Premenstrual Dysphoric Disorder (PMDD)
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- What is PMDD?
- Symptoms of PMDD
- Causes of PMDD
- Prevention of PMDD
- Risk factors for PMDD
- Complications of PMDD
- When to see a doctor about PMDD
- Diagnosis of PMDD
- Conventional treatment of PMDD
- Alternative/complementary treatment of PMDD
- Living with PMDD
- Caring for someone with PMDD
Alternative/complementary treatment of pre-menstrual dysphoric disorder (PMDD)
Alternative medical practitioners such as naturopaths do not really think that PMDD is a psychological condition, but that it is just an amplification of PMS, which means that PMDD basically has nutritional deficiencies which can be treated with alternative/complementary therapy.
To get a better understanding of your PMDD (or PMS), see a qualified naturopath who can tailor a program of nutrition, supplements, lifestyle changes and herbs just for you.
Herbs
There are a number of herbs which are routinely recommended for assisting with not only reducing symptoms but also to help balance hormones:
- Chamomile (matricaria chamomila) - an excellent herb for relaxing the whole body and is particularly useful for women whose PMDD causes sensitivity, irritability, crying, timidity and feelings of inadequacy
- Chaste berry (agnus castus) - this is the berries of the chaste tree, indigenous to Southern Europe, the Mediterranean and Asia. The berries contain compounds which act on the pituitary gland, specifically on the production of luteinising hormone to influence progesterone levels during the second half of the menstrual cycle, which is when PMDD occurs. Chaste berry is highly effective in treating menstrual irregularities, breast pain and premenstrual complaints
- Dandelion (taraxacum officinale) - is an excellent natural anti-diuretic which is well tolerated by most women, which makes it an excellent tonic for women that have symptoms of fluid retention symptoms. Dandelion also works on the liver to detoxify it from all toxins in general and excessive amounts of eostrogen in particular
- Dong quai (angelica polymorpha) - is a herb widely used for treating PMDD as it has analgesic and sedative properties, which is good for treating anxiety and pain symptoms. Note: excessive doses can cause uterine contractions and should be avoided in women who are trying to get pregnant
- Lavender (lavandula vera) - as an essential oil is beneficial for reducing nervous tension and to treat insomnia as it is a relaxant. Lavender can be applied in a number of ways - a few drops to the pillow, some drops to an oil burner, as a room spray or even a few drops on the skin (as long as it is the diluted form). Note: some people may be allergic to the oil if applied topically, so use with caution in this manner
- Lemon balm (melissa officinalis) - is a very soothing herb, which has mild muscle relaxant properties, so is beneficial for anxiety symptoms, especially for insomnia as it helps to reduce the time to get to sleep and assists with a better quality of sleep. Lemon balm is very effective if stress has adversely affected the stomach and digestive system too
- St John's wort (hypericum perforatum) - is a well known and much used herb to treat mild to moderate depression from any cause. It is widely used in many countries by doctors) as an alternative treatment to anti-depressant medications. St John's wort helps to support the nervous system as a whole, which means it is helpful for all PMDD symptoms, but it also has a sedative effect which means it is good for women with anxiety and insomnia symptoms. Note: St John's wort should never be used together with anti-depressant medications as this combination can produce serious health effects
- Valerian (valeriana officinalis) - is a herb that is widely used for its calming effects on the mind. It is especially useful for stress-related anxiety, tension and insomnia and for depression caused by stress or nervous tension. Studies show that valerian is an excellent non-addictive sleep aid, as it helps people fall asleep quite quickly and improves the quality of sleep. Valerian is useful for anxiety and stress, but lower doses needed to be used during the day for this purpose. Note: about 2%-5% of people experience the opposite effects when taking valerian - they become more alert, more awake, more wired up and do not calm down and relax if they take valerian, so try it at a smaller dose to be sure or try other herbs such as chamomile or lemon balm which are gentle and soothing
Vitamins
There are a number of vitamins especially beneficial for reducing PMDD symptoms:
- Vitamin B1 - thiamin is very useful in supporting the nervous system, which may not be functioning as effectively as normal and may not be able to handle stress as well as it should
- Vitamin B2 - riboflavin is very useful in supporting the nervous system, which may not be functioning as effectively as normal and may not be able to handle stress as well as it should
- Vitamin B3 - niacin is very useful in supporting the nervous system, which may not be functioning as effectively as normal and may not be able to handle stress as well as it should
- Vitamin B5 - pantothenic acid is very useful in supporting the nervous system, which may not be functioning as effectively as normal and may not be able to handle stress as well as it should
- Vitamin B6 - pyridoxine is involved in the synthesis of specific neurotransmitters that regulate mood and which may be at abnormally low levels during PMDD. Vitamin B6 helps to balance the amount of certain neurotransmitters, thereby reducing mood swings and depression, anxiety and regulating mood during PMDD
- Vitamin B12 - cyanocobalamin is very useful in supporting the nervous system, which may not be functioning as effectively as normal and may not be able to handle stress as well as it should
