What is premenstrual dysphoric disorder (PMDD) and how does it differ from regular PMS?

By Natural Health and Wellness Expert, Nat Kringoudis

Premenstrual dysphoric disorder (PMDD) is said to affect around 1 in 20 women. PMDD can leave women suffering with severe symptoms from as early as ovulation, right through to the period time. This is the key difference between PMDD and PMS where the later, women typically experience symptoms for 4-5 days in the lead up to menstruation.

Both PMDD and PMS are due to hormone changes in the luteal phase (from ovulation to menstruation). The severity and duration of these symptoms is what differs most for women who have PMDD with some women experiencing symptoms for up to half of her cycle.

What are the signs of PMDD?

Most common symptoms of PMDD include:

• very low mood or depression and a general feeling of hopelessness
• extreme mood swings ranging from sadness to anger or even rage
• physical symptoms may include swelling, puffiness and extreme bloating
• breast tenderness
• headaches and general body aches
• possible bowel changes

Are there any factors that make someone more susceptible to PMDD?

Given that PMDD is a result of hormone changes if there are pre-existing hormone imbalances this may contribute and worsen symptoms.

It has also been noted that for those who have experienced trauma, be it childhood or more recently, there may be increased hormone sensitivity, which is important to consider although not the only contributing factor.

It’s always important to look at the genetic mother line if there is a history of PMDD, it may mean you have a predisposition.

Can PMDD change over time and how is it affected by perimenopause?

Given the timing of the symptoms in PMDD (the second part of the cycle) it’s likely that symptoms are related to the hormone progesterone which is predominantly produced in the second half of the cycle as a result of ovulation.

Progesterone is naturally a calming hormone. If sex hormones are imbalanced during the luteal phase or specifically progesterone is low, it can result in a variety of symptoms including breast distention, swelling or bloating, puffiness, headaches, and mood changes. Progesterone levels may also decrease during times of elevated stress as cortisol levels rise. Supporting progesterone in the second phase of the cycle may assist with symptoms.

Women report changes and less severity of symptoms when their hormones are supported and in times of lessened stress.

During perimenopause, we begin to see a very slow, natural decline in ovarian function. This is perfectly normal and may span over 20 or more years, however, as a result, we begin to see small hormone fluctuations that can contribute to mild symptoms. When we couple this with high stress and cortisol we can see higher fluctuations due to the impact of cortisol on other sex hormones, which results in bigger shifts and more obvious symptoms. This may contribute to PMDD symptoms.

How is PMDD affected by hormonal medications such as the Pill?

The pill is most commonly prescribed to treat a variety of problems from acne to PMS/PMDD, period pain to missing periods as it works by suppressing hormones. Sadly this cannot treat the cause of the imbalance and when a woman ceases using birth control, many symptoms may return often worse than before.

Depression, anxiety, low moods as well as headaches and fluid retention as all known side effects many women experience whilst taking synthetic birth control. If there is a history of mood changes or mood disorders or headaches, it is best advised to speak to your doctor about the side effects of the pill and to determine if this is right for you.

Can PMDD and PMS get worse if you are going through a traumatic period (for instance grief or burnout)?

PMDD and PMS symptoms are often proportionate to stress levels. Cortisol and progesterone are in competition and under stress, the rise in cortisol impacts progesterone which may explain why these symptoms are heightened. I’ve seen many women come into the clinic after a vacation reporting their symptoms were far less severe.

It’s important to say – stress comes in many forms including loss, overwhelm, work or home pressures, but it can extend to lack of sleep or poor nutrition. Every little bit you can do to help your body through times of pressure counts.

Are there any steps women can take to improve the effects of PMDD?

• PMDD and PMS do respond well to specific care. As we’ve established, stress is a huge factor when it comes to hormone imbalances and specifically cortisol and progesterone so here are a few things that have been shown to help.
• Those experiencing Magnesium, vitamin D and vitamin B6 deficiency may be more likely to have symptoms of PMS and PMDD. Generally these are safe to supplement but it is advised to speak to your health care provider to see if this is right for you.
• Assess your stress levels. Stress becomes habitual and we can exist in a state of overwhelm momentarily but when it is constant, it begins to take its toll on the body and hormones. Start to become conscious of when you feel overwhelmed as a first step – you can’t do anything about it if you’re not even aware you’re actually feeling it.
• Moving your body has been shown to positively impact both mood and sleep issues associated with PMDD and PMS. Aim to move your body at least every second day if not daily.
• Focus on nutrition as it has been shown to help. Increasing quality fats and protein as well as fibre will help with cravings and balance blood sugar levels to reduce inflammation. Increasing vegetables and nutrient dense foods goes a long way.

What should you do if you think you might have PMDD?

Speak to your health care provider about symptoms and concerns that you may have and remember it’s ok to ask for help. Try these steps above also to see if you notice any positive changes. Your health provider may have more specific recommendations that suit your individual needs and take into consideration your health history also.