Pre-Menstrual Dysphoric Disorder (PMDD)
Pre-Menstrual Dysphoric Disorder (PMDD) is a severe extension of PMS symptoms which can be debilitating to women. PMDD presents cyclically, with extreme mood fluctuations, marked irritability and anger and depressive symptoms which are prevalent in the week leading up to your period and usually resolve within a couple of days of your bleed. It often goes undiagnosed, and can severely affect your relationships, work and every day life.
PMDD and PMS are associated with higher levels of inflammation, high levels of oestrogen and abnormalities in serotonergic transmission. While any women with a menstrual cycle can develop PMDD, those with a history of trauma, family history of PMDD, depression or other related mood disorders are more likely to be affected by PMDD.
Through nutritional medicine, we aim to regulate the HPA axis, support liver detoxification, support nutrient deficiencies commonly affected in this condition and increase the production of specific neurotransmitters which are depleted in this condition via dietary modification, lifestyle strategies and supplementation. Below is some of the research I have conducted and links I have found between PMDD and dietary and lifestyle factors.
Serotonin:
Women with PMS/PMDD have been found to have abnormalities in their serotonergic transmission, with a lower density of serotonin transporter receptors. PMDD symptoms can be provoked in susceptible women if tryptophan, the precursor of serotonin, is depleted, or if a serotonin antagonist is administered. Peripheral serotonergic function has been shown to be altered during the luteal phase in women with PMS, with decreased platelet uptake of serotonin, decreased whole blood serotonin and decreased platelet monoamine oxidase activity.
Cortical Reactivity:
Several studies have demonstrated that women with PMDD have altered cortical activity or physiologic arousal relative to healthy comparison patients. Studies have demonstrated that with magnetic stimulation, symptomatic women do not experience the normal increase in neuronal inhibition in the luteal phase, a time when progesterone and ALLO levels are elevated.
Brain Neurocircuitry:
Recent studies have indicated that the brain structure and function are altered in women with PMDD. Ovarian steroids have been found to modulate activity in brain regions relevant to the symptoms of PMDD, including the prefrontal cortex, reward systems and stress neurocircuitry.
Dietary Modification:
It is thought that caffeine, sugar and alcohol intake may increase PMS symptoms. Increasing complex carbohydrate intake pre-menstrually has been shown to improve mood, carbohydrate craving and memory in PMS, by potentially increasing tryptophan, a precursor to serotonin.
Bright Light Therapy:
Bright-light therapy has been very promising in alleviating symptoms of PMDD. Parry et al. first demonstrated that bright-light therapy in the early morning and evening could alleviate PMDD symptoms. A follow-up study by Lam et al. found that bright white light in the evening also improved symptoms. A meta-analysis of bright-light therapy on depression associated with PMDD found a great deal of heterogeneity in the small numbers of studies performed
Progesterone and Allopregnanolone:
Progesterone levels are low during menses and the follicular phase and are mirrored by progesterone's main metabolite, allopregnanolone (ALLO), also a neuroactive steroid. Progesterone and ALLO increase in the luteal phase and decrease quickly around menses. This chronic exposure followed by rapid withdrawal from ovarian hormones may be a key factor in the etiology of PMDD.
PMDD and ADHD:
PMDD symptoms can make ADHD symptoms worse.
As well as experiencing PMDD, ADHD symptoms like focus & concentration can also get in the lead up to menstruation.
This is in part due to the fact that hormones such as oestrogen regulate neurotransmitters such as dopamine. Sensitivity to fluctuations in hormones like oestrogen which drops after ovulation and again in the luteal phase leads to interference with transmission of dopamine, which subsequently worsen ADHD symptoms. Supporting neurotransmitters and hormones is the key to reducing symptoms.
Trauma and PMDD:
In fact, a history of trauma is actually considered a risk factor for getting PMDD.
This is because PMDD exacerbates with stressful events, causing dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in specific areas of the brain such as the amygdala to become hyper vigilant.
Liver Support:
Reducing excess oestrogen is vital in getting on top of PMS, so liver detoxification support is key here:
Sleep: Improve sleep hygiene, bed time routine, regulate circadian rhythm; insomnia during luteal phase: progesterone deficiency, basal core body temperature.
Liver supporting foods.
Supplementation: NAC, Glutathione, Taurine, Inositol, Brassica oleracea var. italica.
Milk thistle.
Dandelion root.
