PMDD: What is really going on?
Premenstrual dysphoric disorder (PMDD) is a serious mood disorder, where negative symptoms emerge and then disappear, in response to the changing hormones of a women’s menstrual cycle. There are typically no symptoms in the ﬁrst two weeks of the menstrual cycle, up until ovulation. This is where oestrogen hormone rises - oestrogen improves our mood and sense of well-being. Symptoms appear, however, in the second half of the menstrual cycle, after ovulation, and can last up until menstruation starts. The symptoms of PMDD emerge, when there is a change from a rise in oestrogen hormone, to a rise in progesterone hormone. The negative symptoms associated with PMDD include:
• depressed mood
• decreased interest in usual activities
• poor concentration
• change in appetite
• sleep change
• Feeling overwhelmed
• physical symptoms, such as breast tenderness, bloating or headaches.
I want to explain the main hormones involved in a women’s menstrual cycle, so you can better understand PMDD. After a women’s period, levels of oestrogen hormone start to increase (check the blue line in the graph below). Oestrogens role in the ﬁrst half of the menstrual cycle is to thicken the uterus lining. Oestrogen is a happy hormone. It enhances mood and libido, and boosts serotonin (increasing feelings of well-being and happiness) & dopamine (motivation and pleasure). Oestrogen has many other beneﬁts for bone health, muscles, brain, heart, skin & metabolism. This is why women typically feel pretty good in the 10 days or so after their period, because oestrogen is rising.
Once ovulation occurs (the egg releases from the ovaries), progesterone hormone starts to rise (check the orange line in the graph above). In the right amounts, progesterone thins the uterus lining in such a way that a women’s period should be relatively light, with little to no pain. If enough progesterone is made, it has a calming effect on the nervous system and makes it easier to cope with stress. It also promotes deeper sleep.
Out of the two hormones oestrogen and progesterone, progesterone seems to be the hormone that those with PMDD are sensitive too. As aforementioned, progesterone is usually soothing to mood, but in PMDD, the rising levels of progesterone can cause anxiety and low mood.
Why is there a negative mood reaction to progesterone?
When we make progesterone, it actually converts into something called AlloPregnenalone (AlloP). AlloP is great for ones mood, with both anti-depressive and anti-anxiety effects. In order for women to feel the calming, mood boosting affects of AlloP, it has to be bind to something called a ‘receptor’ in the body (a receptor essentially passes on a message). Only by binding to receptors in the body can the calming, mood boosting affects of AlloP be felt! It is thought that women with PMDD have receptors, which don’t respond so well to AlloP. Therefore, they don’t feel those positive effects of AlloP, and the person is more prone to anxiety, depression, insomnia, and mood disorders. In most people, the right amounts of progesterone is good for their mood, because it converts into Allo-P, which allows the person to feel its affects. However, as you will see, many of us don’t make enough progesterone.
What can be done to support those suffering from PMDD?
I carry out genetic testing with most of my clients. This allows us to see whether there is a genetic issue with receptors - this is often the case. The use of targeted supplements, one of which includes Magnesium Glycinate, can help to improve receptor function. At the same time as supporting the receptor function, we want to support progesterone production. Most of us have suboptimal levels of progesterone (read on to ﬁnd out why). This will ensure we are converting enough progesterone into AlloP.
What is the difference between PMS (premenstrual syndrome) and PMDD? I ﬁnd a lot of my clients have symptoms of both.
PMS is more likely to be due to an imbalance between progesterone and oestrogen. The symptoms of PMS
can start as early as 7-10 days before a woman’s period, but is most typically felt in the 3 days before. Once
we have used oestrogen within our menstrual cycle, we need to break down and get rid of oestrogen from the body. It is now considered a toxin; it must pass through the liver and back to the gut, before being removed, via the stool or the urine.
Can you guess what happens? The modern world places numerous stressors upon our digestive system and liver, which make it far harder to break down and remove oestrogen. Oestrogen recirculates back into the body, and we are left with unopposed oestrogen. Levels of oestrogen and progesterone become imbalanced; we don’t have enough progesterone to balance oestrogen.
As the same time, progesterone production can be exacerbated by different forms of stress. Whether that be
blood sugar imbalance, lack of sleep, over exercising, nutrient deﬁciencies or mental stress. Remember, progesterone is responsible for calming the nervous system. Not making enough progesterone will increase anxiety, low mood and irritability, in the run up to a women’s period (PMS). This imbalance between
oestrogen and progesterone is extremely common amongst women, and will present as heavy or painful
periods, breast tenderness, blood clotting, spotting and/or hormonal acne.
We need to support the bodies removal of oestrogen. This can help reduce heavy, painful periods, blood clots and breast tenderness. At the same time, we need to support progesterone levels, to reduce PMS, low mood, and irritability before menstruation.
So, whether it be a genetic issue at the receptor level, or an imbalance between oestrogen and progesterone, these are a few ways to start addressing PMDD. Remember, a women’s period is an underlying expression of her health.