EXPLORING CONVENTIONAL AND COMPLEMENTARY APPROACHES TO TREATING PMDD

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). It causes severe physical and emotional symptoms that occur 1-2 weeks before your period. PMDD is a mood disorder that became an official diagnosis in 2013 with the DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders). PMDD causes severe mood changes that affect 3-8% of women and is often under diagnosed or misdiagnosed because of its similarity to PMS. Unlike regular PMS, PMDD causes intense emotional and physical symptoms, like extreme mood swings, irritability, depression, anxiety, and fatigue. These symptoms can seriously impact daily life. The exact cause isn't fully understood, but it may involve hormonal fluctuations and brain chemistry changes. Managing PMDD often requires a combination of medical treatments, lifestyle adjustments, and emotional support.

This commonly missed diagnosis can stop women from receiving the proper treatment. PMDD is more intense than PMS, with more significant physical and psychological symptoms that significantly impair functioning and quality of life.

Those with PMDD report this condition interferes with their ability to maintain their daily lives, work, and relationships.

If your PMS symptoms are severe enough to disrupt your daily life or cause distress, you may have PMDD.

What is the difference between PMS symptoms and PMDD?

Mild-moderate PMS is common. It affects up to 75% of women with regular menstrual cycles. Many women report having mild-moderate changes in mood changes. While PMS often causes mild to moderate symptoms like bloating, mood swings, and fatigue, PMDD leads to much more intense emotional and physical reactions. PMDD can result in debilitating depression, extreme irritability, and severe anxiety, significantly impacting daily activities and relationships. PMDD is more severe compared to the milder, more common symptoms of PMS. While PMS is manageable for most, PMDD can greatly interfere with everyday life and demands more attention.

The most common symptoms of PMS can include:

bloating
cramping
headaches
breast tenderness
headaches
constipation
diarrhea
acne flare-ups
mild irritability
joint or muscle aches
food cravings or increased appetite
tiredness

The main difference between PMS and PMDD is that PMS does NOT significantly impair quality of life.

PMDD should not be mistaken for PMS, as it involves much more severe physical and emotional symptoms. The onset of PMDD takes place during the luteal phase of your menstrual cycle, which is the time between when you ovulate and when your period starts. The luteal phase lasts approximately two weeks for most people but can be longer or shorter.

Emotional symptoms of PMDD can include:

Extreme irritability or anger
Feeling overwhelmed and "on edge"
Depression or suicide ideation
Anxiety
Feelings of hopelessness or self-deprecating thoughts
Severe mood swings or heightened sensitivity to rejection
Increase in interpersonal conflicts (with family, friends, or at work)

Behavioral symptoms of PMDD can include:

Decreased interest in your usual activities (work, school, or seeing friends)
Difficulty concentrating
Low energy
Appetite changes (under-eating or overeating)
Changes in sleep (hypersomnia or insomnia)
Overwhelmed or feeling out of control

Physical symptoms of PMDD can include:

Fatigue
Headaches or Migraines
Heart palpitations
Breast tenderness
Painful periods
Dizziness
Joint or muscle pain
Back pain
Bloating
Decreased sex drive
Gastrointestinal symptoms: Constipation, diarrhea, or nausea/vomiting

The intensity of the emotional/behavioral symptoms can destabilize your daily life and interfere with all aspects of life, including work and relationships. The symptoms will resolve when your period starts, only to return after the next time you ovulate.

What causes PMDD?

Although the exact cause of PMDD is unknown, multiple underlying factors can contribute to PMDD.

Risk factors for PMDD can include:

History of PMS
History of postpartum depression or postpartum anxiety
History of anxiety or depression
History of past traumatic events
Cigarette smoking
Obesity

A drop in serotonin that stems from a rapid decline in estrogen during the luteal phase may cause hormonal imbalances. These hormonal balances are a risk factor for PMDD.

Is there a way to test for PMDD?

There is no specific test to diagnose PMDD. Your doctor may perform a physical exam and bloodwork to rule out other medical problems. It's important to rule out other causes of your potential causes of symptoms, which can include:

major depressive disorder
generalized anxiety disorder
menopause
fibroids
endometriosis
thyroid problems
hormonal problems unrelated to PMDD

PMDD is a clinical diagnosis based on self-reported symptoms, like depression, anxiety, or mood swings. The timing of these symptoms is the key indicator: They must occur 1-2 weeks before the start of your period and resolve soon after your period arrives. This is during your luteal phase in your menstrual cycle, and corresponds with hormonal change.

Keeping a journal and tracking your moods and periods on a calendar or period-tracking app is essential. Suppose these severe symptoms are cyclically affecting your quality of life. In that case, you must make sure they are well-documented and brought to your doctor. Tracking your symptoms every month may help your doctor diagnose your condition. This means you can start treatment and begin to manage your condition sooner.

How is PMDD diagnosed?

