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Are you fed-up of suffering in silence with debilitating symptoms such as crippling anxiety, mood swings, painful cramps, fatigue and breakouts that take over your life month-after-month? Perhaps you find yourself always feeling guilty for feeling like a completely different person during the week before your period and are sick of this having a negative impact on your relationship?
In this blog post, I uncover everything you need to know about PMS's ugly big sister, PMDD, and despite what your Doctor says, why a hormone imbalance could be making your monthly symptoms worse. I also take you through a few simple, yet key nutrition tips to help optimise your hormones to reduce those unwanted pre-period symptoms!
So, what on earth is PMDD?
Premenstrual dysphoric disorder (PMDD) is a very severe form of Pre-Menstrual Syndrome (PMS), affecting up to 5-8% of women of reproductive age (1). Symptoms can be debilitating, occurring 1-2 weeks before a woman’s period - also known as the luteal phase, and typically ease within the first couple of days of menstruation (hello HUGE sigh of relief when your period arrives!).
Symptoms of PMDD
PMDD has had a wider amount of attention in recent years, thanks to the likes of celebrities such as Vicky Pattison taking to social media and opening up about her experience in living with the condition. While symptoms of PMDD can often overlap with symptoms of PMS and can vary from woman to woman, it's important to note that both the range and intensity of PMDD symptoms are usually more severe and extreme. Symptoms can include (but are not limited to):
• Mood swings
• Depression, feelings of hopelessness
• Suicidal thoughts
• Intense anger and conflicts with other people
• Feeling tense or irritable
• A marked decrease in interest in usual activities
• Trouble focusing or poor concentration
• Fatigue
• Changes in appetite, including food cravings or binge eating
• Feelings of being out of control
• Sleep issues
• Physical discomforts such as breast tenderness, acne, cramps, bloating, headaches, joint or muscle pain, and hot flashes.
According to mental health charity Mind, it’s important to note that PMDD is listed as a mental health problem in the DSM-5, one of the main manuals that Doctors use to categorise and diagnose mental health problems.
Causes + Diagnosis of PMDD
Getting a PMDD diagnosis can be difficult, not just because there aren't currently any tests that can definitively diagnose PMDD, but frustratingly, many health professionals aren't even aware the condition exists which understandably, can lead to many women feeling that their symptoms, despite being severe, aren't taken seriously.
For a woman to be officially diagnosed with PMDD, she is usually encouraged to track her symptoms over a minimum of two cycles to determine whether her symptoms appear cyclically and then disappear during the follicular phase (or when her period arrives). If you suspect you have PMDD but aren't currently tracking your symptoms, I highly recommend you start doing so! Apps such as Flo and Clue can be great way to do this.
Whilst the exact cause of PMDD remains unknown, some experts suggest that it could be to do with how women’s bodies respond to fluctuating hormones during her menstrual cycle (2). Some research also suggests that there may be a genetic link to being sensitive to certain hormonal changes. Studies also suggest that inflammation, poor sleep, a sedentary lifestyle, past trauma and mental/emotional stress also have a causal relationship with PMDD (3).
Hormone testing in PMDD
While conventional PMDD protocols do not recommend hormone testing, in my clinical experience as a registered nutritionist and specialist in women’s hormonal health, comprehensive female hormone testing such as the DUTCH test can provide more insight into hormone level fluctuations throughout the menstrual cycle. This test can also reveal whether things like an oestrogen imbalance or low progesterone are present, along with poor oestrogen metabolism, which may impact the severity of hormonal symptoms.
Typical hormonal patterns we might see on the DUTCH test in those with PMDD symptoms:
Oestrogen Imbalance
Oestrogen has received lots of bad press over the years, but just to set the record straight, it can be an extremely helpful hormone for regulating your cycle and improving your mood… when present in the right amounts! While overly high oestrogen can contribute to painful periods, PMS, bloating and tender breasts, when it becomes too low, you may experience symptoms such as low mood (since oestrogen has been shown to help with serotonin production), poor sleep, food cravings and vaginal dryness.
Low Progesterone
After ovulation, the hormone progesterone increases which helps to stimulate the neurotransmitter GABA in our brain. GABA is our anti-anxiety hormone and can help to promote relaxation and feelings of calm, so if you’re not ovulating regularly and have low progesterone, this may well be affecting things like mood and mental health in general! An no, synthetic progestins found in the pill don’t have the same effect, nor will you be ovulating whilst on it. Lower levels of progesterone can therefore be a trigger for PMDD symptoms such as tension, irritability, anxiety and insomnia.
