Navigating the Complexities of Premenstrual Dysphoric Disorder (PMDD)
By Dr Emily Wiggins & Dr Kelcie Rosendhal
WHAT IS PMDD?
PMDD stands for “premenstrual dysphoric disorder”.
PMDD is a condition that affects women for 2-3 weeks every month. It has the same distinct cyclical pattern and similar physical symptoms as PMS, but is different because there are associated mood disturbances that result in marked social or occupational impairment that can impact important professional and personal relationships.
Approximately 85% of women experience PMS symptoms, but only 3-8% experience the severity of PMDD.
PMDD can be debilitating and affects women's relationships, careers and overall health. Unfortunately, PMDD is often over looked in the health care setting and women can go years without receiving a diagnosis.
HOW IS PMDD DIAGNOSED?
Criteria for a PMDD diagnosis, according to the DSM-V, is summarized below. Please keep in mind that all symptoms must be present during the LUTEAL phase, or second half, of the menstrual cycle:
One or more of the following symptoms must be present:
Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
Marked irritability or anger or increased interpersonal conflicts
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, and/or feelings of being keyed up or on edge
One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms from the criteria above:
Decreased interest in usual activities
Subjective difficulty in concentration
Lethargy, easy fatiguability, or marked lack of energy
Marked change in appetite; overeating or specific food cravings
Hypersomnia or insomnia
A sense of being overwhelmed or out of control
Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain.
HOW TO TREAT PMDD NATURALLY & HOLISTICALLY:
Conventional management typically includes use of an oral contraceptive pill or anti-depressant but we know that lifestyle changes, nutritional and herbal support can also be quite helpful!
Some strategies that our naturopathic doctors use to support women with PMDD include:
1. Dietary Interventions: Increase fiber rich foods. Fiber is necessary for properly eliminating excess estrogen from the body and also feeds the good bacteria (think probiotics) that live in our GI tract. These bacteria, known as the "microbiome", influence our mood and many other aspects of health. We generally recommend increasing vegetable intake to increase fiber consumption. Seed cycling is another great way to increase fiber and balance hormones. Additionally, a high quality protein source and healthy fat should be eaten at each meal. Protein and healthy fats help to maintain proper blood sugar balance and your liver detox excess and unused hormones. It is also important to reduce your intake of refined carbohydrates and sugar. Again, blood sugar balance is vital to sex hormone and stress hormone balance.
2. Balance Estrogen: Estrogen dominance, or too much estrogen in ratio to progesterone levels, can contribute to PMDD symptoms. We must test your hormones in order to understand if estrogen dominance is contributing to your PMDD symptoms. We can test hormones via blood, saliva, urine or a combination of both. If estrogen levels are high, we can help your body to better detoxify your estrogen, or make less estrogen, depending on the root cause of the issue. Sometimes this means dietary changes, increased liver support, optimizing gut health or increasing progesterone levels.
3. Increase Progesterone: Progesterone is often low if estrogen levels are elevated. There are different strategies to increase progesterone if needed, depending on the individual and their goals. We often use herbal interventions and other targeted nutritional supplementation as needed. Stress management is also key to healthy progesterone levels. Cortisol, our primary stress hormone, shares similar metabolic pathways to progesterone. When our bodies are in a constant state of fight-or-flight they put preference into making more cortisol instead of progesterone. This is called the "progesterone steal". It makes sense that reproduction would take a back seat to trying to run away from a tiger!
4. Mental Health Support: We love our patients and clients to have a healthcare team. Working with a trusted mental health provider is extremely important when healing from PMDD.
5. Avoiding Endocrine Disruptors: Endocrine disruptors are chemicals that interfere with our hormones. Some of these chemicals mimic natural hormones and alter the production and/or use of them.
The Environmental Working Group is a great resource for learning more about harmful chemicals in personal and household care products and finding safer options. We love their Skin Deep Database where you can check the safety of your favorite products on their database.
QUESTIONS ABOUT PMDD AND FINDING SUPPORT
Hormone imbalance, including PMDD and PMS, is common but that does not mean that you need to continue suffering.
There are many interventions available to treat the cause of PMDD. Treatment should be individualized and based on your unique history, symptoms, lab testing results and individual goals.
If you suspect you have PMDD and are looking to for a practitioner to help identify and treat the root cause of your symptoms, click here to find out how to become a patient. We work with people locally in Bend, OR and long-distance.