talk about PMDD … and specific conditions because each condition has a very specific way that it needs to be diagnosed."
But once it is diagnosed, PMDD is treatable.
"While there is no cure, various treatment options are available to help manage symptoms and improve quality of life," Dr Vavrek said.
"Nowadays — being medicated — I still get symptoms. But it's a 30 at most on the scale of 1-100 where I used to just fly off the chart," Ms Cardell said.
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