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Ever felt like your world is turned upside down in the days leading up to your period? If you're one of the many women suffering from Premenstrual Dysphoric Disorder (PMDD), you know exactly what I'm talking about.
PMDD can significantly affect your mental and physical well-being, leaving you feeling drained and overwhelmed. But there's hope.
This blog post will explore various natural treatments for PMDD, offering you practical tips and expert insights to help you manage your symptoms more effectively.
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects 3-8% of menstruating women.
PMDD is not a hormone imbalance. It is a neuro-endocrine condition. Estradiol and progesterone are produced in a predictable monthly menstrual cycle by the ovaries.
These hormones act as neurosteroids in the brain, particularly estradiol and allopregnanolone - a metabolite of progesterone. The cyclical changes in the levels of these neurosteroid hormones creates intense symptoms in women with PMDD that can significantly disrupt their daily life.
The symptoms of PMDD include severe mood and cognitive symptoms including:
mood swings,
irritability,
depression,
anxiety,
headaches,
sleep issues such as insomnia and
appetite changes such as cravings.
It can also include premenstrual symptoms such as:
breast pain,
bloating and
fluid retention.
The symptoms are called premenstrual as they appear in the luteal phase of the menstrual cycle and subside once menstruation begins. The impact of PMDD on women's health and mental wellness cannot be overstated, making effective management crucial.
PMDD is a serious condition, can cause suicidal thoughts and if this is your experience, you should always get ongoing support from your health provider.
Related: What is PMDD and what causes it?
8 Natural Treatments for PMDD
Check out these natural treatments that could help reduce your premenstrual symptoms and improve your wellbeing.
1. Body Identical Hormone Therapy for PMDD
Body identical hormone therapy (BHRT) uses hormones that are chemically identical to those your body produces during the menstrual cycle.
A major mechanism underlying PMDD appears to be the falling estradiol levels in the luteal phase. Studies and clinical practice show that maintaining steady estradiol levels during the luteal and early menstrual phases, avoiding the cyclical withdrawal of estradiol is a successful strategy for many women in reducing their symptoms.
This treatment also works for some women who experience menstrual migraine, and menstrual headache.
PMDD hormone therapy is a good option for women wanting to address the actual mechanism driving their cyclical symptoms which is the falling neurosteroid hormone levels, particularly estradiol.
How Body Identical Hormone Therapy Works
Body identical hormone therapy involves the use of bioidentical hormones such as progesterone and estrogen (estradiol) to prevent significant cognitive and mood symptoms that occur as a result of acute neuro-steroid withdrawal in the luteal phase.
These hormones are derived from plant sources such as wild yam or soy and are tailored to match an individual's unique hormonal needs.
Benefits of BHRT for PMDD
Symptom Relief: BHRT can help alleviate mood swings, depression, and anxiety associated with PMDD as well as some of the physical symptoms of PMDD.
Personalized Treatment: Your treatment can be adjusted if needed to better suit your needs.
Fewer Side Effects: Compared to synthetic hormones, BHRT is often better tolerated with fewer side effects.
Dose of BHRT for PMDD
Two studies have looked at the use of continuous estradiol across the cycle and one used 200 microgram estradiol patches for 3 months vs placebo and then each group changed treatment.
When women switched from estradiol to placebo, their improved symptoms deteriorated, and when women switched from placebo to estradiol symptoms were improved (Estradiol for PMDD 1989).
This study used cyclical norethisterone alongside the estradiol patches.
The International PMDD Guidelines recommend 100 microg estradiol patches with either
10 days of 2x100mg utrogestan or
10 days of 1mg norethisterone or
or Mirena IUD (levonorgestrel).
Many women respond well to the calming anxiolytic effects of natural progesterone as it is converted to allopregnanolone.
A small number of women experience progesterone/allopregnanolone sensitivity and become more tearful or flat with natural progesterone so do better with norethisterone or IUD mirena as this does not increase the levels of allopregnanolone in the brain.
Of note, identical hormone therapy is not contraceptive (unless used with a mirena IUD) so if you prefer a hormonal therapy that is also a contraceptive, then hormonal birth control pills may be a better option for you.
2. The Role of Vitamin B6
Vitamin B6 (pyridoxine) is a water-soluble vitamin that plays a crucial role in brain function and mood regulation. It is a cofactor in the synthesis of monoamines and γ-aminobutyric acid (GABA). Research suggests that B6 supplementation can help alleviate PMDD symptoms.
Benefits of Vitamin B6 for PMDD
Mood Regulation: Vitamin B6 helps produce neurotransmitters such as serotonin and dopamine, which regulate mood.
