PMS is not normal but quite common, affecting about 95% of women of reproductive age, while PMDD affects up to 10% of women. Premenstrual syndrome (PMS) includes physical and mental-emotional symptoms during the luteal phase of the menstrual cycle (two weeks before menstruation), which can lead to substantial distress and unhappiness. Unlike common premenstrual symptoms, Premenstrual Dysphoric Disorder (PMDD) goes beyond the usual mood swings and physical discomfort. PMDD significantly impacts the lives of those who experience it. In this article, we will explore the key aspects of PMS and PMDD, including symptoms, root causes, diagnosis, and potential natural treatment options for greater hormone balance.
Symptoms of PMS
Typical complaints of PMS are cyclic irritability, tension and unhappiness.
Emotional symptoms of PMS may include:
anxiety, stress, anger, depression;
mood swings;
poor concentration, poor judgement;
food cravings;
change of sex drive.
Physical symptoms of PMS may include:
sleeping difficulty or disturbance;
headache;
abdominal cramps;
fatigue;
constipation or diarrhea;
breast tenderness;
acne flare-ups;
joint pain.
Symptoms of PMDD
PMDD symptoms are debilitating and include:
Severe Mood Swings: PMDD often causes extreme mood swings, ranging from intense irritability, anger, rage to profound sadness, anxiety, suicidal ideation.
Physical Symptoms: Individuals with PMDD may experience physical symptoms such as bloating, breast tenderness, diarrhea, constipation, and headaches.
Sleep Disturbances: Insomnia or disrupted sleep patterns are common during the luteal phase for those with PMDD.
Difficulty Concentrating: Cognitive functions may be impaired, making it challenging to focus or make decisions.
Fatigue: Many individuals with PMDD report feeling extremely tired and lacking energy.
Jealousy: Many individuals can experience intense feelings of jealousy that they normally don't feel.
Root Causes of PMS and PMDD
Getting to the root cause of symptoms is the foundation for holistic medicines such as naturopathic medicine, ayurvedic medicine, and functional medicine. It is believed that disease is due to an imbalance or stress in the mind that then affects the body, the spirit, and how one relates to the environment. So when we are looking to heal or feel better, we need to address the mind first and then work to restore and balance the body. Symptoms are the body's intelligent way of signaling imbalance.
The exact cause of PMS and PMDD is unknown and multifactorial. This means that there are several factors contributing to these premenstrual conditions. Estrogen surplus, progesterone deficiency, and a decline in acetylcholine, dopamine, and serotonin have all been proposed. Those with PMDD have a higher sensitivity to these hormonal changes, especially with lower serotonin levels.
Research suggests a variety of factors associated with PMS and PMDD:
Early childhood or previous experience of trauma, abuse, and/or neglect
Alexithymia, difficulty identifying and expressing internal emotions
Chronic criticism of oneself and the world around them
Chronic overworking
Excessive people pleasing or lacking boundaries
Excess intake of sugary foods and drinks
Excess intake of deep fried foods, artificial foods, and fast foods
Excess intake of coffee or caffeine
Chronic alcohol use
Gut health imbalance - infections, leaky gut
Chronic stress
Chronic overthinking and worry, weakening spleen function
Irregular meals or overfasting
Chronic emotions such as rage, anger, embarrassment, and depression, damaging liver function
Not prioritizing sleep or rest
Less habitual exercising or movement of the body
Neuroticism
Poor social support
Nutrient deficiencies of B vitamins, Vitamin D, calcium, and magnesium.
These factors are not to shame but to shine light on what may be contributing to the severity of symptoms. Healing is all about self discovery and self compassion.
Diagnosis of PMS and PMDD
There are no gold standard measures such as lab work or imaging specific to diagnosing PMS or PMDD. Women who suspect they may have signs and symptoms of PMS or PMDD should be evaluated by their gynecologist for a complete workup and physical exam. Since there are also mental-emotional health symptoms present in PMDD, an evaluation by a mental health professional may also be encouraged. Tracking symptoms with an app or journal may be helpful information to share with health professionals. A few top rated menstrual cycle trackers are: Flo, Clue, Spot On, Cycles.
To meet criteria for PMDD, a woman must experience five or more of the symptoms listed above during the week before most menstrual cycles within a year, symptoms must interfere with work and life, and symptoms can not be caused by another medical condition.
Treatment Options
Currently, conventional medicine emphasizes treatment of PMS and PMDD symptoms rather than addressing the underlying root causes. A conventional doctor will usually prescribe:
NSAIDs such as ibuprofen to ease abdominal cramps, pain, and breasts tenderness;
Anti-depressant drugs, for examples, Prozac or Zoloft for controlling emotions in cases of severe PMS or PMDD;
Birth control pills to stop ovulation and disrupt the menstrual cycles;
Diuretics to reduce water retention.
Holistic treatments emphasize overall wellness and alleviation of symptoms. Naturopathic doctors focus on treating the whole person, addressing underlying root causes, and preventing future symptoms. Each person has different needs and sometimes a combination of conventional and holistic treatments is warranted. Holistic treatment options that promote greater hormone balance include but are not limited to:
Regular Movement
Stretching, walking, swimming, jogging, dancing, martial arts, gardening, yoga, shaking, bouncing, tai chi, qi gong.
