PMDD: Premenstrual Dysphoric Disorder

A Natural Treatment Approach

Up to 80% of us women are familiar with PMS (Premenstrual Syndrome). Those physical and emotional symptoms that show up within the week before our period that we always joke about being so "surprised" by. Every month we feel like a different person, we don't know why we're craving so much ice cream or salt, we don't know why we're so moody, we don't know why our anxiety or depression is so bad... and then our period starts, and suddenly we're okay again. 🤦🏼‍♀️

Why. Are We So Surprised. Every. Single. Month???

We can be sure those symptoms will fade with some much-needed hormone rebalancing and optimization, because we feel significantly better when we address our

• blood sugar

• sleep

• gut health (especially its impact on serotonin production)

• liver health (especially clearing xeno/estrogens)

• thyroid

• micronutrients

• inflammation

• HPO (hypothalamus-pituitary-ovarian) axis

• HPA (hypothalamus-pituitary-adrenal) axis
  

Then about 3% - 8% of us women suffer from a much more severe version of PMS called Premenstrual Dysphoric Disorder (PMDD). For those of us in this category, symptoms are so disruptive on a daily basis that it interfere's with our lifestyle, our sense of stability, sense of Self, and our relationships.

Diagnosis can be found in the DSM 5th ed., and is based on timing, symptoms, impact on daily life, exclusion of another mental health disorder, medical condition, or substance use, and must occur for at least two cycles.

Timing

It begins around the same time as PMS, in the second half of the luteal phase (progesterone) phase. This is usually 7-10 days before menstruation starts and it can last into the 4th day of our flow -- the follicular (estrogen) phase. Once our blood flow stops, the symptoms cease as well. This time frame usually exceeds the milder version of PMS.

Symptoms

Diagnosis must include a total of 5 symptoms, 1 of which must be from among the first four listed.

Psychological/Emotional symptoms can include

• mood swings

• irritability or anger

• sadness/despair/hopelessness/depression, even including suicidality

• anxiety

• panic attacks

• crying

• increased interpersonal conflicts

• lack of interest in or attention to activities and relationships

• persistent fatigue

• difficulty focusing or thinking

• feeling out of control

Somatic symptoms can include

• breast tenderness

• bloating

• headache

• joint or muscle pain

• food cravings

• overeating / binge eating

• weight gain

• insomnia

• hypersomnia
  

Key Neurotransmitters on our Brain Chemistry

The abnormal response of our physiology to our monthly hormonal shifts of estrogen and progesterone during our luteal phase have been seen to have significant effects on our brain chemistry. Specifically, serotonin and GABA are two important neurotransmitters impacting our mental health and mind-body connection. This is why we commonly see SSRI prescriptions such as fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and venlafaxine used to combat the mood symptoms.

But these neurotransmitters do more than affect our mood -- they affect our digestion, sleep, focus, motor control, platelet aggregation (blood clotting), and more. So when we aren't getting the appropriate amounts, we see an increase in symptoms.

Naturopathic Solutions

There are many effective, natural ways to support the body back into a state of homeostasis and vitality. Your starting point all depends on your level of capacity, so be easy with yourself on how much you feel you can do. If you try to start treating yourself during a PMDD phase, you might find it difficult to do much. You might find it easier to start in-between your PMDD cycles, but I encourage you to start where you're at now.

Ideally you would be working with an integrative/functional/naturopathic/holistic doctor to run labs and help guide you, but there are things you can do at home until then. These are in no particular order.

Culinary Medicine

• Plan to eat 3 meals a day. Do not worry about whether you are hungry. Just commit to eating 3 meals a day.

  • Breakfast: Within 1 hour of waking

  • Lunch: 4 hours later

  • Dinner: 2 hours away from bed

• Notice how you feel after you eat. Pay attention specifically to your mood, your gut, and your energy. If you're someone who likes to track things, start a food journal -- either by hand with all your favorite colored pens/pencils/etc, or on your phone, your laptop, whatever -- with a column entitled "How I felt afterward". Be consistent with tracking everything you eat and drink, every day, for up to 1 month. I have my own form I provide my patients, but you can make yours. Getting good at predicting how you will feel after you eat something will help you gain much more control and knowledge over what is exacerbating, neutral to, or helpful in relieving your symptoms. Are you eating enough? Too much? How does that particular food feel? You want to eat to feel satisfied -- not hungry, not full, not bloated, not tired, and definitely not worse mood-wise.

• Be intentional with high-quality proteins: grassfed, organic, and wild. I am really enjoying the quality and cost of Wild Pastures right now, so they are my first recommendation (no affiliation). If you are a meat eater the impact of pasture-raised, regenerative farming methods have a distinct impact on your hormone health, in a big way.

• Be vigilant avoiding inflammatory vegetable oils at all costs. These are in most (if not all) restaurants and fast food chains.

• Be intentional about healthy fats on a daily basis. My favorites include

  • Raw Milk

  • Avocado

  • Ghee or Grassfed Butter

  • Please (please, please) do not cook with any oil other than Avocado oil or Grapeseed oil. Graza makes a high-heat olive oil that is acceptable, but they are the exception.

