Premenstrual Dysphoric Disorder: How to manage your PMDD naturally.

 

At some point menstruating human beings will experience cyclical symptoms associated with hormonal mood disorders. Often discussed as Premenstrual Syndrome (PMS), its big sister Premenstrual Dysphoric Disorder (PMDD) is often missed, and underdiagnosed (1).

PMDD affects 3-8% of menstruating women (2). It is more severe and disabling than PMS and consists of behavioral, affective and somatic symptoms that occur every month during the Luteal phase of the cycle (2). 

Why do these symptoms occur?

We need to shift the narrative of PMDD. Initially thought to be a disorder characterised by hormonal imbalance, research has failed to demonstrate this (3). Instead what they have found is a sensitivity to normal hormonal fluctuations during the menstrual cycle or reproductive transitions (e.g. pregnancy and menopause) (4). This has been shown to occur in women with genetic, endocrine, neural and psychosocial factors that may increase this sensitivity (5).

Below we will look at the symptoms of PMDD. For PMDD sufferers at least 5 symptoms are present in the final week before the onset of their period and start to improve within a few days after their period. Finally these symptoms become minimal or absent in the week post menses (6).

Symptoms

  • Mood swings, feeling sad or tearful suddenly

  • Increased sensitivity to rejection

  • Irritable, angry

  • Increased interpersonal conflicts

  • A shift in mood towards depression, feelings of hopelessness

  • Increased anxiety, or feeling on edge (3)

On top of these people with PMDD may also experience:

  • Insomnia

  • Overwhelmed or out of control

  • Decreased interest in usual activities

  • Lethargy, low energy

  • Changes in appetite

  • Poor concentration

  • Physical symptoms: Bloating, weight gain, Breast tenderness or swelling (6)

These symptoms can be debilitating and affect the quality of a person's life to the point where they need to take time off work and pause their life every month. 

The table below helps you identify through an easy diagram what symptoms you may be experiencing and if this is a condition you may want to investigate with your naturopath or a G.P.

7, 8.

Natural ways to support PMDD

So now you might be thinking what are the treatment options for this condition? 

Medically this condition is usually treated with neuromodulators such as antidepressants and hormonal contraceptives such as the oral contraceptive pill (2). These can be really helpful for some women. If you would rather look at natural ways to support continue reading. 

These are my treatment priorities when it comes to PMDD and what I have found to help the most. 

Herbal treatments: St John's Wort and Chaste tree. 

  • Chaste Tree (Vitex) has shown great benefit in ameliorating the somatic and emotional symptoms of PMDD (2). 

  • St John's wort has also shown to be an effective alternative to antidepressants (2). I find this herb lifts my clients moods and brings much needed stability back into their luteal phase. It acts similar to antidepressants by increasing serotonin in the synapse. Be cautious with this herb if taking medications including hormonal contraceptives. 

    Calcium/Vitamin B6

  • Calcium fluctuates during the menstrual cycle (2). It plays an important role in the mood symptoms of PMDD as calcium regulates neurotransmission (9).

  • In clinical trials 500mg of calcium daily has shown to have a beneficial effect in women with PMS (10).

  • B6 is a critical cofactor for enzymes that create GABA, dopamine and serotonin (11). 40mg daily has been shown to reduce PMS related symptoms (7).

Investigate, Investigate, Investigate

Hormonal imbalances can still exist alongside PMDD physiology, meaning you may be sensitive to the fluctuations of hormones but this is being exacerbated by pre existing hormonal imbalances. In the clinic I also do comprehensive hormone testing to check what else may be going on. This includes DUTCH hormone testing and a comprehensive blood work panel. I regularly find hormonal imbalances, thyroid disorders, vitamin D deficiencies in people suffering from PMDD.

I have found that people with PMDD have had marked improvement treating their symptoms naturally and have been able to feel like themselves again in their luteal phase. A combination of therapeutic supplementation, testing and addressing underlying root causes all contribute to large improvements in quality of life. If you think you may be experiencing PMDD or want to look at an individualized treatment plan for you, please do not hesitate to get in touch.

If you are after support please book a consultation or a clarity call.

Naturopath
 

References

1. Metagenics institute. Available from https://www.metagenicsinstitute.com.au/protocols/premenstrual-syndrome-premenstrual-dysphoric-disorder

2. Rapkin AJ, Lewis EI. Treatment of Premenstrual Dysphoric Disorder. Women’s Health. 2013;9(6):537-556. doi:10.2217/WHE.13.62

3. Schweizer-Schubert S, Gordon JL, Eisenlohr-Moul TA, Meltzer-Brody S, Schmalenberger KM, Slopien R, et al. Steroid hormone sensitivity in reproductive mood disorders: on the role of the GABAA receptor complex and stress during hormonal transitions. Frontiers in Med. 2021 Jan 18; 7:479646. doi: 10.3389/fmed.2020.479646.

4. Schmidt PJ, Martinez PE, Nieman LK, Koziol DE, Thompson KD, Schenkel L, et al. Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels. Am J Psychiatry. 2017 Oct 1; 174(10): 980-89. doi: 10.1176/appi.ajp.2017.16101113.

5. Schweizer-Schubert S, Gordon JL, Eisenlohr-Moul TA, Meltzer-Brody S, Schmalenberger KM, Slopien R, et al. Steroid hormone sensitivity in reproductive mood disorders: on the role of the GABAA receptor complex and stress during hormonal transitions. Frontiers in Med. 2021 Jan 18; 7:479646. doi: 10.3389/fmed.2020.479646.

6. Reid RL. Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome) [Updated 2017 Jan 23]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Table 1, Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD) Available from: https://www.ncbi.nlm.nih.gov/books/NBK279045/table/premenstrual-syndrom.table1diag/

7. Metagenics institute. Available from https://www.metagenicsinstitute.com.au/protocols/premenstrual-syndrome-premenstrual-dysphoric-disorder

8. American Psychiatric Assn A. Diagnostic and statistical manual of mental disorders (5th ed.). 5th ed. Arlington: American Psychiatric Publishing; 2013.

9. Li HJ. Premenstrual dysphoric disorder (PMDD) is associated with estradiol-dependent aberrations in intracellular calcium homeostasis and the endoplasmic reticulum stress response (Doctoral dissertation). 2019. Harvard Medical School.

10. Shobeiri F, Araste FE, Ebrahimi R, Jenabi E, Nazari M. Effect of calcium on premenstrual syndrome: a double-blind randomized clinical trial. Obstet Gynecol Sci. 2017 Jan;60(1):100-105. doi: 10.5468/ogs.2017.60.1.100.

11. Clayton PT. B6-responsive disorders: a model of vitamin dependency. J Inherit  Metab Dis. 2006 Apr-Jun;29(2-3):317-326.

 
 
Womens Health, Hormonal balance, Female Health, Fatigue, Mental Health, Inflammation, SupplementKatherine MatthewsHormones, Endometriosis, PCOS, Fertility, Taurine, PMDDComment