PREMENSTRUAL DYSPHORIC DISORDER
PMS vs PMDD | How to Know if You Have PMDD
Understanding PMDD and Naturopathic Treatment Options
What is PMDD?
PMS versus PMDD is a common question we get as naturopathic doctors who focus in women’s hormonal health. Premenstrual Dysphoric Disorder (PMDD) is characterized by intense affective (mood) and behavioral symptoms. This comprehensive guide aims to delve deeper into PMDD, offering insights into diagnostic criteria, pathophysiology, and evidence-based management. As naturopathic doctors, our mission is to provide a thorough understanding and holistic approaches that address the root causes of hormonal imbalances, offering valuable support for individuals navigating the complexities of PMDD.
The major difference between PMS and PMDD is duration and intensity. PMDD lasts longer and is more extreme in its symptom picture. PMDD is not just an inconvenience to be lived though, it can be a recurrent period of extremely challenging emotional states which affect a woman’s career, relationships and overall life.
How is PMS Diagnosed?
To diagnose premenstrual syndrome, a woman has any of the following symptoms that begin 5-7 days prior to menses, and that resolve with the onset of flow:
- Bloating
- Cramping
- Headaches
- Irritability
- Breast tenderness
- Sleep disruption
- Acne
- Food cravings
- Mood swings
How is PMDD Diagnosed?
To diagnose PMDD, a woman must have any of the following symptoms below, and they must:
- Be to an extreme degree (interfering with relationships or work)
- Last for up to 14 days prior to menses
- Symptoms must resolve within 4 days of the onset of flow
- Be present for at least 3 consecutive months
The Symptoms include:
- All symptoms listed in PMS, but to a higher degree of intensity
- Rage
- Anxiety
- Depression
- Extreme fatigue
- Insomnia
- Hot flashes
- Feelings of hopelessness
- Thoughts of suicide or harming others
- Loss of interest in regular activities
In 2022, PMDD secured its place in the International Classification of Diseases 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), signifying its recognition as a distinct gynecological disorder. The diagnostic criteria emphasize the cyclic nature of symptoms.
No genetic marker has consistently been associated with the PMDD, nor have abnormalities in macroscopic blood levels of sex hormones been found. This does not however, rule out an alteration of the hormone receptor level sensitivity at the various emotional areas of the brain. Further research will be needed to fully elucidate the underlying mechanism of PMDD.
Hormonal lab results will often be normal in women with PMDD, and PMDD is often thought of as an abnormal response to normal hormonal changes. Though PMDD is not diagnosed using lab testing, it is still important to run a thorough set of blood work, including hormones like estrogen and progesterone, to rule out any other causes of their PMDD-like symptoms. Other imbalances in the body can sometimes mimic PMDD, therefore lab testing to rule out conflation of symptoms is wise. Here is a list of lab testing to due when PMDD is suspected:
- Thyroid testing (TSH, T4, T3)
- Adrenal function testing (DHEA, cortisol)
- Vitamins (D, B12)
- Minerals (iron)
- Blood sugar testing (HbA1C, fasting insulin, continuous blood glucose monitoring)
Unraveling the Pathophysiology
The Neuroscience of PMDD
The results of a small study suggested that brain activity across the menstrual cycle is different between healthy controls and women with PMDD. In the study, brain imaging occurred during an emotional processing task related to anxiety control. The study was too small to draw any overarching conclusions, but the researcher stated that her findings show that women with PMDD had both higher reactions in the follicular and the luteal phase.
Genetic Links and Environmental Factors
Twin studies highlight a genetic link to PMDD susceptibility, with observed polymorphisms in genes related to serotonergic receptors, estrogen receptors, and ESC/E(Z). Beyond genetics, trauma and chronic stress significantly increase the likelihood of PMDD, unveiling the multifaceted nature of its aetiology.
Why the Standard Treatments for PMDD are Not Ideal
Women who ask their doctor about help for PMDD are often prescribed an antidepressant, a hormonal contraceptive or both. Here’s why they are not great treatment options.
Antidepressants Don’t Cure PMDD
While antidepressants can be valuable tools in addressing mental health concerns, they may not serve as a universal cure for PMDD. For some patients, integrating an antidepressant into their treatment plan proves effective, providing much-needed relief. However, for many others, it might not align with their specific needs. Taking mood-altering medication throughout the entire month, when PMDD-related depression surfaces closer to their menstrual cycle, prompts a legitimate concern about the necessity and appropriateness of such continuous medication.
