All About PMDD: Is it my hormones, my brain, or both?

Understanding PMDD: More Than Just Severe PMS

PMDD (premenstrual dysphoric disorder) has been gaining much-needed attention in recent years. Many women discover their monthly PMS symptoms are far more severe than typical, eventually leading to a PMDD diagnosis. This article takes a deep dive into what PMDD really is, its signs and symptoms, underlying causes, and effective treatment options to help you better understand your body and find the right approach for you.

What is PMDD and How Do You Know If You Have It?

PMDD is a severe, often debilitating form of PMS. Think of PMS as a spectrum ranging from mild to severe. Mild PMS where you feel slightly more sensitive or notice minor changes before your period is normal. However, severe symptoms that significantly disrupt your quality of life typically indicate PMDD, placing it at the highest end of the PMS spectrum.

PMDD is characterized by physical and psychological symptoms that occur in the week or two before your period and disappear a few days after menstruation begins. These symptoms can profoundly impact daily life and relationships.

Psychological Symptoms of PMDD:

• Anger and irritability
• Feeling “out of control” or paranoid
• Depressed mood and anxiety
• Mood swings and crying spells
• Emotional sensitivity
• Loss of interest in usual activities

Physical Symptoms of PMDD:

• Sleep disturbances (insomnia or excessive sleep)
• Severe fatigue
• Breast tenderness and pain
• Swelling in hands, feet, or other areas
• Appetite changes
• Hot flashes, bloating, and constipation
• Pelvic pressure, backache, and headaches
• Heart palpitations and acne

Many physical symptoms overlap with other gynecological conditions like endometriosis, uterine fibroids, or ovarian cysts. It’s crucial to see a gynecologist who will rule out other diagnoses before labeling your condition as PMDD.

Even if you don’t meet the full criteria for PMDD diagnosis, disruptive PMS symptoms shouldn’t be dismissed as “normal.” This article focuses on the psychological aspects of PMDD, though the principles apply to both PMS and PMDD.

What Causes the Psychological Symptoms in PMDD?

Why do some women experience severe PMDD while others barely notice PMS symptoms? The leading explanation is the “neurotransmitter-hormone” hypothesis, which also involves inflammation and stress hormone systems.

The Neurotransmitter Hypothesis Explained

This hypothesis suggests PMDD results from interactions between neurotransmitters (serotonin, norepinephrine, GABA) and hormones (estrogen and progesterone). The key insight: it’s not that hormone levels are abnormal, but that women with PMDD have nervous systems that are more sensitive to normal hormone fluctuations.

Consider this example: Two women have identical estrogen (80) and progesterone (5) levels. Sarah experiences severe psychological symptoms before her period, while Laila has no symptoms at all. This illustrates the core concept—it’s about nervous system sensitivity to hormones, not abnormal hormone levels themselves.

How Hormones Affect Neurotransmitters

Estrogen and progesterone significantly influence neurotransmitter production and activity, and these effects are amplified in PMDD:

• Estrogen increases production of serotonin, dopamine, and epinephrine
• Progesterone boosts GABA production

While these might sound beneficial, imbalances can cause problems. Too much neurotransmitter activity can create a “wired” or “on-edge” feeling, while too little can lead to anxiety and depression.

How is PMDD Treated?

Since hormone levels typically fall within normal ranges, PMDD treatment focuses on reducing nervous system sensitivity and supporting both hormonal and brain health.

Conventional Medical Approaches

SSRI medications and birth control pills are often prescribed together for PMDD:

• SSRIs target neurotransmitter balance
• Birth control addresses hormonal fluctuations

However, these medications come with side effects and risks, and symptoms typically return when medications are discontinued. SSRIs can increase suicidal thought risk with long-term use, while birth control carries blood clot risks and can deplete essential nutrients like vitamin B6.

Natural Treatment Options

Many patients prefer natural alternatives that don’t carry these risks. Here are evidence-based nutrient approaches:

Magnesium, Vitamin B6, and Calcium Combination:

• Magnesium: Helps with period cramps and mood regulation (consult your doctor if on blood pressure medication)
• Vitamin B6: Supports mood symptoms at 100 mg/day (don’t exceed this dose)
• Calcium: Reduces mood symptoms at 1,200 mg/day
• Omega-3s: Essential for brain health at 3,000-4,000 mg/day

Important Notes:

• Consult your healthcare provider before starting supplements
• Most supplements reach peak effectiveness after 3 months of consistent use
• Herbal options include St. John’s wort, vitex/chaste tree berry, ashwagandha, reishi mushroom, and motherwort

Addressing Root Causes

Alongside supplements, addressing underlying factors is crucial for long-term management:

• Detoxify environmental estrogens from chemicals in personal care and household products
• Optimize gut health with daily bowel movements and proper fiber intake (estrogen exits through stool)
• Support liver function where estrogen detoxification occurs
• Provide brain-supportive nutrients from foods and supplements
• Manage stress through HPA axis support and inflammation reduction

Finding Your Path Forward

Effectively addressing PMDD requires targeting both hormonal and brain health. If you’re struggling with PMDD, know that you’re not alone and multiple treatment options exist. Work with a provider who makes you feel heard and validated, and remember: your treatment plan should leave you feeling empowered, not overwhelmed.