Hormonal Balance: It assists in hormone metabolism, helping to balance estrogen and progesterone levels.
Energy Boost: Vitamin B6 supports energy production, reducing fatigue and irritability.
How to Increase Vitamin B6 Intake
You can find vitamin B6 in foods like poultry, fish, potatoes, bananas, and chickpeas. Supplements are also available and can be taken under the guidance of a healthcare provider.
Clinical Trials for B6 and PMS/PMDD
A clinical trial using 80mg vitamin B6 found improvement in PMS symptoms over 3 cycles.
Among women who met diagnostic criteria for PMDD, the women who used a multi-nutrient supplement had improved symptoms over the women who just took B6, indicating there may be multiple nutrients that can be optimised to support hormone and neurotransmitter functioning in women with PMDD (B6, Nutrients and PMS 2020).
A meta-analysis of 9 studies using B6 for PMS suggests that at doses of 50-100mg, vitamin B6 can improve PMS symptoms (B6 for PMS 1999).
It appears a decent multivitamin containing at least 50mg of B6 would be worth trialling to get the benefit of B6 alongside other micronutrients to support optimal brain health in PMDD.
3. Vitex Agnus-Castus (Chaste Tree)
Vitex agnus castus is also known as chaste berry. It has been used for centuries as a herbal remedy to treat menstrual-related symptoms. Studies have shown that it can help with PMS and PMDD by reducing symptoms in the luteal phase.
Vitex works via a number of mechanisms including:
reducing prolactin secretion by dopamine D2 receptor agonism (increased effect at dopamine receptors)
increased binding of opioid receptors and
increased binding of estrogen receptors.
Benefits of Vitex Agnus-Castus for PMDD
A 2017 meta-analysis showed that in 5 studies that compared vitex with placebo, vitex was superior to placebo.
When vitex was compared with fluoxetine (a SSRI), vitex was superior at reducing physical symptoms of PMS/PMDD such as breast tenderness/headaches/fluid retention, but was inferior to fluoxetine at reducing mood symptoms.
A further meta-analysis showed that at doses of VAC Ze 440 extract 20 mg and 30 mg were superior to placebo at reducing symptoms (Vitex for PMS 2019).
It may be a good option to use if physical symptoms are particularly troublesome.
4. The Power of Magnesium
Magnesium is an essential mineral that plays a crucial role in over 300 biochemical reactions in the body. It has been found to help alleviate PMDD symptoms by stabilizing mood and reducing inflammation.
Benefits of Magnesium for PMDD
Mood Stabilization: Magnesium helps regulate neurotransmitters that influence mood, such as serotonin.
Reduced Inflammation: This mineral can reduce inflammation, which is often exacerbated during the luteal phase.
Improved Sleep: Magnesium promotes better sleep quality, helping to alleviate fatigue and irritability.
How to Incorporate Magnesium
You can increase your magnesium intake through dietary sources such as leafy greens, nuts, seeds, and whole grains. Additionally, magnesium supplements are available and can be taken under the guidance of a healthcare provider.
Some studies show low magnesium levels in women with PMS compared to women without PMS (Magnesium Across The Menstrual Cycle 1994).
Limited evidence shows that magnesium supplementation at 250 mg daily helps with PMS symptoms and is more effective when combined with B6 (PMDD Management 2022).
5. Boosting Wellness with Vitamin D
Vitamin D, often referred to as the "sunshine vitamin," is vital for overall health and well-being. It is often low in people who live in countries with low UV over winter and also where regular sunscreen is utilised.
Recent studies have shown that it can also help manage PMDD symptoms through its role as an antioxidant and its role as an anti-inflammatory.
Benefits of Vitamin D for PMDD
Mood Enhancement: Vitamin D is an important neurosteroid and has important functions in the brain. Lower levels of vitamin D are associated with higher risk of anxiety and depression.
Immune Support: It strengthens the immune system, helping to combat low energy and fatigue.
Bone Health: Vitamin D is essential for calcium absorption, promoting bone health and reducing muscle pain.
How to Get More Vitamin D
Spending time outdoors in sunlight is one of the best ways to boost your vitamin D levels, although this has to be balanced with sunscreen use to reduce skin damage from UV rays.
You can also include vitamin D-rich foods in your diet, such as fatty fish, fortified dairy products, and egg yolks. Supplements are another option, particularly during the winter months when sunlight exposure is limited.
Studies show that vitamin D supplementation of 50,000 IU vitamin D3 fortnightly reduced PMS symptoms and markers of inflammation over 4 months (Vitamin D and PMS 2019).
