Pre Menstrual Dysphoric Disorder (PMDD) - Natural Solutions

Many women feel "off" a week or so before they get their periods. You may get depressed, cry often, feel angry, have tender breasts, feel sleepy, have less energy, experience acne breakouts and feel heavy or bloated. This means you are most likely suffering from PMS. If your symptoms are extreme and are affecting your quality of life, the way your interact and react with those close to you, you maybe suffering from a more severe form called Pre-menstrual Dysphoric Disorder. (PMDD).

PMS vs PMDD

It has been estimated that 75% of women will suffer from mild PMS whereas PMDD is much less common, affecting 3-8% of women. There are a lot of crossover symptoms in both PMDD and PMS. These symptoms usually begin seven to 10 days before your period starts and continue for the first few days of your period.

Common Symptoms of both:

• Breast tenderness

• Bloating

• Fatigue

• Changing sleep patterns

• Food cravings

• Headaches

• Mood changes

In PMDD you may experience or or more of these more severe symptoms:

• Sadness or hopelessness

• Anxiety or tension

• Extreme moodiness

• Marked irritability or anger

The cause of PMDD isn't clear. Underlying depression and anxiety are common in both PMS and PMDD, so it's possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.

There is no offical diagnoses of either PMS or PMDD but a good doctor, specialist, Naturopath or Medical herbalist can help by listening to you, and use treatments directed at minimising your symptoms.

One of the most common factors in PMDD is low progesterone. Progesterone converts into a neurosteroid called allopregnanolone, which calms GABA receptors. GABA is a neurotransmitter that blocks impulses between nerve cells in the brain and therefore is known for producing a calming effect. It’s thought to play a major role in controlling nerve cell hyperactivity associated with anxiety, stress and fear. Low levels of GABA may be linked to anxiety or mood disorder, chronic pain and epilepsy.

For women with PMDD, allopregnanolone does not calm GABA receptors but instead can produce anxiety and other negative mood symptoms. Research has shown that women with PMDD have an abnormal response to allopregnanolone because of a problem with GABA receptors on the cells.

Treatments

The conventional treatment for PMDD is

• SSRI antidepressants to modulate GABA receptors, and/or

• hormonal birth control to shut down ovulation and progesterone.

The problem with this approach is that:

• SSRI antidepressants may increase the risk of osteoporosis.

• Contraceptive progestin drugs carry their own set of mood side effects.

• Women need ovulation and progesterone for long-term health. According to Professor Jerilynn Prior, “regular menstrual cycles with consistently normal ovulation [and progesterone]…will prevent osteoporosis, breast cancer and heart disease.” (1)

Natural Treatment of PMDD

• Magnesium, relieves PMS and PMDD by enhancing the action of progesterone on the central nervous system. Magnesium biglycinate is the best form as their are two amino acid, gylcine, molecules attached to to help calm the GABA receptors. This helps supports a healthy GABA response and relieves PMS by “normalizing the action of progesterone on the central nervous system.” The best form is magnesium glycinate or bisglycinate because the amino acid glycine also calms GABA receptors.

• Vitamin B6, has had one clinical trial (2) showing positive results in PMDD by lowering prolactin, boosting GABA, and helping with histamine clearance.

• Low Histamine Diet, Histamine is a well known driver of PMDD symptoms and chronic inflammation. Histamine intolerance and overload are both linked to hormone imbalance so by eating a low histamine diet you may help normalise the sensitivity of GABA receptors. You can read more about the histamine and hormone link here

I like to give my clients a powder based magnesium, taurine and activated B formula all in one. This helps limit the supplements needed. Along with a low histamine Diet and in some cases, an antihistamine can be used in the short-term.

References

(1) The Hormone Repair Manual - Lara Briden

(2) https://pubmed.ncbi.nlm.nih.gov/31928364/