Understanding PMDD/PMS and a Natural Approach to Healing
- Brittany Hancock
- Oct 16, 2024
- 7 min read
Updated: Dec 28, 2024
What is PMS?
PMS (premenstrual syndrome) relates to a group of symptoms that occur during your luteal phase (after ovulation) just before your menstrual cycle commences. So PMS can really occur any time between day 16-28 of your cycle depending on how long your cycle (28 days is a typical cycle). It occurs because the hormones change resulting in impacting your daily life and sometimes it can be very disruptive.
Some PMDD symptoms include:
Spotting, short luteal phase (time after ovulation till period)
Breast tenderness, fluid retention
Cravings
Feels of weight gain
Anxiety, depression, mood swings & irritability
Low libido
What is PMDD?
Some unfortunate women, however, experience PMDD (Premenstrual Dysphoric Disorder), which is a more severe form of PMS. Yes, some of the symptoms overlap however, PMDD can be debilitating and result in severe mood swings / depression. Around about 3-8% of women experience PMDD these days and that number is increasing! Tory Eisenlohr-Moul has said females are twice as likely to be diagnosed with depression than men!
Women often note it impacts their work, daily activities and personal relationships as well. We have all seen the Instagram reels and tik tok talking about how scary women are in their luteal phase – well likely some of these women will have PMDD.
There are no tests for PMDD, so diagnosis is determined by the pattern of symptoms by a practitioner. We usually look at the symptoms over three cycles and a great way to track that is via a menstrual symptoms diary – if you reach out I can provide you one of these. PMDD is diagnosed based on symptom patterns over several cycles.
What sets PMDD apart from depression, is that the symptoms both mental and physical subside improve once your period begins.
Symptoms of PMDD:
Feelings of hopelessness
Sadness
Depression
Irritability
Anxiety
Low energy / overly tired
Changes in appetite, including overeating or cravings
Breast tenderness
Bloating
Headaches
Joint or muscle pain
Sleep disruption
What causes PMDD?
During that later part of the cycle (your luteal phase) your hormones levels change drastically, see the graph below. In particular it is estrogen and progesterone that drop. This decline in hormones is when the body realises it is not pregnant and therefore, doesn’t need the progesterone to sustain a pregnancy so falls dramatically leading to the shedding of your uterine lining, which is your period.
These hormones are so very delicate and can be easily influenced by lifestyle and environmental factors. Which is a good and a bad thing! Since you can have an active role in regulating your hormones but also having a ‘bad health week’ can massively impact your cycle.
Your stress levels in particular have a large effect as well as toxins, BPAs, sugar and your liver health. All of these factors contribute to your hormonal health. In fact, it is known as a vital sign of women’s health and is your health score card as such for the month.
Ok so what actually causes, PMDD? Well, many believe that PMS and PMDD are caused by hormonal imbalance which can be true to an extent if your hormones are not balanced, but it is more about HOW the brain responds to hormonal fluctuations. Tory Eisenlohr-Moul stated in her research that there is an “abnormal sensitivity to normal ovarian steroid changes (i.e., hormone sensitivity)”. This is where neurotransmitters come into play, e.g. serotonin and GABA. Both of these are key to mood regulation. Therefore, the goal is to stabilise the GABA receptors, in particular, to establish progesterone resilience.
Now we want to establish this progesterone resilience because progesterone can be very good for the brain and the mood. This is because it converts allopregnanolone, which calms GABA receptors.
But the good news is we can help! We can influence the body and you don’t have to live like this forever. We need to look at all these factors, from hormones, to neurotransmitters to your lifestyle.
The key role inflammation plays in this cycle
If your body is inflamed from any other conditions, e.g. endometriosis, PCOS, insulin resistance, Type 2 diabetes etc then these can also heighten PMDD symptoms. Addressing these other issues / symptoms can also help in the PMDD recovery. Also, any nutrient deficiencies leaves the body struggling to function, especially nutrients like B6, vitamin D, calcium and magnesium. All of which are depleted by high stress.
There is little research on PMS and PMDD which is shocking considering how debilitating it can be for women. Even the conventional treatments being the Oral Contraceptive Pill and SSRIs (Anti-depressants) are not well researched to impact PMS and PMDD.
Early childhood trauma and PMDD?
There has been researching showing that 83% of women who have been diagnosed with PMDD have reported being exposed to an early childhood trauma.
I'm on the Pill – what does this mean?
The Pill usually contains progestins not progesterone and this is a very important distinction. Progesterone can be very good for mood, however, progestins have been shown to have negative effects on mood. This is because progestin does not convert to allopregnanolone (that we talked about before, helps calm GABA receptors), only progesterone converts to allopregnanolone. The pills that contain progestins NOT progesterone include levonorgestrel, drospirenone and norethisterone. All of these have been linked to depression and anxiety. This is not PMS or PMDD, this is a medication side effect and should be addressed with your doctor.
