How PMDD can disrupt lives every single month.

We’ve all heard of PMS. Monthly symptoms that can indicate some hormonal imbalances in the lead up to your period; low mood, cramping, bloating and sore breasts. However PMDD (Premenstrual Dysphoric Disorder) is something different entirely.

Imagine feeling perfectly okay for three weeks of your cycle, then in the 7 to 10 days leading up to your period, your whole outlook on life changes. Anxiety, depression, moods so low you feel like you can barely get out of bed. 

This condition affects between 2-8% women and individuals who menstruate and is not related to hormonal balances at all. It’s actually a condition of the brain, where changes to female reproductive hormone levels at this time of the cycle (the luteal phase) impact neurotransmitters in the brain such as GABA, Serotonin and dopamine. Research shows that people with PMDD have a higher sensitivity to the effects of hormonal changes on neurotransmitters that can cause some pretty extreme changes to mood and emotional outlook in this time. It’s interesting to note that people going through the changes of perimenopause have reported the onset of PMDD symptoms, likely due to the increase in hormonal fluctuations, and in particular the way that progesterone levels drop more and more during this time.

Doctors are finally starting to catch up on the research, and more women and menstruating people are being diagnosed with the condition than ever before. A rating scale is now typically used by physicians to diagnose PMDD, called the Carolina Premenstrual Assessment Scoring System (C-PASS) which can help doctors gauge the frequency and severity as well as the timing of the onset of symptoms in their patients.

The criteria used are broken down into three categories:

1. A rapid, sudden onset of 5 symptoms including depression, irritability, anxiety, affect lability, decreased interest, difficulty concentrating, fatigue, feeling out of control, insomnia, change in appetite, breast tenderness or breast swelling. The symptoms reported interfere with usual activities - work, family, social life.
   
2.  A rapid, sudden offset of the above mood and associated symptoms after 7-10 days. This may coincide with menstrual bleeding, but in women with irregular, amenorrhoeic or medication impacted cycles – the bleeding may not necessarily signal improvement in mood. 
3. An absence of new stressors or clear precipitating psychosocial factors causing depression. 
    

My beautiful and talented friend JR has been living with PMDD for years. Here’s how she describes her experience every month:

"Experiencing PMDD is like entering a dark, murky state of consciousness every month, usually in the week before my period. For me, it arrives without warning. It doesn’t creep in gradually or give me time to prepare. Instead, it appears suddenly—a nasty surprise that sends me tumbling down the rabbit hole at the slightest trigger.

Once it takes hold, I spiral. I become overwhelmed by feelings of worthlessness, inadequacy and deep depression. I begin to question everything—my relationship, my work, my abilities as a parent, and the friendships I hold dear. During this time, I experience body dysmorphia and struggle to look at myself in the mirror.

My mind descends into a dark place, deep down that rabbit hole, where even the smallest tasks feel impossible. Some days, all I can do is reach for a Valium and retreat beneath the blankets. Other times, I am so ashamed and so desperate to hide my suffering from my family that I book a hotel room for a night or two, seeking solitude until the storm passes.

Usually, after a few days, the darkness lifts and I can see the light again. But during those days, when PMDD has its grip on me, it is one of the loneliest places I have ever known. It is like becoming a stranger to myself, trapped inside a mind I no longer recognise, waiting for the person I know myself to be to return."

In the past, the common treatment for PMDD was the OCP (the pill) as well as SSRI- anti-depressant medication, but more recently new treatments are coming to light. Newer research has shown that progesterone therapy in particular can be helpful in soothing the nervous system, and softening the blow to GABA levels in the brain due to the normal drop in progesterone in the luteal phase.  Taking bio-identical progesterone (prescribed by your doctor) can help to ease mood and depression symptoms in some people.

Another area of research coming to light is the link between histamine and the brain. If histamine (chemicals produced by the immune system to protect you and act as neurotransmitters in the brain) levels are higher than normal in the body this can directly cause changes to mood including depression and anxiety. In the luteal phase when oestrogen is high and progesterone is dropping, this can cause a histamine response in the body causing depressive moods. Some women report taking antihistamine medication around this time can have a profound impact on their mood, reducing the low and depressive moods they can experience around this time. The drawback to using this kind of medication ongoing is the effect on the gut microbiome which can lead to inflammation in the gut and body over time. 

What’s really exciting for natural medicine practitioners is that natural solutions are also coming to the forefront for PMDD. One of the most successful in trials is the use of saffron in a therapeutic dose for mood balance. Studies are showing that the use of saffron therapeutically (in supplement form) is proving to be just as effective, if not more, as the use of SSRI’s to reduce depression and anxiety associated with PMDD, as well as having  bonus usefulness in reducing period pain. It's the crocin, and safranal components of saffron that act in similar ways to SSRI (inhibiting the reuptake of dopamine, norepinephrine, and serotonin) so those elements are being used to manufacture supplements to help PMDD sufferers. 

We are also seeing that the use of magnesium in supplement form can have a positive impact on PMDD symptoms because of the way it works on soothing the nervous system, however some PMDD sufferers say that while it is helpful, especially in those who struggle with sleep around their luteal phase,  it cannot be the only form of treatment they use.

Working on reducing inflammation in the body is also helpful when it comes to managing PMDD because of the way that inflammation can cause hormonal imbalances, and the way that inflammation in the gut can directly affect the balance of brain chemicals (via the gut brain axis, linked to each other by the vagus nerve.) Working on improving the balance of gut bacteria and reducing pro-inflammatory foods and drinks from the diet is always a good place to start when trying to treat any type of hormone, immune or brain health related symptoms.

I hope if you are struggling with symptoms like the ones outlined in the diagnostic tool above, that you seek treatment through your doctor, and remember that if you do not get the answers and help you need, you deserve a second opinion. As a women’s health nutritionist, and as the friend of someone who lives with PMDD, I am passionate about helping you too.