While mood swings, breast pain, and a number of other premenstrual symptoms are unpleasant for everyone who experiences them, some people are particularly affected. When these symptoms start interfering with daily living, premenstrual dysphoric disorder (PMDD) is the likely diagnosis.

What is PMDD? How can Naturopathic Medicine help?

PMDD is considered a severe form of premenstrual syndrome (PMS), and differs in that mood disturbance is a predominant feature of PMDD. While the cause of this condition is not fully understood, there are many treatment options, both pharmaceutical and non-pharmaceutical. Many people prefer to try non-pharmaceutical approaches first, so it is important to know that there are options. As with other hormonal concerns, addressing diet and nutrition can be an incredibly helpful first step. A naturopathic doctor can help determine if PMDD is a concern for you, and guide you through all of your treatment options.

Understanding your menstrual cycle can help determine whether or not PMDD is a concern.

The menstrual cycle is divided into two phases, the follicular phase and the luteal phase. The follicular phase is the first two weeks of the cycle, with day one being the first day of bleeding. The luteal phase is the last two weeks of the cycle, and ends with the onset of bleeding. In PMDD, symptoms occur during the luteal phase of the cycle, and typically resolve in the follicular phase. Understanding the timing of PMDD helps rule out other disorders that appear similar, like depression, generalized anxiety disorder, and thyroid conditions.

What are the symptoms of PMDD?

PMDD is commonly associated with the following symptoms: depression, anxiety, mood swings, irritability, decreased interest in usual activities, difficulty concentrating, fatigue, appetite change, sleep pattern changes, overwhelm, breast tenderness, headaches, body pain, and bloating. These symptoms occur only in the luteal phase of the menstrual cycle and are typically relived once bleeding begins. It is also important to note that these symptoms are severe enough to interfere with work, school, relationships, and other normal activities.[1]

Nutritional therapies for PMS & PMDD.

When it comes to figuring out what to eat to ease symptoms, the research can be scarce. Some common recommendations for PMS and PMDD include, limiting caffeine and simple carbohydrates, and increasing the intake of complex carbohydrates.[2] Simple carbohydrates are more processed, and include things like sugar, white bread, and pasta. These tend to cause spikes in blood sugar, which can contribute to mood disturbance and fatigue. Complex carbohydrates are found in whole grains, legumes, and many different vegetables. These types of foods tend to have a more balancing effect on blood sugar, thereby improving energy and mood. In addition, focusing on complex carbohydrates can help lower premenstrual food craving.[3] This is particularly helpful because food cravings during the luteal phase can make following a healthy diet very difficult.

One study looked at overall eating habits in women with PMDD and found that during the luteal phase, women were consuming more calories, more sweets, and felt they had less control over what they were eating.[4] The researchers attributed these eating habits to changes in a hormone called leptin that normally controls appetite. Another study found that women with PMDD tended to crave high-sweet-fat foods during the luteal phase, and experienced a positive emotional response and reward from eating these foods.[5]

While there isn’t a lot of research about foods that help, it makes sense that eating nutrient dense meals with good quality protein, healthy fats, and complex carbohydrates could be beneficial. This means focusing on a whole foods diet, and including a variety of vegetables and fruit, legumes, nuts, seeds, fish, and other animal protein.

B vitamins, calcium & magnesium may help with reducing symptoms of PMS & PMDD.

Eating a wide variety of whole foods insures that a wide variety of vitamins and minerals are consumed. There are some studies that have explored the benefits of individual vitamins and minerals for the treatment of PMS and PMDD.

One study looked at whether B vitamins improved symptoms of PMS and found that women who consumed higher levels of vitamin B1 and vitamin B2 were less likely to experience PMS.[6] Vitamin B2 is found in foods like, spinach, beet greens, mushrooms, eggs, and collard greens. Vitamin B1 is found in foods like, sunflower seeds, flax seeds, asparagus, beet greens, and spinach.

Vitamin B6 supplementation has also been found to be helpful for mood related premenstrual symptoms in women with PMS.[7] Vitamin B6 is found in many foods, including tuna, spinach, bell peppers, cabbage, and cauliflower.

Another study found that compared to women that didn’t experience PMS, women who had PMS had lower blood levels of calcium and magnesium.[8] Other studies have found that in women who experienced PMS, supplementing with calcium improved symptoms of depression and fatigue, and reduced appetite.[9] While dairy is a well-known source of calcium, it is also found in many green leafy vegetables, like, collard greens, spinach, beet greens, and kale. Even though these studies are usually looking at supplements, eating a diet rich in vegetables, and other healthful foods, insures that you are getting the nutrition you need to feel well.

What if dietary approaches aren’t providing relief?

If dietary modifications are not causing enough of an improvement, targeted nutrient supplementation and botanical medicine are beneficial next steps. With that said, sometimes the severity of symptoms warrants a pharmaceutical approach, and that is OK. In that case, antidepressant medication has been found to be beneficial for many people struggling with PMDD.[10] Birth control pills are another pharmaceutical option.[11]

What to expect when working with a Naturopathic Doctor.

Naturopathic doctors will be able to determine if PMDD is the appropriate diagnosis, explain the treatment options for PMDD, and make a plan to help manage the symptoms and improve quality of life. Keep in mind, many naturopathic doctors in BC, including all of the doctors at Juniper Family Health, have their pharmaceutical prescription license. Don’t suffer through PMS or PMDD, there is help.

To book an appointment with a Naturopath at Juniper Family Health please call 778-265-8340 or book online here.  

References:

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5thedition(DSM-5), American Psychiatric Association, Arlington, 2013.

[2] Pearlstein T. Treatment of premenstrual dysphoric disorder: therapeutic challenges. Expert Review of Clinical Pharmacology 9(4): 2016.

[3] Pearlstein T, et al. Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatry Neurosci 33(4): 291-301. 2008.

[4] Ko, CH et al. The late-luteal leptin level, caloric intake and eating behaviors among women with premenstrual dysphoric disorder. Psychoneuroendocrinology 56: 52-61, 2015.

[5] Yen JY. Et al. The high-sweet-fat food craving among women with premenstrual dysphoric disorder: emotional response, implicit attitude and rewards sensitivity. Psychoneuroendocrinology 35 (8): 1203-12, 2010.

[6] Chocano-Bedoya P. et al. Dietary B vitamin intake and incident premenstrual syndrome. The American Journal of Clinical Nutrition. 93(5): 1080-1086, 2011.

[7] Kashanian M. et al. Pyridoxine (vitamin B6) therapy for premenstrual syndrome. International Journal of Gynecology and Obstetrics. 2006.

[8] Saeedian Kia, A. et al. The association between the risk of premenstrual syndrome and vitamin D, calcium, and magnesium status among university students: a case control study. Health Promot Perspect. 5(3): 225-230, 2015.

[9] Hofmeister S. et al. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 94(3): 236-240. 2016.

[10] Shah NR et al. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis. Obstet Gynecol. 111:1175, 2008.

[11] Halbreich U et al. Continuous oral levonorgestrel/ethinyl estradiol for treating premenstrual dysphoric disorder. Contraception 85:19, 2012.