Is it PMDD just PMS?
Confused as to what the hell is causing your mood swings, depression and anxiety to spiral, insomnia, headaches, bloating, food cravings and more. It may be PMDD.
PMDD stands for Premenstrual Dysphoric Disorder, which is a severe form of premenstrual syndrome (PMS) that affects some women during the luteal phase of their menstrual cycle (this is the time between ovulation and your period). Within 1-2 days of menstruation, it can be like a switch, with little to no symptoms until after ovulation in the next cycle.
What is the difference between PMDD and PMS?
PMDD
· Lasts for 1-2 weeks
· Symptoms more severe, affecting daily life, work and relationships
· Anger, irritability and hostile behaviour are key symptoms
PMS
· Lasts 2-7 days before period is due
· Symptoms less severe, still interfering with daily life, but can generally still function
PMMD is a recognised mental health condition, for a diagnosis a woman or AFAB should have in the majority of their menstrual cycle:
- at least 5 of the following symptoms
- in the final week before the onset of their period.
- start to improve within a few days after the onset of their period, and become minimal or absent in the week after their period.
Symptoms (must include one of the below)
- Mood swings
- Sad, tearful, increased sensitivity to rejection
- Suicidal thoughts
- Anger, very irritable, hostile behaviour
- Markedly depressed mood, feelings of hopelessness, self- depreciating thoughts
- Anxiety, tension, feeling on edge
Along with at least 4 of the below symptoms
- Poor concentration
- Decreased interest in usual activities
- Fatigue
- Change in appetite, over eating, food cravings
- Insomnia or need for increased sleep
- Overwhelm, feeling out of control
- Breast tenderness (I hate this term as be excruciating for some women)
- Bloating
- Joint or muscle pain
- Weight gain
Ok, so I have the above symptoms, what the hell is going on with my body?
In the time after ovulation, the hormone progesterone begins to hit its peak levels within a menstrual cycle. Normally, progesterone can be great for mood and very calming as it converts to a neurosteroid called allopregnanolone which then acts on GABA receptors. GABA is a neurotransmitter which has an inhibitory effect on the body, meaning it calms some nerve cells and functions of the body leading to a calming affect which is anti-anxiety, lowering of stress and supportive of sleep.
Now in PMDD sufferers this function of allopregnanolone, affecting GABA receptors is not functioning as it should. So instead of getting the benefits of increasing progesterone and GABA, women are left feeling more anxious and/or angry, irritable and with insomnia.
Other factors that I have seen play into PMDD, is elevated oestrogen and its connection with high histamine, which also has a stimulatory effect on the brain. HPA- axis dysregulation aka adrenal issues from chronic stress, zinc and copper imbalances are some of other things I will investigate with my patients suffering with PMDD.
Key Assessments and Treatment
When investigating PMDD, I like to see general health markers, thyroid, and standard nutrient assessment of iron, B12, folate, calcium, magnesium and vitamin D. It is also important to assess hormones on cycle day 2 or 3 as well as oestradiol and progesterone 7 days post ovulation for that person (ie this is not always cycle day 21). Other more functional assessments include:
- Cortisol and DHEA-s
- Plasma Zinc and serum copper
- Whole blood histamine
- Urinary iodine
Treatment strategies will generally include:
- Magnesium and Zinc (dose dependant on blood levels) as they are key for supporting GABA as well as supporting hormone balance
- Taurine for adrenal support if needed as well as having a calming effect on the brain
- Glycine is also a key amino acid to support GABA
- Saffron is a key herb here with a 2020 study showing it be as useful for treating PMDD as the antidepressant fluoxetine, but with minimal side effects, compared to the antidepressant.
Along with these, I am always working with a patient’s diet and lifestyle, making adjustments for them specifically be it they need a low histamine diet, more support for oestrogen clearance and lifestyle strategies to promote sleep and lower stress.
Know someone that would find this post helpful? I would love you to share so women don’t need to suffer with this cyclical condition.
If you suspect you have or would like support to heal from PMDD I would love to help support you. I also see people for support with other mental health and hormonal conditions, fertility and preconception care.
Appointments are available worldwide through Zoom or in- person in Margaret River, Western Australia
Click here to book, I also offer free 10min discovery sessions to see if I am the right practitioner for you.