- Vitamin D - the hormone vitamin D assists in the absorption of calcium and thereby gives relief to some of the symptoms associated with PMDD which are related to a deficiency of calcium (excess of eostrogen)
- Vitamin E - the powerful antioxidant and free radical scavenger vitamin E helps to alleviate breast tenderness, fluid retention and pain symptoms associated with PMDD
Minerals
There are a number of minerals especially beneficial for reducing PMDD symptoms:
- Calcium - plays quite a big role in hormone regulation. It has been shown in various studies that the level of calcium drops in the two weeks preceding menstruation. Those studies showed that if calcium levels were increased at this time, many of the symptoms of PMDD were reduced. Calcium supplements should be taken with Vitamin D and magnesium to ensure there are correct ratios of all three nutrients
- Chromium - is especially beneficial for regulating insulin levels in women with an exaggerated insulin response and reducing the cravings associated with PMDD
- Magnesium - is important for hormone production and metabolism, as well as for the proper use of calcium and vitamin D. Magnesium deficiency during PMDD is associated with decreased levels of dopamine (which is a neurotransmitter that helps to calm the brain) and an inability to synthesise linoleic acid properly. Studies show that magnesium deficiency is common in women with PMDD. Chocolate, which contains magnesium, is a food often craved by women experiencing PMS, due to the body's need for magnesium
- Zinc - acts as a hormone regulator due to its function with various enzyme processes in the body, so it is very useful for controlling PMDD symptoms by balancing the hormones circulating in the body. In addition to this, zinc helps to metabolise linoleic acid properly (which is needed to produce the anti-inflammatory PGE1 prostaglandins that help reduce pain and fluid retention)
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Other nutrients
There are a number of important nutrients which can be beneficial in helping reduce symptoms:
- DHA/EPA - these two omega-3 essential fatty acids are found mainly in fish oil and have excellent anti-inflammatory properties due to the excellent omega-3 fatty acids they contain. Fish oil which contains high levels of DHA/EPA are often prescribed for women with PMDD to help with pain, depression and fluid retention especially
- Evening primrose oil - this supplement is especially beneficial for the pain group, but it is also great for all women experiencing all types of PMDD as it helps to reduce inflammation. Evening primrose oil is also great for women experiencing breast pain and tenderness, depression, irritability and fluid retention. The GLA (gamma-linolenic acid) in EPO (evening primrose oil) helps to regulates the hormone prolactin, which may be too high in some women, causing the symptoms of PMDD
- Linoleic acid - is required to ensure proper synthesis and metabolism of PGE1, which is a specific anti-inflammatory prostaglandin that has been shown to assist women who have either fluid retention or pain symptoms. One of the richest sources of gamma-linoleic acid (GLA) is evening primrose oil, which is why it is most often prescribed for women with PMDD
- Tryptophan - is an essential amino acid which is the precursor of serotonin, a neurotransmitter in the brain that helps to normalise mood (it relaxes and calms the brain). Some scientists think that an imbalance in serotonin could be an underlying factor in women who experience the depression and anxiety symptoms, so supplementation of tryptophan may help to ease these type of symptoms
- Tyrosine - is a non-essential amino acid which is involved in the proper function of the thyroid, as well as adrenal and pituitary glands. Some scientists think that an imbalance in any of these glands, but especially the adrenal glands (which control how well we handle stress) could be one of the underlying factors of PMDD and especially the anxiety symptoms and tyrosine may be the key to this. In addition, an imbalance of the thyroid hormones can cause symptoms very similar to PMDD and in fact, most women with PMDD (or severe PMS) seem to have some type of thyroid disorder - these two conditions seem to go hand-in-hand (although science is yet to prove why and solve the riddle of these disorders)
Dietary modifications
There are a number of dietary modifications that can be implemented to help reduce symptoms of PMDD:
- Increase fibre intake - fibre binds with excess eostrogen in the blood to help get rid of it and help normalise levels of eostrogen, which reduces the symptoms associated with anxiety. Fibre also helps digestion, by ensuring there is no build-up of toxins or waste by removing them and reducing bloating
- Increase foods high in vitamin B6 - this mineral is really important in PMDD as it is a precursor to serotonin, a neurotransmitter that is responsible for maintaining mood on an level (and happier) basis. Eating foods rich in vitamin B6 (and taking a supplement if necessary) can help to regulate serotonin levels, improve mood and may reduce anxiety and depression symptoms associated with PMDD
- Increase intake of fish - oily fish contains the beneficial omega 3 essential fatty acids DHA/EPA, which have a proven anti-inflammatory effect on the body and are very useful in preventing pain, fluid retention and inflammation symptoms of PMDD
- Increase intake of phytonutrients - (or phytochemicals) are responsible for flavor, color, and disease-resistance in plants (fruits, vegetables, whole grains and legumes). Most are antioxidants that benefit humans by enhancing immunity, strengthening heart and blood vessels and preventing tumors. They are also found in smaller amounts in nuts and seeds. Certain phytonutrients (namely phytoeostrogens) can help to balance abnormal hormone levels that occur during PMDD - and they are found mainly in: soya, flax seeds, wheat, rice, oats, barley, carrots, potatoes, apples, cherries, plums and parsley. Vegetable oils such as safflower, wheatgerm, corn, olive, linseed (flaxseed), peanut, soya and coconut oils also have some level of phytoeostrogens
