Ever heard of PMS? Ha, who am I kidding. You are most likely living out this misery each month, just before your period. Am I right? Approximately 75% of the female population is affected by pre menstrual symptoms (PMS), such as mood swings, cravings, bloating, breast tenderness, and low energy. You're not alone in this. Although, PMDD is different from PMS. PMDD is more like an evil step sister that shows up every month around that time before your period. PMDD affects about 3-8% of the female population, although it feels like it's more prevalent because the more women that I speak with, more of them share that it affects them too. PMDD is premenstrual dysphoric disorder, classified as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — which, in my opinion, helps contribute to the narrative that women are crazy, hormonal, emotional, sensitive, etc. PMDD is like PMS except on steroids. It's like a monster that comes out and completely takes over you for 7-14 days before your period each month, which marks the luteal phase. So let's just set the record straight, if you're suffering from PMS or PMDD, you're NOT crazy and don't allow anyone to treat you or dismiss you like you are. And guess what, it's not all in your head, in fact it's mostly in your gut - which is good news because we can do something about it.
PMDD is treated as a mental disorder. For a woman to receive a PMDD diagnosis by a doctor, it requires keeping a diary of her symptoms for at least a few months to confirm that her symptoms occur during luteal phase and in a cyclical pattern, or complete a questionnaire, plus she needs to have at least 5 of 11 symptoms defined by the DMS-5 for a PMDD diagnosis.
PMMD symptoms include:
Feeling sad, depressed, hopeless, worthless
Mood swings; suddenly feeling sad or tearful
Increased irritability and or anger; frequent conflicts and outbursts
Increased anxiety or the feeling of being on edge all the time
Lack of energy, feeling fatigued
Decreased interest in normal activities
Problems with concentration
Changes in appetite, either overeating or craving a specific food (binge eating)
Changes in sleep pattern, either hypersomnia or insomnia
Feeling overwhelmed or out of control
Breast swelling or tenderness
Joint or muscle ache
A sensation of bloating or weight gain
Again, PMDD is different from PMS because it typically lasts longer than PMS symptoms. PMDD symptoms are severe enough that it's difficult to function in normal life, not just a bit uncomfortable. While PMS may cause you to snap at a loved one, PMDD causes full-on episodes of anger that often leave women with massive relationship issues that sometimes can’t be repaired. Women with PMDD often have to rearrange their lives and work to accommodate their monthly struggles. A PMS sufferer may get anxiety or feel depressed, but a woman with PMDD gets extreme anxiety and may wrestle with suicidal thoughts.
Just like with PMS, PMDD is often rooted in inflammation and high levels of estrogen circulating throughout the body. This is why I'm so passionate about empowering women with the knowledge, so they can reclaim their own healing power. Learning how to tune inwards, working in sync with female biology and naturally detoxing and reduce inflammation all lead to feeling nourished instead of feeling out of control and thinking that this is just 'normal'. When we focus on improving gut health, and supporting the body, we start to feel alive again. By eating, exercising, and working in alignment with your cycle phases, that supports your hormones, you get to show up as your best self during luteal phase and any day of the month.
Other reasons, beyond estrogen and inflammation associated with PMDD include, allopregnanolone and GABA which are a byproduct of progesterone (calming hormone) and when allopregnanolone doesn't work as it should, it aggravates the GABA receptors and instead of feeling relaxed and calm, women with PMDD feel anxious, moody, irritable and angry.
Another reason is histamine intolerance. Histamines are the compounds that we typically think of when we think of allergic reactions, like hives or hay fever. If you’re experiencing some of the following symptoms, your PMDD and PMS could be tied to histamines:
Headaches or migraines around ovulation and/or just before your period
PMS type symptoms — anxiety, low mood, etc. around ovulation
Itching or skin aggravation
And lastly, depression is strongly correlated with dysregulated gut and immune function, and inflammation. The luteal phase is associated with increased pro-inflammatory molecules and thus increased inflammation, compared to the follicular phase. Research shows that women with premenstrual symptoms have increased pro-inflammatory markers compared to those without premenstrual symptoms. And to top this off, we now know that 90% of serotonin is made in our gut, not our brains, so even more reason to nourish your gut, which helps tame the PMDD symptoms.
Treatment for PMDD, per traditional medicine, has been to use selective serotonin reupdate inhibitors (SSRI) or antidepressants, which may help with the mood symptoms and hormonal contraceptives as means to regulate the hormonal cycle and prevent ovulation. However, what if we could integrate nutrition too, what would that look like?
Integrative Nutrition approaches for PMDD include:
Balancing blood sugar
Incorporating more Omega3s in your diet like flax meal, chia seeds, walnuts, etc.
Prioritizing self care, like sleep and addressing your stress in ways that feel nourishing
Supporting gut health – histamine problems stem from gut dysbiosis
Encouraging proper liver detoxification (dandelion tea is one of my favorite)
Cutting out histamine rich foods from your diet, like nightshades
Taking natural antihistamines like vitamin C and quercetin (flavonoid rich foods such as apples, pears, onions, radish, parsley, sage, tea, and red wine)
Adding in magnesium and Vitamin B6 from foods and/or supplements
As a personal health and nutrition coach, I empower women with the information that support them to tap into their own inner knowing. Specifically, we go over what type of nutrition is optimal for balanced hormones in each phase of the cycle, when to do a HIIT vs Pilates workout to build lean muscle and increase athletic performance, plus how to structure life and work schedules so that it's in alignment with female biology. If you want to reclaim your life and feel alive, sign up for my Nourished to Alive program where we get to create a personalized plan that fits your lifestyle and supports your overall wellbeing. You don't have to suffer through this, or go through it alone; there are resources and support waiting for you right here. If you’ve tried everything, and you still can’t seem to figure out how to get a handle on your symptoms, then reach out and let’s evaluate what’s going on. Chances are you need more specific guidance on how to get your endocrine system working for you. I’d love to help point you in the right direction!