Birth Control Pills Don’t Cure PMDD
Contrary to the assumption that regulating macroscopic hormone levels is the sole solution to PMDD, hormonal contraceptives, such as birth control pills, might not offer the comprehensive relief desired. PMDD involves intricate interactions within the body, extending beyond merely hormonal fluctuations. Surprisingly, these contraceptives could even heighten the risk of depression in some women. As we delve deeper into understanding PMDD, it becomes evident that a nuanced and holistic approach is essential, one that goes beyond the limitations of standard treatments and considers the individual dynamics of each woman’s body and symptoms.
Naturopathic Strategies for PMDD
Dietary Interventions
Dietary changes stand as a foundational approach to address hormonal symptoms contributing to PMDD. In general, following our hormonal eating guidelines may be helpful, but each patient has specific dietary needs, be that a higher requirement for certain nutrients or food reactions contributing to inflammation that need to be identified and avoided. Having a 1-on-1 assessment to determine your ideal food intake is the most efficient path to long-term hormonal health.
Physical Exercise
Regular movement is integral to overall health, but it is medically therapeutic for women with PMDD. Starting an exercise regime earlier in the month so that you can carry it through the premenstrual phase is crucial for minimizing symptoms of PMDD.
Psychotherapy
Counselling of any type that suits you is a very important aspect of a PMDD care plan. It not only will help reduce your baseline anxiety and depression, but also give you tools to manage the cyclical peaks with behavioural interventions. Doing therapy and naturopathic medicine in tandem is like working with both your body and mind together.
The Best Supplements for PMDD
Vitamins, minerals, and amino acids play a crucial role in influencing neurotransmitter and hormonal activity, offering a valuable adjunct to comprehensive PMDD treatment.
Vitamin D and Calcium
Vitamin D is endemically low in Canada, and supplementation is required for most women to keep blood levels in normal range. Beyond its benefit to immune function and bone health, vitamin D plays a vital role in both hormone regulation as well as mental health. Vitamin D, known for improving blood levels of calcium, shows promise in PMS and PMDD treatment, especially for those with deficiency. Low levels of vitamin D and calcium during the luteal phase of the menstrual cycle can cause and/or intensify the symptoms of PMS. Calcium and vitamin D supplementation can increase serum levels of these 2 micronutrients and may eliminate or reduce the severity of PMS symptoms.
Omega 3
Another important supplement for general health and mental health is omega 3, usually in the form of purified fish oil. There is also research that it can be particularly helpful for PMS, and therefore likely for PMDD. The results of meta-analysis showed that omega-3 fatty acids were efficient in reducing the severity of PMS in women, especially when used for longer durations.
Vitex Agnus Castus (or Chastetree Berry) for PMDD
Chastetree berry aids in balancing progesterone levels and reducing elevated prolactin levels, potentially benefiting symptoms of PMDD.
In a systematic review, it was concluded that using Chastetree berry for treatment of PMS/PMDD is a safe and efficacious alternative to be considered for the treatment of PMS/PMDD symptoms, and associated with a reduction of over 50% in symptoms for most women experiencing PMS/PMDD, with no serious side effects.
Magnesium for PMDD
Essential for a healthy mood, hormones, and overall calm, magnesium is a crucial mineral for addressing PMDD symptoms. Magnesium-rich foods like nuts, seeds, and greens can contribute to your magnesium intake, and sometimes supplements like magnesium bisglycinate or citrate are appropriate depending on a patient’s symptoms and activity level.
Vitamin B6 for PMDD
Vitamin B6 plays a pivotal role in women’s health, particularly in optimizing hormones. Aim for 50-100 mg of B6 daily to address irritability, fatigue, insomnia, and mood swings. Chickpeas, salmon, and avocados are excellent dietary sources of vitamin B6.
Naturopathic Intervention: A Personalized Approach
Navigating the intricate landscape of PMDD requires a holistic understanding and personalized approaches. Naturopaths play a vital role in addressing root causes, offering dietary guidance, nutritional support, and herbal interventions tailored to individual needs. As we continue to explore the complexities of PMDD, collaboration between healthcare professionals ensures a comprehensive and patient-centered approach, empowering individuals on their journey to manage and overcome PMDD.
Your Doctor: Meet Dr. Sarah
Dr. Goulding is a Naturopathic Doctor who has a special focus on digestion and hormone health. She completed her doctor or naturopathic medicine degree at the Canadian College of Naturopathic Medicine, and holds a Bachelor’s of science in neuroscience and biology from Dalhousie University.