6. Healthy Dietary Patterns for PMDD
A balanced diet rich in healthy whole foods can support brain and hormone health. One study compared 3 dietary patterns and compared their PMS symptoms:
Traditional Dietary Pattern: high in eggs, tomatoes/passata, fruit, and red meat
Healthy Dietary Pattern, rich in dried fruits, spices, and nuts.
Western Dietary Pattern, with high consumption of fast food, carbonated drinks, and processed meats.
Consumers of the western dietary pattern had more symptoms of PMS, whereas consumers of a healthy or traditional dietary pattern had lower PMS symptoms (Dietary Patterns and PMS 2020).
As with most studies about nutrition and mood, whole food diets appear to best support hormone and brain function. Aim to include more whole foods in your diet including:
Whole Grains: Brown rice, quinoa, and whole wheat bread.
Lean Proteins: Chicken, turkey, fish, steak and plant-based proteins such as beans, lentils, edamame.
Healthy Fats: Avocado, nuts, seeds, and olive oil.
Vegetables: Eat the rainbow: broccoli, cauliflower, kale, spinach, onions, garlic, pumpkin, beetroot, sweet potato (kumara) and other leafy greens.
Fruits: Berries, apples, citrus fruits, kiwi fruit, melon, mango.
Time-Restricted Eating
Research has shown that short-term intermittent fasting can lead to greater parasympathetic activity and lower luteal cortisol levels in women (Intermittant fasting and female hormones 2022).
It has been proposed that intermittent fasting in the luteal phase could have beneficial effects on neuro-endocrine mechanisms and therefore reduce symptoms, however trials on women with PMS/PMDD have not been conducted.
7. The Impact of Exercise on PMDD
Regular physical activity can be a powerful tool to reduce PMDD symptoms. Exercise helps release endorphins, which are natural mood lifters, lowers inflammation, improves mood and boosts energy.
Benefits of Exercise for PMDD
Mood Enhancement: Exercise releases endorphins, which improve mood.
Stress Reduction: Physical activity helps reduce stress and anxiety.
Increased Energy: Regular exercise boosts energy levels and reduces fatigue.
A meta-analysis of women experiencing premenstrual symptoms who participate in regular exercise demonstrate some degree of improvement in their physical, cognitive and mood symptoms (Exercise for PMS 2020).
Current guidelines suggest you should aim for at least 30 minutes of moderate exercise 5 days per week, such as walking, swimming, or jogging.
8. Yoga for Premenstrual Dysphoric Disorder
A regular practice of yoga has beneficial effects on the nervous system, which in turn has beneficial impacts on the hormones. Yoga combines physical movement, mindfulness, and breathing techniques, making it an effective tool for supporting mood, wellbeing and reducing PMDD symptoms.
Benefits of Yoga for PMDD
Stress Relief: Yoga helps calm the mind and reduce stress levels.
Improved Mood: The combination of physical movement and mindfulness can improve mood.
Enhanced Mind-Body Connection: Practicing yoga can help connect the mind and body, promoting overall well-being.
A clinical trial of women with premenstrual mood symptoms who performed a yoga 30 mins each week over 3 months, demonstrated a reduction in frequency and severity of premenstrual depressive symptoms, physical symptoms, and anger/irritability (Yoga PMS RCT 2023).
Evidence-Based Medications for PMDD
Many women use medications alongside natural approaches to PMDD, especially if symptoms and impact on quality of life are significant. The following treatments can be helpful to treat PMDD in some women:
Selective Serotonin Reuptake Inhibitors (SSRIs)
Oral Contraceptives
Gonadotropin-Releasing Hormone Agonists (GnRH Agonists).
Frequently Asked Questions About PMDD
Is PMDD A Hormone Imbalance?
PMDD is not a hormone imbalance. It is a sensitivity to the NORMAL hormonal changes that occur during the luteal phase (last week) of the menstrual cycle when hormone levels fall.
In women with PMDD they are more sensitive to the falling neurosteroid effects of estrogen and progesterone and the neurotransmitters that these hormones influence.
Learn more about hormones, neurotransmitters and PMDD.
Conclusion
PMDD is a complex neuro-endocrine condition that can have significant impacts on your daily life.
There are a number of natural treatment strategies and lifestyle changes backed by scientific research for treating PMDD that can help improve your symptoms and quality of life.
Remember to consult with your healthcare provider, who can advise on optimal treatments for your specific situation. Different approaches impact women differently so it is important to find what works best for you!
Stay positive and take care of yourself. Your mental and physical well-being matters!
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Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you explore the best option to treat PMDD.
Dr Deb Brunt is a women's health and menopause specialist in Dunedin, New Zealand and also provides health coaching internationally to support optimal health habits so you can live your best life.
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