Before I started putting together this month’s article, I did a quick google to see what the top 3 responses in google were if I typed in “PMDD is…”
Here are the answers that auto populated:
PMDD is…ruining my life
PMDD is… it real?
PMDD is…killing me
This felt to me like an internal monologue that you go through on a monthly basis with PMDD. Let’s get into this important condition. Today I want to explore what the condition is (basically, how it would be explained by a doctor), what kind of symptoms suggest PMDD and how to get it diagnosed. Then I want to explore what is happening in the body and what kind of sensitivities could worsen your symptoms. Then we will look at what kind of interventions can help with PMDD – what your doctor might suggest and then what sort of food, lifestyle and supplement suggestions could support you.
What is PMDD?
PMDD stands for premenstrual dysphoric disorder and it is explained as a mood disorder which includes emotional, cognitive and physical symptoms impacting someone during the luteal phase of their cycle (post ovulation up until their period starts, although some people comment that they start to feel better on Day 2 or 3 of their next cycle). Since 2013 it is officially classified as a mental health problem in the DSM-5, the official manual produced by the American Psychiatric Association that doctors use to diagnose mental health problems.
What are the Symptoms of PMDD?
The critical thing to remember about the symptoms is the timing of them – for PMDD, these appear during the luteal phase of the cycle (10 – 14 days before your period starts). If they are affecting your ability to work and maintain relationships, it is important that you seek support through your GP, counsellor or a trusted health professional who can sign post you.
Mood swings
Feeling upset or tearful, for example if you feel that others are rejecting you
Lack of energy
Less interest in activities you normally enjoy
Feeling hopeless
Feeling angry or irritable
Coming into conflict with people around you
Feeling anxious tense or on edge
Feeling overwhelmed or out of control
Difficulty concentrating
Suicidal feelings
Breast tenderness or swelling
Pain in your muscles and joints
Headaches
Feeling bloated
Changes in your appetite, such as overeating or having specific food cravings
Sleep problems
How do I get a PMDD diagnosis?
Getting a diagnosis can be difficult because it is a diagnosis of exclusion, meaning that your healthcare professional wants to rule out other conditions. There can also be rinstances of misdiagnoses with other mental health conditions. Speak to your GP about your concerns and be prepared that they might send you away to track your symptoms over 2 to 3 months before providing you with a referral or an intervention.
One of the most important things you can do is to keep a symptom diary alongside tracking your cycle. For someone with PMDD, the irony of this is that when your symptoms are at their worst, it becomes very difficult to maintain tasks like this. If you have a friend or family member who can help you to keep on top of your tracking by tracking alongside you or checking in with you everyday and keeping notes then that works for some people.
A GP is looking for a significant shift in your symptoms in the luteal phase of your cycle, this is the time after ovulation and before your period comes.
What is Going on Inside my Body?
There are a few theories as to what is contributing to the presence or PMDD. Some of them include:
Genetic Susceptibility – having PMDD or PMS in a family member can make you more susceptible. There is research that has identified particular genetic polymorphisms that are associated with the incidence of PMDD – namely Oestrogen receptor alpha, which infleunces how the body responds to oestrogen.(Huo et al 2007).
Progesterone and Allo-pregnenalone (a progesterone metabolite) – we know that symptoms happen post ovulation, so it is unsurprising that progesterone is a significant factor. However, it is more about the breakdown pathway being favoured by the body, those that tend to break their progesterone down the alpha pathway, to allopregnenalone, and have a predisposition to PMDD will be impacting their GABA receptors. We normally expect GABA to be a calming neurotrasnmitter, but allopregnenalone impacting GABA receptors in those with PMDD can have the opposite effect being very over stimulating and impacting mood and anxiety.
Serotonin fluctuations during your cycle
Although it is normal for serotonin levels to fluctuate, with higher levels in the follicular phase (period to ovulation) and lower levels in the luteal phase (ovulation to just before period) linked to fluctuating oestrogen levels. In PMDD, we sometimes see lower levels of serotonin generally or altered activity, which impacts the symptoms in the luteal phase.
Brain differences
Brain imaging of those with PMDD do show differences from healthy controls, especially in areas linked with emotional regulation. Both differences in volume and changes in activity levels have been seen in certain areas associated with emotional regulation.