Natural remedies for PMDD
Firstly, as mentioned taking a holistic approach and looking for where your lifestyle and food choices are impacting your digestion, hormones and liver. However, there are a few specific remedies for PMDD that help with symptom control and ill walk you through these now:
Addressing histamine and mast cell activation
Histamine is an immune-signaling amine that causes allergies and swelling, it also plays a role in ovulation, libido and neurotransmitters. It is highest in your luteal phase of your menstrual cycle, which is why if not balanced can have an effect on anxiety and sleep (presenting as PMS/PMDD). You can look into natural antihistamine remedies including quercetin, SAMe, reducing alcohol, high histamine foods and dairy (specially casein). There was a 16-week double blind randomised control study completed by Deaking University called the ‘MOO’d study’ showed that casein is very inflammatory to women and can cause mental disturbances.
Vitamin B6
Vitamin B6 is required for hormonal balance as well as for production of neurotransmitters, serotonin and GABA, both of which help stabilise mood. B6 also helps with the clearance of estrogen and histamine.
Vitex
Vitex which supports progesterone and has been seen to provide some soothing effects to PMDD. It also helps reduce high levels of prolactin.
REMEMBER that high quality supplements and the right therapeutic dosage will get to the results you would like. So make sure you are taking a good supplement / herbal remedy that is of quality and for at least 3 months (Best used under the guidance of a naturopath).
Calcium
Calcium is involved in the release of serotonin and dopamine which can cause some neuro dysfunction if you have a deficiency in calcium. Estrogen is also involved in the calcium uptake which is why estrogen falls in the luteal phase these effects can be magnified. Calcium levels can be impacted by vitamin D or lack there of, therefore, it is important to check your vitamins D levels as well.
Reduce inflammation
Chronic inflammation interferes with the body functioning properly on many levels. But in particular in the hormonal cycle, it can interfere with ovulation and can reduce progesterone. As mentioned before we want to optimise progesterone as it positively affects mood so the less inflammation we have the better! Look at anti-inflammatory foods/diet and also herbs such as turmeric.
Magnesium
Magnesium is involved in the production of neurotransmitters such as serotonin and is also depleted in high levels of stress. Therefore, this could be handy in brining calmness to the body, increasing the happy hormones and repleting the body of vital nutrients.
My naturopathic approach to PMDD
At my naturopathic clinic, I look at the full holistic picture of your life and your symptoms to understand your root cause for PMDD. PMDD and PMS is bio individual and requires an individualised response.
Studies have shown than herbal medicine and acupuncture have been effective in reducing PMS/PMDD symptoms by 50%. Would you like to reduce your symptoms by 50%? Feel free to book a FREE 15 minutes consultant below and we can see how we help you out and find the right approach for you.
Sources:
Jang, S. H., Kim, D. I., & Choi, M. S. (2014). Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review. BMC complementary and alternative medicine, 14, 11. https://doi.org/10.1186/1472-6882-14-11
Cerqueira, R. O., Frey, B. N., Leclerc, E., & Brietzke, E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives of women's mental health, 20(6), 713–719. https://doi.org/10.1007/s00737-017-0791-0
Shobeiri, F., Araste, F. E., Ebrahimi, R., Jenabi, E., & Nazari, M. (2017). Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. Obstetrics & gynecology science, 60(1), 100–105. https://doi.org/10.5468/ogs.2017.60.1.100
Joffe, H., de Wit, A., Coborn, J., Crawford, S., Freeman, M., Wiley, A., Athappilly, G., Kim, S., Sullivan, K. A., Cohen, L. S., & Hall, J. E. (2020). Impact of Estradiol Variability and Progesterone on Mood in Perimenopausal Women With Depressive Symptoms. The Journal of clinical endocrinology and metabolism, 105(3), e642–e650. https://doi.org/10.1210/clinem/dgz181
Eisenlohr-Moul T. Premenstrual Disorders: A Primer and Research Agenda for Psychologists. Clin Psychol. 2019 Winter;72(1):5-17. PMID: 32362679; PMCID: PMC7193982.
Kulkarni J, et al. The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD). Psychiatry Res. 2022 Feb;308:114381
Arab A, et al. Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature. Int J Prev Med. 2020 Sep 22;11:156
Rapkin AJ, Lewis EI. Treatment of Premenstrual Dysphoric Disorder. Women’s Health. 2013;9(6):537-556. doi:10.2217/WHE.13.62
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