The week before your period, you crave chocolate, suddenly find your partner super irritating, and feel somewhat bloated.
That’s pretty normal PMS (premenstrual syndrome).
The week before your period, you sink into a sudden, deep depression. You can’t get out of bed because of crippling fatigue. You lose all motivation and ability to focus at work, and relationships become strained.
That’s not PMS… but it might be PMDD (premenstrual dysphoric disorder).
PMS is something most women experience. In fact, up to 85% of women report dealing with PMS at some point in their life. It’s largely due to the hormonal shifts that occur during the menstrual cycle, specifically when progesterone and estrogen levels drop right before your cycle begins. Hormonal imbalances, like estrogen dominance, can make symptoms more prominent.
But PMDD is different. It affects about 5% of American women, and while it is often thought of as “really bad PMS,” that description doesn’t even begin to reveal just how disruptive PMDD can be. What makes PMDD so debilitating is that it symptoms often interfere with relationships, work, and overall health. It quite literally brings normal life to a halt every single month.
Because PMDD is often overlooked by health professionals and misclassified as bad PMS, many women suffer with PMDD for years. Traditional hormonal panels often appear “normal”, leaving women frustrated and without answers. The good news is, there is help, and there are natural ways you can treat PMDD—starting today.
What Is PMDD?
PMDD shares some of the symptoms of PMS, such as moodiness and cravings, but symptoms are far more intense and typically last much longer. Symptoms usually appear 7-14 days before your period and resolve within a day or two of your period starting.
According to Harvard Health, PMDD is classified as experiencing five or more of the symptoms of PMDD.
- Anxiety or tension
- Sudden mood changes
- Loss of interest in daily activities
- Difficulty concentrating
- Decreased energy
- Food cravings and appetite changes
- Insomnia or sleepiness
- Physical symptoms, such as breast tenderness or bloating
PMS vs PMDD — What’s The Difference?
If you’re a little unsure if you have PMS or PMDD, you’re not alone. Women who struggle with PMS can often experience one or more of the symptoms above.
What makes PMDD different from PMS is the severity and duration of symptoms.
While PMS may feel like an annoyance, PMDD is a major life disruption. The mood shifts experienced in PMDD are dramatic. An otherwise happy person may find herself suddenly severely depressed and anxious the week before her period, but fine the rest of the month.
The best way to figure out if you’re experiencing PMS or PMDD is to track both your cycles and the severity of your symptoms monthly. I recommend following the Fertility Awareness Method (FAM), and using a cycle tracking app.
PMDD Stigma — Are Women Crazy?
There is so much embedded in our culture about women being “crazy” or controlled by hormones that many women are hesitant to speak up when they suspect PMDD. That’s a huge issue because PMDD can literally be life threatening if left unaddressed.
If you have or suspect PMDD, it isn’t your fault and there’s nothing to be ashamed of. It’s not because of something you did or didn’t do. But you also don’t have to accept suffering every month. There are steps you can take to feel better.
What Causes PMDD?
The exact cause of PMDD still isn’t known with 100% certainty, but there are some studies that provide insight into common root causes.
Recent research suggests that there are differences in how women respond to certain hormones. Because of genetic differences, some women may be more sensitive to the effects of estrogen and progesterone. This means two women can have the same levels of hormones, but very different physiological responses. While more needs to be discovered, it’s incredibly validating for women with “unexplained” symptoms.
Research also suggests that women who suffer from symptoms of PMS (remember: most women who have PMDD are misdiagnosed with PMS) also have something called hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Specifically, women with PMS have elevated cortisol levels during the luteal phase.
The HPA axis is your body’s stress response system. It is also impacts the production of sex hormones like estrogen and progesterone. HPA-Axis deregulation, sometimes also referred to as “adrenal fatigue,” is basically a condition where your body stops responding to the cortisol being created. It’s a problem deeply rooted in the brain and how the body responds to stress. It’s typically caused by exposure to chronic stress from a variety of different sources, including diet, exercise, lack of sleep, and mental and emotional stressors, which can all cause chronic cortisol output.
There’s also a known connection between stress and trauma and PMDD, which makes sense because stress and trauma can also cause HPA-Axis dysregulation. Because of this connection, working to resolve HPA-Axis dysegulation will likely reduce symptoms of PMS and PMDD.
Lastly, women suffering with PMS and PMDD may actually be experiencing thyroid issues, since many of the symptoms overlap. If you’re suffering from PMDD and haven’t gotten a full thyroid panel done, get one done by a qualified practitioner who can help you understand functional ranges.
PMDD and Estrogen Dominance
Estrogen dominance is often a factor in PMS, and many believe it can play a role in PMDD as well. It’s a common hormonal imbalance because our modern world is the perfect storm for estrogen dominance.
Too much estrogen can cause a variety of symptoms, including fatigue, insomnia, and mental health issues. Estrogen impacts both the production of the neurotransmitter serotonin, as well as serotonin receptors in the brain. When estrogen levels aren’t where they should be, it can change the body’s production or the brain’s ability to use serotonin.
Estrogen dominance occurs when estrogen levels rise above normal, or when progesterone is low relative to estrogen. By reducing your exposure to endocrine disruptors and supporting your body’s ability to properly detoxify estrogen, you can resolve estrogen dominance naturally. Even if you don’t have estrogen dominance, supporting your gut, liver, and adrenals will support the proper detoxification of hormones, and can improve the symptoms of PMS and PMDD. Read more about How to Reverse Estrogen Dominance Naturally.
