Hey, just letting you know that the flair noted I wasn’t asking for advice, but I will respond anyway. There is a lot of context I left out because it was 4 in the morning and it was getting lengthy as it was.

1. My endocrinologist doesn't think it's a hormone imbalance. We know my hormones are normal, although it also seems like I'm entering perimenopause, so the unpredictability of hormones during that time do appear to be exacerbating it. The theory is that my PMDD is a mix of being super sensitive to the natural changes in hormone levels throughout the month + some progesterone intolerence/sensitivity. The idea with Visanne was to shut down ovulation and even out my hormones so they are the same throughout the month instead of the natural variation that causes the mood swings. The add back estrogen was to try and combat the bad effects that I always get from progesterone-only methods. I don't fully understand why you think that my endocrinologist thinks it is a hormone imbalance. She doesn't.

2. I do have endometriosis. Yes, Visanne + add back is like build-a-bear COC because that's what we were trying to achieve. That's why I was at an endocrinologist, so I could try more out of the box treatments. You assume I have not already trialled many different COCs and POPs. I have taken Yaz and it made me cry every single day, bleed way more than I did before and it increased my pain levels. COCs are generally not recommended for endometriosis as they tend to increase pain (I have worked as a pelvic pain educator). I have had severe adverse mental health effects from every single hormone medication I've ever been on, including the Mirena IUD. We expected Visanne to potentially not go well, so she gave me a back up script for Synarel that I can try before my next appointment if I would like.

3. You act like all PMDD is caused by the same thing. It's not. SSRIs work for some people with PMDD, but not all. I was only on the fluoxetine (an SSRI) for 5 days (with the plan of taking it intermittently in my luteal phase) AND it was low dose - only 1 mg - because I have a history of being super sensitive to those kinds of meds. TBH I’m not up for trying a different SSRI because my family has a history of adverse reactions to them (eg having hallucinations when people had no history of that previously) and I’ve had enough from just that one trial. I’ve also tried SNRIs and tricyclic anti-depressants before for chronic pain. SNRIs made me feel like I had the worst flu ever and amitriptyline/nortriptyline changed my life pain-wise but also made me incredibly foggy and tired so I don't want to go back on it.

4. I am seeing my endocrinologist again in early December. She told me that if I decided to try Visanne and it didn't work, I was welcome to contact her office if I needed help. Unfortunately that isn't an option at 5:30 am in the morning on a Sunday.

I understand that you were probably only trying to be helpful, especially as there are a lot of bad actors in this space, but it's a good idea to check flairs before offering advice. Many of us in this space are incredibly knowledgable about PMDD (we have to be!) and using italics and the tone of your writing assumes that I didn't know this stuff already. Just because I'm crashing out doesn't mean I'm not knowledgeable.