PMDD Wellbeing Guide

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a premenstrual condition that usually arises after ovulation and continues until menstruation, greatly affecting emotional well-being. While PMDD shares similarities with PMS, it is more severe, and the underlying mechanisms that contribute to PMDD are notably different from those associated with PMS.

Symptoms of PMDD

• Depression 

• Anxiety 

• Irritability 

• Mood swings  

• Rage 

• Feeling out of control  

• Easily overwhelmed  

• Severe self-loathing 

• Feelings of hopelessness 

• Insomnia  

• Fatigue 

• Unable to perform usual tasks   

Diagnostic criteria

The DSM-5 diagnostic criteria is used to diagnose PMDD. PMDD is diagnosed when at least 5 of the criteria are present two weeks before menstruation, with symptoms subsiding within 2 days of bleeding.   

Myths

Is PMDD caused by a hormonal imbalance........NO! Although PMDD is a condition that affects women in their luteal phase (your luteal phase begins after ovulation and lasts until menstruation), it is not caused by a hormonal imbalance. PMDD is caused by an abnormal response to the normal hormonal fluctuations that occur throughout a monthly menstrual cycle.   

So what’s causing my mood symptoms? After ovulation, progesterone is produced, and it creates a metabolite known as ‘allopregnanolone’ (allopregnanolone is a neurosteroid) that interacts with gamma-aminobutyric acid (GABA) receptors in the brain.   

What on earth are GABA receptors? GABA receptors are neurotransmitters that play a large role in calming the nervous system and, therefore, regulating mood. However, those with PMDD do not get the calming effects of allopregnanolone, rather, the GABA receptors react negatively to this neurosteroid, leading to severe mood disturbances.

Nutrition tips

Don’t Skip Breakfast

Breakfast is the most important meal of the day. Skipping meals disrupts female hormone production and regulation, elevates cortisol, destabilises blood sugar, and leads to fatigue. For optimal energy and hormonal balance, consume a minimum of 30 grams of protein before 10:00 AM.

Up Your Protein

Protein hype is for good reason, protein is needed for the synthesis of neurotransmitters and hormones. Adequate protein intake reduces stress hormones like adrenaline and cortisol, leading to better sleep, decreased anxiety, and fewer blood sugar fluctuations, which contributes to stable weight management.

Up Your Luteal Phase Complex Carbohydrates

Complex carbohydrates are highly beneficial for the menstrual cycle. Complex carbohydrates stabilise blood-sugar levels which, in turn stabilises mood,  offer sustained energy, and help manage cortisol (our stress hormone) levels due to their high fibre content and low glycemic index. Some suggestions for complex carbohydrates are - sweet potatoes, quinoa, brown/red rice, beans, and buckwheat.

Increase Your Antioxidants

Research shows that people with PMDD often have higher levels of inflammation. Inflammation can contribute to PMDD symptoms due to its effect on the HPA-axis. The HPA-axis is your body's main stress response system. When inflammation is high, it can disrupt the HPA-axis, which can worsen your PMDD symptoms.  Therefore, eating foods packed with antioxidants can help fight inflammation. Antioxidant-rich foods include omegas - sardines, olive oil, chia seeds, and flax seeds.

Lifestyle tips

Stress Management

Stress increases cortisol levels which, causes mood and hormone dysregulation. How we manage stress is unique for each of us. Prioritise activities that help nourish your nervous system. I always recommend marking in your calendar your luteal phase to remind yourself to slow down. Additionally, pencilling in a luteal phase self-care day. This might look like a massage, visiting a bathhouse,  an acupuncture session and so on.

Prioritise Sleep

Prioritise sleep, aim for 7-10 hours a night. Magnesium glycinate can be beneficial for relaxing the body and promoting sleep,  avoiding caffeine at least 6 hours before you intend on going to bed, and regulating your circadian rhythm by reducing white-light exposure before bed and getting natural light exposure first thing in the morning and again before the sun goes down.

Skip Your Morning Coffee

Allowing at least two hours between waking up and consuming caffeine helps reduce the early morning spike in cortisol levels and promotes regulation of the body's circadian rhythm. This delay allows time for efficient clearance of adenosine (a neurotransmitter that promotes sleepiness) from the system, thereby reducing the likelihood of an afternoon energy crash. Consider substituting with a herbal tea, such as chamomile, which can calm your nervous system and therefore reduce inflammation.

Exercise Daily

The benefits of exercise on mood have been evidenced time and time again. Exercise increases endorphins,  improves sleep, reduces stress and feelings of anxiety, and improves your self-esteem.  Move in a way that feels best for you and your body. My suggestion is, during your luteal phase, aim for exercise in the outdoors. Being in nature and exposing yourself to fresh air and sunlight can improve mood and reduce stress levels.

Supplements

Calcium

Calcium follows a similar pattern to oestrogen in the body; when oestrogen drops, so does calcium. Calcium is responsible for the neurotransmission and release of monoamines like serotonin and dopamine. So when we have a dysregulation of calcium in the luteal phase, we see this impaired release of serotonin and dopamine, leading to mood disturbances.

Vitamin B6

Vitamin B6 can help ease your premenstrual symptoms like breast tenderness, bloating, mood swings, and fatigue. It boosts your body's natural mood regulators (epinephrine, serotonin, and dopamine), which can help stabilise mood. B6 also plays a vital role in healthy hormone balance, especially oestrogen. When B6 levels are low, a hormone called prolactin can increase, which may lead to psychological symptoms.

Taurine

Taurine is structurally similar to natural calming neurotransmitters in your body like, GABA and glycine, which help promote relaxation in your nervous system. Taurine may improve sleep quality, reduce symptoms of PMS related to hormonal imbalances, and lessen the frequency or severity of pre-menstrual migraines.

Magnesium Glycinate

Magnesium glycinate is wonderful for mood regulation as it supports the body's production of dopamine, serotonin, and melatonin. It also helps alleviate pre-menstrual symptoms such as headaches, fluid retention, bloating, and breast tenderness and promotes a restful night's sleep.

Always consult with a healthcare professional before making any decisions about your health, including starting new medications and/or treatments. Take care xx