Premenstrual dysphoric disorder (PMDD) is challenging. It’s challenging for women, their families, and it has been challenging to navigate in medicine. PMDD affects about 3-8% of the female menstruating population, and causes significant impairment of daily function. 

PMDD was once thought to be just a more severe version of PMS (premenstrual syndrome), however now PMDD has criteria that distinguish it as unique and as is “true” diagnosis. Beyond receiving a PMDD diagnosis, there are MANY challenges women with PMDD face, such as the following 11 symptoms: 

  1. Significantly depressed mood, hopelessness, self-defeating thoughts
  2. Significant anxiety, tension, irritability, “uptight”
  3. Sudden mood changes of sadness, or easily feeling rejected
  4. Anger, irritability or increased conflict with others
  5. Lack of motivation for usual activities
  6. Difficulty concentrating
  7. Lethargy, easily fatigued, low energy
  8. Changes in appetite, food cravings, overeating
  9. Hypersomnia, insomnia
  10. Overwhelmed, feeling out of control
  11. Additional physical symptoms: breast tenderness, swelling, headaches, joint or muscle pain, bloating, weight gain (1). 

These symptoms will often present in the second half of the cycle, or in the days leading up to the menstrual cycle, and can be so debilitating for women that they cannot continue to function in their work. Home and close relationships usually suffer. Depression, anger and anxiety predominate, however many women feel self-defeat, despair, and hopelessness. Truly this is a debilitating disorder. Not only that, but women with PMDD have greater than a 50% lifetime likelihood of developing another mental health disorder, such as clinical depression.  It might seem obvious, but PMDD only occurs in ovulating women, who are premenopausal. Many of these women are hoping to conceive in the future. Unfortunately, many of the pharmaceutical or surgical therapies used to manage PMDD will not promote fertility, or may be contraindicated for fertile women. 

It is unclear why PMDD occurs in some women, however it appears to be connected to the large fluctations in sex hormones: estradiol, and progesterone, as well as related to serotonin dysregulation.  Common PMDD prescriptions reflect these connections, as most women are offered:

  • Hormonal birth control pills/injections
    • Shuts down ovarian production of hormones, inducing false cycles or inducing amenorrhea to prevent natural hormonal fluctuations
    • Causes many side effects including nutrient deficiencies, loss of libido, weight gain, mood imbalances
  • Antidepressant medications 
    • Selective serotonin re-uptake inhibitors chemically control the levels of serotonin in the brain chemistry to induce an artificial stability and “control”. 
    • Causes many side effects such as weight gain, worsening of symptoms, fatigue, drowsiness, sleep changes, loss of libido. 
  • Full hysterectomy including removal of the ovaries. 
    • This just seems ridiculous, and is definitely a last resort for some. However risks include infertility, inducing menopause in pre-menopausal women, increased risks of developing osteoporosis and cardiovascular related events such as strokes and heart attacks, as well as the usual complications and risks associated with any major surgery. 

What can you do now, to support yourself?

  1. Exercise: especially during your luteal phase or before menses. Exercise releases endorphins naturally, and it’s possible that these are lacking in your luteal phase.
  2. Symptom diary: tracking your periods, symptoms, and the onset of severe symptoms helps your health care practitioner to rule out the possibility that your symptoms are PMS with concomitant clinical depression, or generalized anxiety.
  3. Dietary changes: Reduce alcohol, simple sugars, refined carbohydrates, salt, red meat, and caffeine. Increase intake of fruits and vegetables, plant oils such as olive oil, grape seed oil, coconut oil. Increase intake of nuts, seeds and legumes. Increase intake of fish and flaxseed oil. 

Seek Health Care Practitioner Advice and Support for the following: 

  1. Cognitive Behavioural Therapy: a psychotherapeutic technique that promotes stress management, and ways to assess behaviour and coping mechanisms. 
  2. Calcium: the recommended daily intake of calcium is about 1000mg, and research has shown 1000mg-1200mg per day to beneficial for PMS. 
  3. Herbal therapy: dandelion, dong quai, black cohosh, st. johns wort, and wild yam have evidence and traditional uses for varying aspects of PMS support. Use caution with all herbs. Do not self-prescribe these! 
  4. GLA: from borage oil, or evening primrose oil has been shown to be beneficial for PMS. 
  5. B vitamins: B6 specifically has been studied, with positive results, for it’s benefits for PMS symptom improvement.

PMDD is a condition that effects reproductive aged women. Receiving a diagnosis requires thorough investigation of symptoms, their timing and duration, as well as ruling out other factors. Prescription therapies, and surgeries, while effective for some, can cause unwanted side effects, or a not an option for women who are wanting to conceive. Natural therapies can be effective in the management of PMDD. It is always best to speak to a registered health professional before starting any new vitamins, herbs or supplements, especially because not all options are safe.

NOTE: It is VERY important to note that these recommendations may not be useful or safe for everyone, especially if you are taking medications. You should always consult a medical or naturopathic doctor before initiating any new supplements or vitamins. Remember that “natural” does not always mean safe.