Conventional Treatments and Medication for PMDD
The most common conventional treatments for PMDD are hormonal contraception (the birth control pill) and medically induced menopause with a drug called Leuprolide. Unfortunately, both of these medications have a long list of side effects. For some women, the birth control pill only makes matters worse and can cause more problems long-term.
Sometimes, antidepressants and anti-anxiety medications like SSRIs are also prescribed, even if no other psychiatric conditions exist. In severe cases, a hysterectomy is done to complete remove the uterus and ovaries.
Some women find relief with these treatments, and others don’t. Unfortunately, many of these medications do not treat the root cause, so the problem still exists long-term.
Natural Treatments for PMDD
Whether you’ve tried conventional treatments for PMDD without relief, want a more natural approach, or are looking for something complementary, there are natural treatments for PMDD that can help. Ultimately, to heal or resolve PMDD, you must treat it with a holistic approach that addresses stress, inflammation, gut health, and hormones. The natural treatments below, along with steps to resolve HPA-Axis dysregulation and Estrogen Dominance, can be a part of an effective treatment plan.
1. Support Proper Hormone Function for PMDD
While many women who experience PMS and PMDD appear to having “normal” hormone levels, often it’s the testing that isn’t showing the clearest picture. So, the first step to figuring out what may be at the root of your PMDD symptoms is to do a DUTCH hormone test. This should be reviewed by a qualified practitioner who can help you understand what’s going on with certain hormonal imbalances and how to resolve them.
The most common hormonal imbalance that can create symptoms of PMDD is high estrogen, also known as estrogen dominance. This can occur when estrogen levels are too high, or when progesterone levels are too low. A proper holistic treatment plan includes supporting the liver and gut to eliminate hormones, reducing exposure to xenoestrogens, and reducing stress to support progesterone production. For more information on this, check out How to Reverse Estrogen Dominance Naturally.
2. Get Vitamin B6 and Calcium
Research shows that supplementing with vitamin B6 reduces PMDD symptoms like depression, perhaps by increasing the neurotransmitter GABA or decreasing the hormone prolactin. Calcium has also been shown in studies to help reduce symptoms of PMS.
In clinical trials, the dose used was 80 mg daily of B6, and 500 mg of calcium. Both of these nutrients are also readily available in dark leafy greens, such as broccoli, cabbage, bok choy, and kale.
3. Eat Diversely
Following an anti-inflammatory diet rich in fruits, vegetables, and high-quality protein including grass-fed meats, fish, and eggs must be a part of any treatment plan for PMDD. A nutrient-dense diet will support proper gut and liver function, and provide the body with essential micronutrients, which will help to support proper hormonal balance.
Try to make sure that you’re eating high quality protein and fat with each meal, and adding at least 1-2 servings of fresh fruits and vegetables with each meal. Don’t try to reduce calories, which will leave you hungry and frustrated. Simply try to improve quality!
It’s also helpful to test out a short-term elimination diet, which will eliminate foods that commonly cause inflammation, blood sugar issues, and gut problems, including processed grains, sugar, and seed oils for a set period of time. Many people will see incredible results from this in as little as 28 days. Check out the 4 x 4 protocol in my book, Coconuts and Kettlebells, for more information about small dietary shifts that support proper hormone function.
4. Supplement with Magnesium for PMDD
Up to 80% of people are deficient in magnesium. Magnesium is critical for supporting the stress response, and is the catalyst for over 300 reactions in the body that connect to proper detoxification, energy production, and even digestion. Women are much more prone to magnesium deficiency because it’s depleted during pregnancy.
Because of this, magnesium is one of the few supplements I recommend just about everyone take. Research shows magnesium supplements can reduce PMS/PMDD symptoms, and that it works even better when paired with vitamin B6! Not to mention, it’s been show to help mood disorders not related to PMDD.
I highly recommend taking a high quality combination magnesium supplement, like Magnesium Breakthrough.
5. Take Vitex for PMDD
Vitex (aka chaste berry) is an herb that has been used to treat period problems for centuries, and lots of modern-day research backs up its efficacy. One research review found that vitex improved PMS and PMDD in all eight studies that were compared. It also was found to be just as effective for treating PMDD as oral contraceptives. Most women benefit from 100-200 mg daily.
6. Sleep + Cycle Syncing Your Workouts
I know, super boring advice, right? But don’t overlook this! Most women are not sleeping enough, which can directly impact stress, your adrenal health, and therefore hormonal balance. You will not be able to balance hormones long-term without prioritizing your sleep.
Daily exercise can also improve symptoms of PMDD. I highly recommend syncing your workouts to your cycle in order to support your physiology. For more information about cycle syncing your workouts, check out How to Train With Your Menstrual Cycle.
Get on the Path to Treating PMDD Naturally
If you’re struggling with PMDD, you know how scary and overwhelming it can be. It can feel like a nightmare rollercoaster you’re forced to ride once a month.
There’s no easy answer, but I hope this information can help you better understand the condition and give you some natural ways to treat PMDD.
If you know someone who is struggling with PMDD, please consider sharing this article with them! Hormone and period issues are under-addressed, and this information can help women make informed decisions about their health and their options.
Have experience with treating PMDD naturally? What worked for you? I’d love to hear your experience in the comments below!