  • Cold, high-quality Olive Oil shooters!

    • 2 tablespoons + honey + lemon.

• Lastly, fiber. Whether fruits or vegetables, eat your fiber. And if you do this, complex carbohydrates will take care of themselves. I promise. No micromanaging these. Just focus on the quality proteins, fats, and fiber, and your carbs will fall in line. We aren't eliminating them, just allowing them to naturally take their appropriate amount in line.

If you follow these guidelines, you will be managing your blood sugar, insulin, cortisol, and your migrating motor complex - the movement of your intestines that ensures you poop! This also helps estrogen metabolism, serotonin production, and toxin elimination.

Movement

The most valuable way to approach this is engaging in literally anything you feel like doing.

• walking slowly to the mailbox

• walking to that tree and sitting under it to get some fresh air and sunlight. maybe you do a plank, maybe you don't. maybe you stretch, maybe you don't.

• sitting on the edge of a pool with your legs hanging down and moving them back and forth in the water

• using your organic wine bottles as weights for your arms while you watch TV

• pretend boxing

• weed your yard

• clean something in your house

• wash your bath so you can take one

• bake something

• cook something

• if you can muster up going to the gym -- wow.

• it literally doesn't matter. but if you move, your mood will benefit, even if only a little. some is better than none.

Alcohol

Decide that alcohol is a no-go for now. It will just make everything much worse.

Talk Therapy

• If you don't already have one, start scheduling free consultations with different therapists. Having someone in your corner to provide support, an objective perspective, and guidance toward developing a healthier relationship with ourselves can be a game changer in the mind-body bi-directional impact on our health.

• Psychology Today

• Find an Analyst

• My preference and bias is for Jungian Analysts, but find someone you click with.

Targeted Nutrient Considerations

This approach is not getting to the root of the problem, but it can help modulate the severity of symptoms as you work towards addressing your underlying susceptibility. Supplements will never be the final solution.

Talk to your doctor for dosing recommendations.

• Magnesium deficiency is common in most people due to its high demand in the body, not least of all because of stress and its impact on the nervous system. There are many different types of magnesium, but magnesium glycinate is known to be particularly helpful for anxiety and nervous system regulation. Magnesium malate can help with energy, magnesium l-threonate helps with memory and cognition, and magnesium citrate can help with stubborn constipation.

• Vitamin B6 supports magnesium absorption as well as serotonin and GABA production.

• Saffron (Crocus sativus L.): a beautiful spice with an antidepressant effect through a serotonergic mechanism. "In particular, a number of clinical trials demonstrated that saffron and its active constituents possess antidepressant properties similar to those of current antidepressant medications such as fluoxetine, imipramine and citalopram, but with fewer reported side effects." - Hausenblas, et al. (2018)

Homeopathy

I saved the best for last. Homeopathic remedies are the only form of medicine that can treat the whole person at once. When your case is taken by a trained homeopath and licensed doctor you are evaluated based on your whole medical history, specific expression of symptoms in great detail, and treated for the culmination of mental, emotional, and physical symptoms. No other medicine can do all of this at the same time, greatly reducing (mostly eliminating) the need for supplements, and does not require lifelong use.

Homeopathy is an energetic, natural medicine that stimulates your biochemistry and the body's wisdom to self-correct. It works on the quantum level of healing, increases capacity, is safe, effective, and cost-efficient. Homeopathy is made in a lab from single natural substances which cannot be patented, are potentized into different levels of strength, and requires an experienced clinician to manage progress and response.

As a licensed naturopathic doctor this is my main treatment modality for hormones, chronic illness, anxiety and depression, and the medicine I most recommend for treating PMS and PMDD. I hope you will consider this as a possible adjunct to your healing journey!

Homeopathy

Depth Medicine

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing, pp. 171-176.
   

2. Goroll, A. H., & Mulley, A. G. (2014). Primary Care Medicine: Office Evaluation and Management of the Adult Patient (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
   

3. Guzel, T., & Mirowska-Guzel, D. (2022). The role of serotonin neurotransmission in gastrointestinal tract and pharmacotherapy. Molecules, 27(5), 1680. https://doi.org/10.3390/molecules27051680
   

4. Hausenblas, H. A., Saha, D., Dubyak, P. J., Anton, S. D. (2018). Saffron in the treatment of depression, anxiety, and other mental disorders: Current evidence and potential mechanisms of action. Journal of Affective Disorders, 227, 330-337. https://doi.org/10.1016/j.jad.2017.11.020
   

5. Noah, L., Dye, L., Bois De Fer, B., Mazur, A., Pickering, G., & Pouteau, E. (2021). Effect of magnesium and vitamin B6 supplementation on mental health and quality of life in stressed healthy adults: Post-hoc analysis of a randomised controlled trial. Stress and Health, 37(5), 1000-1009. https://doi.org/10.1002/smi.3051
   

6. Pizzorno, J. E., Murray, M. T., & Joiner-Bey, H. (2016). The Clinician's Handbook of Natural Medicine (3rd ed.). St. Louis, MO: Elsevier, pp. 830-842