Your PMS or PMDD is treatable.

PMS vs PMDD?

Both PMS and PMDD can involve psychological and physical symptoms that cause significant impairment during the luteal phase (two weeks prior to your period) of your cycle.

Both are typically relieved with the start of your period or by day 4 of your period. 80% of women complain of some type of PMS symptoms arising prior to their periods, although only 20-30% of women report that it causes a significant impairment in their life.

Signs of PMS

Common symptoms of PMS are breast tenderness, bloating, cramping, confusion, social withdrawal, headaches, joint or muscle pain, swelling of extremities, acne, irritability, depression, anxiety, and anger.

An “official” diagnosis for PMS requires at least 1 symptom-free week per month, and symptoms should arise prior to your period and abate or improve within the first 4 days of your period.

Signs of PMDD

PMDD is a less common, and a more severe type of PMS affecting 2-6% of women. Similar to PMS, to be diagnostic for PMDD you must have symptoms in the two weeks prior to your period and symptoms should start to improve or abate within 4 days of the start of your period. Symptoms should be gone (or significantly better) for at least 1 week following your period.

Diagnosis of PMDD must include 5 of more of the following symptoms: decreased interest in usual activities, mood swings, irritability, anxiety, suicidal thoughts, depression, difficulty with concentration, fatigue, lethargy, change in appetite, hypersomnia (sleep too much), insomnia, sense of being overwhelmed or out of control, breast tenderness, swelling, joint or muscle pain, bloating or a sense of weight gain.

In addition to the above symptoms, to be diagnosed with PMDD you must also exhibit some level of economic or social dysfunction that affects your life. Although PMDD can co-occur with depression disorder, panic disorder, and personality disorders, women with PMDD experience relief from their symptoms for at least 1 week of their cycle every month.

Typically, women who have PMDD often say they feel like completely different people before and after their periods. When we hear this, it’s a sign to start thinking about a PMDD diagnosis.

What are natural treatments for PMDD?

Diet. Diets high in thiamin, riboflavin, non-heme iron (non-animal sources), tryptophan, and zinc are protective to reduce PMDD symptoms.

Progesterone therapy. There are numerous ways to support progesterone and one of our favorite ways is to use the herb Vitex to support progesterone balance. For some women we will actually use a prescription of bioidentical progesterone, although this doesn’t work for everyone.

PMDD symptoms do not show up because of progesterone deficiency (unlike with PMS) but it appears that all women with PMDD have a heightened sensitivity to the fluctuations of progesterone in the 2 weeks prior to their period.

In women who have progesterone deficiency + a sensitivity to the changes in progesterone in their luteal phase: these are the women who will benefit from progesterone therapy.

Gut health.

Serotonin support. See PMS section above.

Cognitive behavioral therapy (CBT)

Light therapy and Vitamin D. 10-20 minutes of morning light, without sunglasses, to help regulate and promote better serotonin and melatonin levels. Adequate Vitamin D levels are important for a whole-person approach to PMDD. For more information on adequate Vitamin D levels and sun exposure check out my skin health page.

Massage. Limited data suggests 1 massage done in the luteal phase of your cycle can reduce depression, anxiety, and cramps for up to 5 weeks in women with PMDD

Acupuncture.

Calcium & B6.

There’s a lot we can do! This is why it’s so important to have a naturopathic specialist for PMDD.

What are typical (conventional) treatments for PMDD?

Here is a link to a great article summarizing conventional treatment (medication) options for PMDD. This guide is intended for healthcare providers, so if you are leaning towards medication management of PMS or PMDD, and you aren’t planning on booking an appointment with us, you can print this out and bring it to your PCP, psychiatrist, or gynecologist to help educate them on PMDD treatment options. 

Are hormonal imbalances or estrogen dominance causing PMDD?

MYTH busted: PMDD is not caused by estrogen dominance.

PMDD is not caused by an excess level of estrogen. This is a commonly held belief in natural medicine which has been disproved in research. Essentially, PMDD comes from a higher sensitivity to the natural fluctuations in estrogen and progesterone throughout our cycle.

So, your hormones can be perfectly in balance, based on labs or other symptoms of your period, yet PMDD symptoms will show up prior to your period because of this sensitivity to the natural changes in your hormones.

In fact, women who have symptoms of PMDD often don’t have a robust enough level of estrogen during the first 2 weeks of their cycle, which may in the end influence more variation of hormones throughout their cycle. We like to use herbs to actually strengthen the follicular phase of hormones, egg quality, and estrogen levels.