Test Spotlight: DUTCH Complete + Cycle Mapping
One version of the DUTCH test I will often use with clients with symptoms that widely fluctuate from day to day during the luteal phase is DUTCH Cycle Mapping, which includes tracking oestrogen and progesterone over the course of your entire menstrual cycle. This can provide some insight into the intensity of the rise and decline of these hormones, which occur over just a few days. For more information on the DUTCH test, and why I would always recommend testing your hormones via this way over a blood test, check out this article.
DUTCH Cycle Mapping Sample Report
Low Dopamine
Homovanillate (HVA) is the metabolite of the neurotransmitter dopamine. Issues with low dopamine may be associated with mood issues such as low mood, sleep issues, addictive behaviours, cravings (particularly for sugar!), pleasure-seeking behaviours, as well as increased sleepiness, impulsivity, feeling less motivation, and fatigue.
Low Vitamin B6
Vitamin B6 is needed for over 100 chemical reactions in the body. The DUTCH test measures two enzymes that need B6 in order to be broken down, xanthurenate and kynurenate, and high levels of one (or both) can indicate vitamin B6 deficiency. Vitamin B6 has been shown to be an important nutrient for supporting healthy progesterone levels during the luteal phase. In one study, a combination of magnesium and vitamin B6 was found to significantly decrease PMS symptoms compared to a control group. However, I would always recommend testing rather than guessing when it comes to vitamin levels before supplementing, so you know you definitely need it.
Treatment options for PMDD include:
Conventional treatment to managing symptoms PMDD:
⁃ The Pill
⁃ Antidepressants
⁃ Hysterectomy
⁃ Painkillers
⁃ GnRH Analogue Injections
⁃ Cognitive Behavioural Therapy
Natural approaches to managing symptoms of PMDD:
⁃ Balancing blood sugar
⁃ Reduce inflammation
⁃ Support healthy oestrogen levels
⁃ Prioritising sleep
⁃ Optimising gut health
⁃ Reduce caffeine
⁃ Liver support and reduce endocrine-disrupting chemicals in your environment
⁃ Targeted supplements such as Magnesium and B6
How can I manage my PMDD through diet?
I've personally seen some AMAZING results in women with PMDD and being able to reduce their unwanted premenstrual symptoms once they make a few small tweaks to their diet.
Balancing your blood sugar and consume enough protein
One of the key things I'll get my clients to focus on is ensuring they have a decent source of protein with each meal. This means no skipping meals (especially not breakfast!) and adding quality protein sources such as eggs, chicken, fish, beef, yoghurt, pulses, beans, tofu, nuts and seeds to their diet. This can really help to support healthy blood sugar levels which, in turn, helps support healthy hormones and can help to reduce cravings. Most clients I work with don't eat nearly enough protein and it really can make the biggest difference!
Correct nutrient deficiencies
A diet lacking in Omega-3 Fatty Acids and also things like Vitamin D and B6 can worsen PMDD symptoms. Oily fish such as salmon, sardines, mackerel, and anchovies are a great source of Omega-3 Fatty Acids help reduce pain and inflammation that make PMS symptoms worse. Ideally you’ll want to aim for at least 1 portion 2-3x a week.
Although the NHS recommends that everyone takes 400IU of Vitamin D during winter months, many of us actually need a lot more. However, it's always best to test to find out your baseline level before supplementing with higher doses of vitamin D. I recommend most clients get their Vitamin D levels tested at least once a year, as it’s thought that up to 70% of people living in the UK have low levels. Vitamin D plays such a vital role in mood regulation, immunity and hormonal health, with optimal levels being between 125-150nmol/L. You can easily test your Vitamin D levels from home by obtaining a test via private labs such as Medichecks. Adding in foods rich in Vitamin B6 such as almonds, avocado, turkey and chicken have also been found to reduce many common PMS symptoms.
Supporting healthy oestrogen levels
Where testing has revealed a dominance of the hormone oestrogen relative to progesterone during the luteal phase, I would encourage to really think about optimal liver and gut detoxification. This can ensure they are processing 'spent' hormones effectively and preventing them from recirculating in the body, which may contribute to the worsening of PMDD symptoms.
One of my favourite tips for supporting oestrogen levels through diet is to increase consumption of brassica vegetables (such as broccoli, cabbage, rocket and kale!) at least once daily,
Want more info?
If you want help with tackling PMDD with practical, achievable dietary and lifestyle changes that are personalised to YOU, feel free to book your free call with me now and find out more about how nutritional therapy can help. There's no pressure, if we aren't a perfect fit, I'll point you in the direction of some other helpful resources.
Alternatively, feel free to download my ‘Say Goodbye to PMS’ eBook – a FREE starter guide to getting your hormones back on track packed full of useful hints and tips to reducing your PMS symptoms naturally.
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