HPA Axis Activity
The hypothalamic, pituitary and adrenal axis is responsible for the connection between the brain and our response to stress. In PMDD we see an altered HPA response with less adaptability and ability to regulate the HPA response.
Histamine + PMDD
It is not coincidence that symptoms flare up around the time that our oestrogen peaks in our cycle – mid cycle and then again 7 days before your period. Unopposed oestrogen (in those who are not producing less progesterone) prompts the mast cells (part of our immune system) to release more histamine. Histamine is linked to both physical and emotional symptoms in PMDD, including anxiety, irritability, depression, headaches and bloating.
What are the Medical Treatments Available?
One of the first line medical interventions is to impact the serotonin levels through the use of SSRIs (Selective serotonin reuptake inhibitors), a class of antidepressants. For some these are recommended throughout the cycle and in others they are recommended in the luteal phase, when symptoms are exhibiting.
Another medical intervention is the use of hormonal birth control to prevent hormonal fluctuations throughout the cycle by blocking ovulation.
What Kind of Food + Lifestyle Adjustments can I make to Manage PMDD?
Lifestyle:
1. The most critical thing is to give yourself a lot of self-compassion. We tend to be incredibly critical of ourselves and this health condition has an impact on our loved ones as well as us. There are physiological things happening in your body that are driving your symptoms, yes there are things you can do to support yourself but give yourself a break for not knowing this in the past.
2. If you don’t already, track your cycle. Once you have an idea of when the mood changes and other symptoms are happening, you can support yourself better. More attention and awareness is really important.
3. Identify your support system – who is in your circle of trust and who can help you out when things feel really challenging? Make sure that your loved ones know what is going on and also let them know when you need their support. This is often something we need to decide during the weeks we’re feeling calmer. It might be helpful to craft some draft texts ahead of time so you don’t need to stress about wording or asking for help when things feel tough.
Maintaining Balance through Food:
1. Having balanced meals – protein + healthy fat + complex carbs is a way to manage your blood sugar as much as possible. Avoid long gaps between meals. Having some balanced snacks ready to go. We want to avoid triggering big dips in our blood glucose as these can set off a stress response in the body and impact symptoms of anxiety.
2. Be mindful of food and drinks that can spike your blood sugar, sugary sodas, pure fruit juice, sweets, cakes and parties – try and limit these and make sure that when you are having them, you are eating these as part of a meal to mitigate the impact on your blood glucose
3. You can influence the alpha/beta pathway that can cause the breakdown of progesterone to more stimulating allo-pregnenalone. Reishi mushroom, nettle root, Omega 3 fats and EGCG from green tea can all support this pathway.
4. Some people find that foods that are high in histamine can worsen symptoms in the luteal phase – working on gut health longer term can help to reduce the impact of histamine, in the meantime consider that strawberries, spinach, tomato, avocado and aubergine can all impact histamine significantly. So a strawberry + spinach smoothie and tomato + aubergine dish on the same say are a bit of a histamine grenade for the body. You can also incorporate more quercetin rich foods that help to support histamine breakdown (capers, red onions and apples are all good sources)
Supplements Might be Helpful:
1. I would always start by making sure you are supporting through food and lifestyle as much as possible. Then our wonder mineral magnesium, which supports energy production, glucose metabolism, sleep and many other processes is a great option. Secondly I would opt for an Omega 3 (make sure it has been third party tested for purity) – this is a good option to support brain health and there is evidence to show it has a positive impact in numerous mental health conditions (depression, anxiety, OCD).
2. There are more targeted supplements that can support PMDD but it is helpful to first identify what your body most needs support with. You could opt for adaptogen support for the HPA axis and stress response. You might find that providing support for steady progesterone production through Agnus Castus (Vitex) can help if your symptoms worsen with dropping levels. If histamine is a big driver and you see some relief managing histamine load through food, there are supplements available that support histamine breakdown (I would also dig into gut health if this is a big symptom for you).
That Was a Lot – What are The Key Takeaways?
It is always worth getting an official PMDD diagnosis, both for validation and to be able to work out the best next steps for you. Prepare yourself with your cycle and symptom tracking information.
There are a lot of possible drivers and managing your gut health and stress response can be really good ways to manage your symptoms.
There are both food changes and supplements that could help to provide symptom relief.
It is really hard to do all these things alone, speak to your loved ones about their support and you can always reach out to a BANT registered nutritional therapist if you feel you need more support