woman struggling with PMDD

Pre Menstrual Dysphoric Disorder (PMDD) is a severe mood disorder. It occurs cyclically, beginning post-ovulation and peaking during the luteal phase of the menstrual cycle. Many view PMDD as a heightened version of PMS, but it is quite severe. PMDD’s defining symptoms include functional impairment, irritability, overwhelm, and depressed mood. Some individuals also experience anxiety, severe depression, and suicidal tendencies.

The average woman experiences around 450 menstrual cycles in her lifetime. For a woman with PMDD, this can mean up to 6 months yearly or over 8 years of cumulative symptoms.

Exploring the Cause

Research shows that ovarian hormone levels are no different in women with PMDD compared to those without it. The increased sensitivity to hormonal fluctuations causes PMDD. Experts estimate that PMDD affects 3-5% of women. The pathogenesis is attributed to an oversensitivity of GABA receptors and a reduced concentration of allopregnanolone (ALLO), a metabolite of progesterone.

Women with PMDD often experience increased stress sensitivity during their luteal phase. This suggests alterations in the stress response and the hypothalamic-pituitary-adrenal axis.

Understanding Steroid Hormones in PMDD

To understand the complex interactions of steroid hormones in PMDD, we need to cover progesterone and its metabolite ALLO.

Progesterone’s Role in PMDD

Progesterone is one of our two major female hormones. It is secreted by the corpus luteum and rises throughout the luteal phase. It drops significantly at the onset of menstruation. Its fluctuating levels are mirrored by its metabolite ALLO, which serves to modulate GABA, one of our inhibitory (calming) neurotransmitters. ALLO overall results in anti-anxiety, anesthetic, and sedative properties similar to the effects of drugs such as Valium. Therefore, fluctuations in ALLO levels are believed to be the key trigger for PMDD.

Other Root Causes of PMDD

Certain genetic polymorphisms, such as alterations in the 5-HTIA receptor which binds serotonin, have been implicated in PMDD. There is also a high correlation between Autism and PMDD, with relevant clinical evidence to support this claim.

Evidence suggests that women with PMDD have alterations in cortisol levels and the hypothalamic-pituitary-adrenal axis, often due to chronic stress and trauma. These alterations are associated with increased inflammation, fatigue, brain fog, and various mood disorders.

So How Do You Know If It’s Just PMS or PMDD?

The most common assessment used to diagnose PMDD is the Daily Record of Severity of Problems. Patients rate the severity and level of functional impairment of symptoms over two menstrual cycles. As many symptoms of PMDD are non-specific, it is important to take a holistic approach to consider other contributors such as thyroid disorders, endometriosis, bipolar disorder, and other conditions.

Conventional Treatment Methods

First-line treatment for PMDD often includes serotonin-modulating antidepressants (SSRIs). Dosing can be tailored, either continuous or premenstrual, and stopped at the onset of menses. Another intervention is the YAZ pill, the only oral contraceptive approved for PMDD. YAZ is a monophasic combined oral contraceptive, meaning it contains both synthetic estrogen and progestin to target mood fluctuations. These medications are quite well studied for their efficacy in enhancing functional impairment associated with PMDD. However, they can cause side effects such as reduced libido, fatigue, and an inability to orgasm.

How Can a Naturopath Help Treat PMDD?

Naturopathy takes a full systems approach to treating PMDD, considering an individual’s root causes such as genetic mutations, HPA axis dysfunction, diet, lifestyle, and nutritional status. Treatment is tailored to the individual to decrease symptom severity and may involve a combination of the following:

  • Zinc, Magnesium, and B6 for hormone modulation.
  • Herbs to support the HPA axis such as Rhodiola, Withania, Saffron, Siberian Ginseng, Kava, and Vitex.
  • Diet review to ensure adequate protein intake, omega-3s, and carbohydrates in the luteal phase to optimize tryptophan levels, a precursor to serotonin production.
  • Review of Vitamin D and Iron status. Specific prescribing of nutrients to reduce inflammation such as curcumin, bromelain, quercetin, and papain if needed.
  • Menstrual education to help the patient understand the different phases of their cycle and how to practice cyclical living to reduce functional impairment. Our Ebook on cyclical living is a great starting tool for this.

 

 

 

 

Woman stretching

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