PMDD vs. PMS: Recognising the Difference and Finding Relief

PMDD (Premenstrual Dysphoric Disorder) affects up to 5-8% of menstruating women and is much more than just "bad PMS." It’s a severe condition that significantly disrupts daily life, relationships, and emotional well-being. Shockingly, it can take an average of 20 years for women to receive an accurate diagnosis and treatment. 

If you’ve been feeling misunderstood or dismissed when discussing your premenstrual symptoms, this post is for you. We’ll explore the symptoms of PMDD, how it’s diagnosed, and both conventional and holistic approaches to managing this complex condition, helping you feel more informed and empowered. 

What is PMDD? 

PMDD is a severe form of PMS that goes beyond the typical premenstrual symptoms many women experience. It profoundly impacts emotional, physical, and mental health, often interfering with work, relationships, and daily life. 

Unlike PMS, PMDD is defined by intense mood-related symptoms like severe anxiety, depression, and anger. These symptoms occur during the luteal phase (1-2 weeks before menstruation) and improve once your period begins. In severe cases it can start straight after ovulation. PMDD is not caused by higher or lower levels of hormones but by an increased sensitivity to the normal hormonal fluctuations that occur during the menstrual cycle. 

Symptoms and Diagnoses of PMDD 

Key differences between PMS and PMDD include the severity of symptoms and the extent to which they interfere with relationships, work, or daily routines. 

PMDD is diagnosed through symptom tracking over at least two menstrual cycles and must meet specific criteria outlined in the DSM-5.  

DSM-5 Criteria

PMDD requires at least five symptoms (with at least one core symptom) occurring during the luteal phase, significantly impairing daily life.

Core symptoms 

• Marked affective lability (rapid, exaggerated change in mood) 

• Marked anxiety 

• Marked depression 

• Persistent irritability 

Other symptoms 

• Decreased interest in usual activities 

• Subjective sense of difficulty in concentrating 

• Lethargy 

• Appetite changes 

• Hypersomnia or insomnia 

• Physical symptoms such as breast tenderness, swelling, headaches, joint or muscle pain, bloating, weight gain 

A healthcare provider can confirm the diagnosis and guide you through treatment options. 

What Causes PMDD? 

The cause of PMDD is not fully understood but we know that it results from an increased sensitivity to hormonal fluctuations during the menstrual cycle. Here’s a breakdown of the factors involved: 

• Allo-pregnenolone (ALLO): This progesterone metabolite typically has a calming effect on the brain by interacting with the GABA system, which promotes relaxation. In women with PMDD, fluctuating ALLO levels can lead to heightened anxiety and irritability. 

• Serotonin dysregulation: The serotonin system is heavily involved in PMDD, with disruptions contributing to mood swings and emotional instability. 

• Stress and trauma: PMDD symptoms worsen with stress, and women with a history of trauma are more likely to experience the condition due to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. 

• Thyroid function: Low thyroid hormones, particularly T3, can exacerbate PMDD symptoms by disrupting neurotransmitter activity in the brain. 

• Genetics: Twin studies suggest a genetic predisposition. 

Treatment Options for PMDD 

Conventional Treatments

Antidepressants: SSRIs are often prescribed to regulate serotonin levels. They can be taken cyclically (only during the luteal phase) or continuously. 

Hormonal Treatments: While commonly used, studies show oral contraceptives may not be any more effective than a placebo for managing PMDD symptoms. 

Holistic and Natural Approaches

A holistic PMDD treatment plan may include lifestyle changes, dietary adjustments, herbal remedies, and targeted supplementation. 

Nutrition and Key Supplements 

Magnesium & B6: Magnesium promotes relaxation and reduces anxiety, while B6 supports serotonin production for mood regulation. 

Taurine: This amino acid helps regulate the nervous system, promoting calm and balance. 

Calcium: A daily dose of 500-1200mg, paired with vitamin D, reduces mood swings and supports neurotransmitter function. 

Herbal medicine - Saffron 

Saffron, taken during the luteal phase, has been shown to be as effective as antidepressants in reducing PMDD symptoms. It supports serotonin levels and improves mood. 

Light Therapy 

Bright morning light therapy boosts serotonin and dopamine, lifting mood and reducing depressive symptoms. 

Stress Management 

Find stress-relieving activities that suit you. Whether it’s yoga, mindfulness, creative hobbies, or nature walks, these practices reduce cortisol and improve emotional well-being. 

Histamine Intolerance and PMDD 

Histamine intolerance may contribute to PMDD symptoms. 

Symptoms of Histamine Intolerance: Include headaches, hives, nasal congestion, digestive upset, headaches, migraines, insomnia, brain fog and anxiety. 

Treatment options: 

• Low-histamine diet 

• Supplements like quercetin, SAMe, B6, black cumin seed extract, and stinging nettle leaf extract 

• Trialing antihistamines may provide relief and gives you a clue whether histamine is contributing to your symptoms. 

For more information about histamine read my post Histamine Intolerance and its Effects on Hormones and Period Health.

Thyroid Health 

Optimise thyroid function, particularly T3 levels, to improve neurotransmitter activity and mood stability. 

When to Seek Help 

If PMDD symptoms are severely affecting your relationships, work, or daily routines, it’s important to seek professional support. Getting support from a Naturopath can provide a personalised approach that addresses the root causes of your symptoms. 

PMDD is a complex condition, but understanding its symptoms and treatment options can make a world of difference. Whether you pursue natural strategies, conventional medicine, or a combination, there’s a path to relief. 

Think PMDD might be affecting you? Book a free discovery call to chat about how my Holistic Health Coaching Program can support you. 

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