According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there must be at least 5 of the following symptoms present for 1-2 weeks before your period over at least six months:

mood swings (increased sensitivity to rejection and sudden sadness)
marked irritability or anger
depressed mood
feelings of hopelessness
anxiety or tension
reduced interest in friends, work, and other activities
lack of energy
appetite changes
trouble sleeping or sleeping too much
overwhelmed or feeling out of control
physical symptoms, such as bloating, breast tenderness, joint or muscle pain, and headache

If you're experiencing signs or symptoms of PMDD, it's important to talk to your doctor for proper diagnosis and support.

SELF-ADVOCATE!

PMDD can have a destabilizing or debilitating effect on your daily life. It's essential that your healthcare provider addresses your symptoms. Getting a diagnosis depends entirely on the knowledge of the professional you see. By advocating for yourself, you can push for an accurate diagnosis, appropriate treatments, and the resources needed to manage the condition effectively. Taking control of your health empowers you to improve your quality of life and helps raise awareness about this often misunderstood disorder. It is important to communicate openly with your healthcare provider about your symptoms.

GPs, Gynecologists, Endocrinologists, and Psychiatrists may not have in-depth knowledge of PMDD. If your doctor is not addressing your concerns or symptoms, you can always seek a second opinion from another doctor. Menopause experts are well-versed in treating PMDD, as they understand how hormones affect mood. You can find a provider at www.menopause.org.

Alternatively, Functional medicine doctors or Integrative Medicine Practitioners who specialize in women's health are holistic-minded providers who treat PMDD.

WHAT ARE TREATMENT OPTIONS FOR PMDD?

You may need to try different approaches to manage your symptoms effectively to determine what works best for you. Be patient with yourself and the process.

Lifestyle changes

Making some adjustments to your daily habits can manage your PMDD symptoms. These include:

Move your body. Exercise does not need to be an intense workout at a gym; going for a brisk 30-minute walk at least three times per week can help boost your mood.
Eat in moderation. Cut back on salty, processed, or sugary foods. Eat foods high in lean protein and complex carbohydrates. Foods high in protein increase tryptophan levels (a chemical your body uses to produce serotonin). Eat plenty of fruits and vegetables and avoid alcohol and caffeine.
Manage your stress. Reaching out to family or friends, working with a therapist, or practicing a relaxation technique like yoga, meditation, or breathing exercises can help keep your stress levels in check.

CONVENTIONAL TREATMENT FOR PMDD

Conventional treatment for Premenstrual Dysphoric Disorder (PMDD) often includes a combination of medication and lifestyle changes. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are commonly prescribed to help regulate mood swings and alleviate emotional symptoms. Hormonal treatments, such as birth control pills, can also be used to stabilize hormone levels.

Hormonal medications

Hormonal medications, including birth control, prevent ovulation and can improve PMDD symptoms by preventing ovulation. Ovulation causes hormonal changes, so preventing ovulation may regulate your hormones and prevent these fluctuations.

Oral contraceptives (birth control pills)

Oral contraceptives are some of the most commonly prescribed medications for rebalancing hormones like estrogen and progesterone. For some, birth control pills are effective for treating PMDD symptoms. But for others, they can make symptoms worse. There can be adverse side effects and health risks associated with birth control pills. The risks and benefits of taking oral contraceptives need to be discussed with your doctor.

Gonadotrophin-releasing hormone (GnRH) agonists

GnRH agonists, like leuprolide and Danazol, are medications that stop your ovaries from producing estrogen and progesterone. This can cause temporary, reversible menopause- which means you stop having your periods. By suppressing these hormones, GnRH agonists create a temporary state similar to menopause, which can relieve severe mood swings, anxiety, and other emotional symptoms associated with PMDD. While this treatment can be effective, it's typically reserved for severe cases and may be used as a short-term option due to potential side effects, such as bone loss or menopausal symptoms.

GnRH analogs can cause menopausal symptoms that can include:

reduced libido
mood swings
night sweats
hot flashes
vaginal dryness
weight changes

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that manages your brain's serotonin levels. Low serotonin levels may cause PMDD.

SSRIs used to treat PMDD include:

fluoxetine (Prozac, Sarafem)
sertraline (Zoloft)
paroxetine (Paxil, Pexeva)
citalopram (Celexa)
escitalopram (Lexapro)

Sexual dysfunction is a commonly reported side effect of SSRIs. Your doctor will work with you to find a medication dosage that offers the most benefit with the fewest side effects.

COMPLEMENTARY AND INTEGRATIVE MEDICINE TREATMENT FOR PMDD

Complementary and integrative medicine treatments for PMDD, such as acupuncture, herbal supplements, and mindfulness practices, can help alleviate symptoms alongside conventional medical approaches. These therapies aim to reduce stress, balance hormones, and improve emotional well-being, offering additional support in managing PMDD.