- Increase intake of sunflower seeds - which are rich in the essential fatty acid linoleic acid which helps to reduce symptoms of PMDD by increasing the amount of the anti-inflammatory prostaglandin PGE1 and reduce pain and inflammation as well as fluid retention
- Increase intake of vegetables - vegetables contain so many vitamins and minerals which may be in deficit during PMDD and so exacerbate PMDD symptoms. Fruit and vegetables are also rich in potassium,which helps to regulate sodium levels in the body and prevent symptoms of fluid retention
- Limit caffeine - coffee, tea (except for most herbal teas), chocolate and some energy drinks all have caffeine, which can all over stimulate the brain and aggravate feelings of depression, irritability and anxiety as well as worsening breast tenderness and bloating, which are not beneficial during PMDD, when calm and relaxation are required
- Limit processed foods - most processed foods are very high in saturated fat, sugar, salt, calories and have little nutritional benefit at any time, but have even less relevancy at PMDD when foods high in nutrients are needed to help support the body and reduce symptoms
- Limit refined sugar intake - sugar is basically empty calories and for women who have unbalanced glucose levels and an exaggerated insulin level to carbohydrates will continue to have symptoms associated with this during PMDD. High sugar intake also increases prostaglandin levels, which make pain and other symptoms worse and in addition to this, excessive sugar intake makes the body excrete too much magnesium, which is needed to calm down the muscles and help them relax and less magnesium means more PMDD symptoms
- Limit saturated fats - saturated fats, especially from non-organic meat may contain various hormones and other chemicals which can further cause imbalance to hormones (especially by increasing eostrogen to excessive levels) and should be avoided
- Reduce dairy intake - intake of high fat dairy foods is associated with a higher than normal eostrogen to progesterone ratio and the anxiety-type symptoms during PMDD, so either eating only law fat dairy foods (milk and yoghurt) and restricting other forms of dairy may be beneficial in reducing symptoms
- Reduce salt intake - women who have an increased sodium retention during PMDD need to limit the amount of salt in foods they eat, especially limiting processed foods, which contain high levels of sodium
- Strictly limit alcohol - this is because alcohol is a natural depressant, so it really does not help PMDD symptoms and should be avoided as much as possible
Lifestyle modifications
There are a number of lifestyle modifications which are recommended for helping women with PMDD reduce symptoms:
- Exercise - studies show that regular exercise in combination with a healthy diet can help reduce all PMDD symptoms to a degree. The reason exercise helps alleviate PMDD is because during physical activity, all the cells receive more oxygen and are able to eliminate more waste (including excess fluid, excess eostrogen and toxins), plus exercise releases endorphins, which create a sense of positivity and happiness, which can reduce symptoms such as depression, irritability and mood swings. Exercise is a great outlet for pent-up frustrations and anxiety, plus it helps to keep hormones in balance
- Sleep - getting enough sleep is important because is helps the body repair and recover from the day's activities. Without adequate sleep, PMDD symptoms can be aggravated as lack of sleep causes anxiety, mood swings and tension
- Socialise - feeling socially isolated can lead to feelings of depression and anxiety, which only further exacerbate PMDD symptoms. It is important to keep in touch with friends and socialise to feel connected to other people, plus it's always good to talk to other women about PMDD as they may be able to sympathise
- Meditate - studies show that any type of meditation which helps to calm the mind is beneficial for significantly reducing symptoms of PMDD, especially the anxiety and depression symptoms
- Tai chi - numerous studies have shown that tai chi has a calming effect on the mind, in a similar way to meditation and can help to reduce symptoms of PMDD, especially the anxiety and depression symptoms
- Yoga - numerous studies show that yoga (either the meditation or the higher energy forms) are very beneficial for helping reduce PMDD symptoms. Yoga has several stances and breathing techniques specifically aimed at relaxing the mind, relieving anxiety and depression and helping the female sex organs (including ovaries and uterus) in general
Alternative treatments
- Acupuncture - a number of studies show that women who regularly received acupuncture for a specific duration had relief of symptoms
Always ensure that you notify your medical practitioner of any supplements that you want to take - it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take BEFORE you try it.
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< 9: conventional treatment 11: living with PMDD > Last reviewed: 15 August 2008 || Last updated: 8 January 2010
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NOTE: Mega doses of any type of vitamin, mineral, amino acid or herbal supplement cannot cure illnesses and in fact can be very dangerous and produce toxic side effects and interfere with medicine you are taking. Always ensure you consult your doctor before taking any type of complementary supplements.
Disclaimer: This guide is not intended to be used for diagnostic or prescriptive purposes. For any treatment or diagnosis of illness, please see your doctor.
