Premenstrual Dysphoric Disorder (PMDD) is a health concern best described as a form of severe premenstrual syndrome (PMS). PMDD affects 3-8% of women worldwide but is not well understood or researched.
What are the symptoms?
PMDD symptoms include anger, irritability, depressed mood, anxiety, lack of pleasure, a sense of overwhelm, difficulty concentrating, fatigue, changes in appetite or food cravings, sleep changes, and physical symptoms such as breast tenderness, bloating or headaches.
These symptoms emerge in the luteal phase of the menstrual cycle, one to two weeks before periods commence, and typically subside within a few days of bleeding.
Over 64% of women experience some kind of mood changes a few days before the onset of menstruation. For women with PMDD these changes are more extreme. Despite having normal hormonal fluctuations during the menstrual cycle, women with PMDD experience an abnormal mood response to these fluctuations. Rage, anger, irritability, intolerance to others, anxiety and depression are commonly reported in women with PMDD. Our patients with PMDD sometimes say extreme statements along the lines of ” I get so mad I feel like I want to kill my husband before my period.”
It is suggested these more extreme changes in mood may be attributable to the effect estrogen and progesterone have on the serotonin, GABA and dopamine systems. These can also alter the renin-angiotensin-aldosterone system, which could explain some of the bloating and swelling that occur during the luteal phase.
Conventional intervention typically involves the contraceptive pill, anxiety medications and anti-depressant medications. For some women this relieves problematic symptoms but may also contribute to other side effects which become more of an issue than the PMDD itself. For those women, considering complementary solutions may be a good option. In traditional medicine practice, herbal medicines have been used to manage PMDD. Some of these natural medications support GABA levels, reduce extreme emotions, reduce depression, minimise physical symptoms and promote relaxation.
Other options often included in a herbal prescription such as withania , ginseng and rhodiola are considered serotonergic – i.e. they support level of serotonin in the brain. Nutrients such as vitamin E, vitamin D, zinc, vitamin B6, 5-HTP, calcium or inositol may be prescribed to help support healthy mood, reduce pain and support hormonal balance.
In naturopathic medicine we consider the individual’s unique presentation and symptomatic picture, rather than the diagnosis. Therefore, our treatment plans are also always tailored to the individual and consider their health history and current lifestyle demands. For some women anger is their key concern, while for others their depression is debilitating.
It helps to be realistic about what changes you can expect and appropriate timeframes. To get the best results we recommend an in-depth assessment and consultation for women with PMDD along with regular reviews to allow for modifications and adjustments of formulas and dosages.
Always seek medical care if you think you may have PMDD.
Want to know more? Contact the Athlete Sanctuary and learn how we can help you.
About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a Master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.athletesanctuary.com.au
References
Hantsoo, L., & Payne, J. L. (2023). Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neuroscience and biobehavioral reviews, 149, 105168. doi.org/10.1016/j.neubiorev.2023.105168
Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American family physician, 94(3), 236–240.
Kashanian M, Mazinani R, Jalalmanesh S. Pyridoxine (vitamin B6) therapy for premenstrual syndrome. (2007) Int J Gynaecol Obstet;96(1):43-44.
Tartagni, M., Cicinelli, M. V., Tartagni, M. V., Alrasheed, H., Matteo, M., Baldini, D., De Salvia, M., Loverro, G., & Montagnani, M. (2016). Vitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders in Adolescents with Severe Hypovitaminosis D. Journal of pediatric and adolescent gynecology, 29(4), 357–361. doi.org/10.1016/j.jpag.2015.12.006
Cerqueira, R. O., Frey, B. N., Leclerc, E., & Brietzke, E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives of women’s mental health, 20(6), 713–719. doi.org/10.1007/s00737-017-0791-0
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