If you’ve already been diagnosed with Premenstrual Dysphoric Disorder (PMDD), it requires no definition. You’re all too familiar with the monthly tidal wave that takes you out each month with symptoms ranging from severe mood changes, irritability, and rage to debilitating physical changes like headaches, cravings, and breast tenderness. It’s like PMS on steroids. Or perhaps you’re just starting to notice the cyclical nature of your symptoms and are wondering if there’s more to it.
What Helps PMDD?
While PMDD affects about 5% of people who menstruate, it’s possible that many more go undiagnosed or are misdiagnosed with conditions like bipolar disorder. Plus, we often assume these symptoms are common, normal, or that we just need to survive until the storm passes. It doesn’t help that research on PMDD is playing catch up. From what we know so far, there’s not one single cause or cure. Rather, it’s a complex condition with multiple contributing factors like a PMDD puzzle.
Recovery can feel far from reach but perhaps there’s another way. As you piece together your own PMDD puzzle, begin with small manageable steps. Each step forward builds momentum on your path to PEACE.
1. Period Cycle Tracking for PMDD
PMDD is not diagnosed with a lab test but rather by a specific set of symptoms and criteria. Getting clarity starts with tracking. This helps your healthcare team differentiate between PMDD and Premenstrual Exacerbation (PME) and related mental health and hormone conditions. Your healthcare provider will request at least a 2-month journal before making a diagnosis. Plus, tracking gives YOU valuable insight into your health. By logging your cycles, you’ll take the most important step of all—creating more awareness around what your body needs. You can track on your phone with an app like Me v PMDD or use a printable tracker.
2. Embrace Where You Are AND Take Action
Do you ever feel at war with your body and wish you could “upgrade” to a new and improved model? Start by separating your self-identity from PMDD. You are so much more than your diagnosis. As you start tracking, you’re also recording your starting point to measure progress along the way. From there, try evaluating your symptoms with curiosity rather than judgement, asking “What is my body trying to tell me?” Yet embracing where you are doesn’t mean standing still. When we start to see symptoms as signs of an imbalance rather than a life sentence, it’s possible to transition from feeling stuck into ACTION.
3. Advocate for Yourself
In a world where we’re often caught between a mix of not enough information and conflicting information remember this first: YOU are the only expert on yourself. Find your voice and be vocal about your symptoms, needs, and preferences when developing a treatment plan. This sets the foundation for productive relationships with your healthcare team. Your support team may include a variety of professionals including your primary physician, OBGYN, therapist, functional medicine practitioner, acupuncturist, etc. Plus, coping with PMDD may require you to advocate for your needs and set boundaries at work and at home to allow time for self-care.
4. Create a PMDD Self Care Plan
With PMDD, even brushing your teeth and washing your face can feel like climbing a mountain. Perhaps you find yourself starting a new plan with lots of excitement during your follicular phase only to crash and burn when you hit Hell Week. Or maybe you feel stuck and don’t know where to start because there’s too much information and not enough at the same time.
Begin by focusing on one habit at a time and start slow. While these initial changes are powerful, it’s also important to have realistic expectations: it may not “fix” everything. PMDD is a complex condition that requires a team approach and a long-term personalized plan. By building a foundation of self-care, you will create more physical and mental resilience to do the necessary work for healing, including in therapy and in the kitchen.
Stress Management for PMDD
Current evidence suggests that people with PMDD experience increased sensitivity to stress during the luteal phase. And it’s not all in your head. There are unique differences in how the brain responds to changes in allopregnanolone and GABA and an altered physiologic response to stress in the hypothalamic pituitary adrenal (HPA axis). Of course, traditional stress management strategies like daily meditation, yoga, deep breathing, and sleep hygiene can all help. Specifically, body-based techniques that help you transition from “fight or flight” mode to “rest and digest” mode may be especially effective. Get back into your body and ground yourself by stimulating the vagus nerve: deep and slow breathing, singing, humming, gargling or a quick blast of cold water on your face.
Nutrition for PMDD
If you’re questioning how you can follow a low-histamine, dairy-free, gluten-free, no sugar diet while fighting fierce cravings, you are not alone. You’ll be most successful if you focus first on what to add in before taking foods out. People with PMDD have increased pro-inflammatory markers compared to controls. This inflammation interferes with brain chemistry, hormone balance, and HPA axis function. As simple as it sounds, begin by filling half your plate with a colorful variety of non-starchy vegetables at most meals, eating fatty omega-3 rich fish or taking fish oil, and choose quality organic protein sources. From there, you can work with a practitioner to explore your unique root factors such as blood sugar dysregulation, histamine intolerance, digestive health, detoxification, and even nutrigenomics.
Supplements for PMDD
Just like nutrition, supplement needs are highly personalized. However, there are common needs across people with PMDD. Magnesium and vitamin B6 are a shining duo due to their impact on GABA production and function and histamine metabolism. Start with a multivitamin to support intake of magnesium, B6 as well as other B vitamins and calcium. B vitamins and calcium are essential for the production and release of neurotransmitters, including feel-good serotonin. If you’re not eating fish oil, supplementing with a high-quality fish oil is also essential. More advanced supplements that target mood and hormones such as Chasteberry and neurotransmitter support, as well as higher therapeutic doses of single nutrients, should be based on individual need and trialed in partnership with a practitioner.
5. Explore your Root Cause
Your PMDD puzzle is unique mix of psychological AND physiological factors. What worked for your sister, friend or online forum acquaintance may not work for you. Trying one medication, supplement, or dietary change after another can lead to further feelings of hopelessness. These single remedies often fall short because they simple mask symptoms or fail to connect the dots between your unique set of driving factors.
It’s time to ditch band-aid solutions and explore your root cause with a whole-person comprehensive approach. There are many interwoven factors that play out in a different way for each person such as genetics, neurotransmitter levels, hormonal imbalances, neuroinflammation, nutrient insufficiencies, stress, and trauma. If that list feels daunting, know that you don’t need to go it alone. Cut out the guesswork and partner with a functional medicine practitioner or functional nutritionist familiar with the intricacies of PMDD.
What’s your next step?
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