Regular Feeling
Feeling your feelings - name them, notice them, listen to them, and then let them go.
Journaling practice.
Talk or CBT therapy.
Somatic therapy.
Mindful Breathing
Belly breathing.
Box breathing.
Alternate nostril breathing.
Meditation.
Nourishing Diet
Regular meals with lots of fruits and veggies.
Increase of complex carbs in the luteal phase - lentils, millet, quinoa, sweet potatoes, beans, etc.
Consumption of fermented foods - yogurt, kefir, sauerkraut.
Filtered water between meals.
Restriction in caffeine and alcohol.
Reduction in sugary, fried, and fast foods.
Seed Cycling for PMS and PMDD: Seed cycling is a gentle practice to balance hormones where you add certain seeds to your diet during the different phases of the cycle. Pumpkin seeds and flaxseeds are eaten from menstruation to ovulation (days 1-13) to support estrogen. Sesame and sunflower seeds are eaten from ovulation to menstruation (days 14-28). You can purchase organic ground seeds with Replenished Roots using the code DRFELTY15 for 15% off any purchase (and not limited to one purchase). ***Seed cycling and other natural treatments usually take at least 3 cycles to see changes or improvement.
Lifestyle Practices
Getting sunshine in the eyes at sunrise and sunset to promote serotonin production.
Reduction in toxic products (cleaning products, makeup, cookware, plastic Tupperware) that can cause hormonal imbalance.
Slowing down for more rest and play, especially in the luteal phase.
Sweating regularly.
Restore gut health, liver health, and gallbladder health for daily bowel movements.
Detox any mold, heavy metals, or toxins.
Doing things that enhance joy.
Prioritizing sleep when the body needs it.
Daily Mindset
Gratitude practice.
Positive self talk.
Challenging negative thoughts.
Prayer.
Meditation.
Supplements Available on Fullscript.com, Dr. Felty's online dispensary
Vitamin D 4000-5000IU throughout the cycle for PMS and PMDD. (Check Vitamin D levels - optimal levels are 40-60).
B Complex throughout the cycle for PMS and PMDD.
Magnesium Glycinate before bed throughout the cycle for PMS and PMDD. Helps with sleep, muscle tension, stress, constipation.
Omega 3 throughout the cycle for PMS and PMDD.
Easy and Free Wanderer or Vitex (Chasteberry) throughout the cycle to reduce PMS and PMDD symptoms.
DIM Detox (Dim + Milk Thistle) throughout the cycle for PMS and PMDD. Helps detox excess hormones and supports liver function.
HPA Adapt (Ashwaghanda, Maca Root, Rhodiola, Holy Basil) throughout the cycle for PMS and PMDD. Helps with stress, concentration, and a sense of calm.
Evening Primrose Oil during the luteal phase for PMS and PMDD. Supports progesterone levels.
Calcium 500mg during the luteal phase for PMDD.
Saffron 15mg/day during the luteal phase for PMS or PMDD.
Emotional Wellness (5HTP, L-Theanine, GABA) during the luteal phase for low serotonin in PMS or PMDD. Great formula for anxiety, panic, depression, sadness. (Do not use when already taking antidepressants).
Other Holistic Modalities That Can Help
Psychedelic Therapy (microdosing mushrooms)
Acupuncture
EMDR/Biofeedback
Hypnotherapy
Massage
Chiropractic Care
Energy Healing
Faith Healing
Managing PMS and PMDD involves a combination of treatments, modalities, and self-care strategies that work for the individual. Support from healthcare professionals, friends, and family is crucial. Developing coping mechanisms such as mindfulness, relaxation techniques, and maintaining a healthy lifestyle can contribute to symptom management and healing. Want to try a meditation program made specifically for PMDD to get in tune with your cycle and reduce PMDD symptoms? Try this one: https://www.periodsuperpower.com/courses/SCA-Application
Conclusion
PMS can be a challenging condition. PMDD can significantly impact the lives of those affected. Understanding the symptoms, root causes, and exploring appropriate treatment options are crucial steps toward managing PMS and PMDD effectively. By raising awareness and fostering open conversations about these often-overlooked disorders, we can contribute to a better understanding and support for individuals living with PMS and PMDD.
Looking for a more personalized approach to help with your PMS or PMDD symptoms? Book a consultation with Dr. Cresencia Felty.
Link to Dr. Felty's supplements for PMS and PMDD: https://us.fullscript.com/plans/drfelty-pms-pmdd
References
Premenstrual syndrome: https://www.ncbi.nlm.nih.gov/books/NBK560698/
PMDD: https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder: https://pubmed.ncbi.nlm.nih.gov/22611222/
Traditional Chinese medicine on treating premenstrual syndrome and premenstrual dysphoric disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571909/#:~:text=TCM%20considers%20PMS%2FPMDD%20to,%E2%80%9Cdisease%E2%80%9D%20and%20TCM%20syndrome.
Management of PMDD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790166/
Disclaimer: This is not medical advice. This article is for educational purposes only. Please speak with your doctor before making any changes or starting any new supplements especially if you are on any medications.