Nutritional supplements

Research has shown that specific dosages of particular supplements can ease symptoms of PMDD. Studies show that important vitamins and minerals, like vitamin B, vitamin D, Calcium, and magnesium, are necessary for the body to make neurotransmitters and maintain hormonal balance.

Calcium and Vitamin D: Daily supplementation has been shown to reduce both emotional and physical symptoms.
Magnesium: Studies have found magnesium may improve symptoms, especially with Vitamin B6. Magnesium may help ease breast soreness and bloating.
Vitamin B-6: Consistent supplementation has significantly improved PMDD symptoms, especially when taken alongside Calcium. Vitamin B-6 can help ease fatigue, irritability, and insomnia.

Inositol

Inositol is a sugar in the body and foods essential for blood sugar regulation and hormone production. Myo-inositol and D-chiro-inositol are most common in supplements. Some studies show that Myo-inositol has been found to be effective at reducing depression and anxiety symptoms, particularly in women with PMDD.

Herbal supplements

Herbal supplements are often used to help manage PMDD symptoms by balancing hormone levels and reducing mood swings, bloating, and irritability. While some women find relief with these natural remedies, it's important to consult a healthcare provider before starting any supplement regimen.

Evening primrose oil (EPO)

According to the American Academy of Family Physicians, "EPO," or Evening Primrose Oil, is an extensively studied herb for its potential benefits in relieving symptoms of PMS. In studies, participants took 500 to 1,000 mg of EPO daily. Research has shown EPO is effective at reducing various PMD symptoms, though it typically can take at least 6-8 weeks to see the benefits. Compliance is essential if your doctor or practitioner recommends it.

St. John's wort

There is good evidence that St. John's works as a natural antidepressant that reduces symptoms of mild-moderate depression, anxiety, and irritability. It may also ease some physical symptoms of PMDD. In many studies, it and selective serotonin reuptake inhibitors (SSRIs) seem to work.

It's important to note that St. John's wort interacts with a large number of medications, including medications used to treat depression or other mood disorders: tricyclic antidepressants, SSRIs, and monoamine oxidase inhibitors (MAOIs). If you are taking any medications, you should not use St. John's wort without first talking to your doctor.

Chaste tree berry (Vitex)

The chaste tree berry, the fruit of the chaste tree or Vitex agnus castus, is widely used to treat PMS and PMDD symptoms, relieving mood swings, headaches, breast tenderness, and pelvic discomfort. Studies show that women who took the Chaste tree berry consecutively for three months reported a significant improvement in symptoms of pelvic discomfort, irritability, and food cravings.

Acupuncture

Acupuncture, an ancient Chinese medical practice, is used as part of an integrative treatment plan that offers a range of benefits for treating PMDD, including regulating hormones, reducing stress, alleviating physical discomfort, and improving mood. Regular acupuncture sessions have been found to reduce PMDD symptoms by 50% without any adverse effects.

Summary

Premenstrual dysphoric disorder (PMDD) is a cyclical, hormone-based mood disorder that is a much more severe form of PMS. Its effects can seriously impact your quality of life. There are both conventional and complementary/integrative treatment approaches that can alleviate the intensity of emotional and physical symptoms that can help you manage PMDD and take control of your symptoms.

Just know that you are not alone in dealing with PMDD symptoms. Choosing the right treatment option can be life-changing. It can alleviate your symptoms, improve your well-being, and bring you the relief you deserve. Don't hesitate to explore all the available options and find the one best suited to your needs.

References

“Complementary and Integrative Medicine Approaches to Treating PMDD: Specialty Testing, Supplements, and Nutrition.” Rupa Health, 16 May 2023, https://www.rupahealth.com/post/complementary-and-integrative-medicine-approaches-to-treating-pmdd.

BioDesign. “Why Functional Medicine Approach Is Best for Premenstrual Dysphoric Disorder (PMDD).” BioDesign Wellness Center, 6 Apr. 2022, https://biodesignwellness.com/blog/why-functional-medicine-approach-is-best-for-pmdd/.
Premenstrual Dysphoric Disorder (PMDD): What You Need To Know About This More Severe Form Of PMS | Dr. Will Cole. https://drwillcole.com/hormone-health/premenstrual-dysphoric-disorder-pmdd-what-you-need-to-know-about-this-more-severe-form-of-pms. Accessed 2 Apr. 2024.

Key, Alyson Powell. “Premenstrual Dysphoric Disorder (PMDD).” WebMD, https://www.webmd.com/women/pms/premenstrual-dysphoric-disorder. Accessed 2 Apr. 2024.

“Premenstrual Dysphoric Disorder.” Wikipedia, 1 Apr. 2024. Wikipedia, https://en.wikipedia.org/w/index.php?title=Premenstrual_dysphoric_disorder&oldid=1216656544.

“Premenstrual Dysphoric Disorder.” Wikipedia, 1 Apr. 2024. Wikipedia, https://en.wikipedia.org/w/index.php?title=Premenstrual_dysphoric_disorder&oldid=1216656544.