Natural Treatments for PMDD (Premenstrual Dysphoric Disorder)

If you are female and have a menstrual cycle, its highly likely you have experienced some of the physical and emotional changes associated with monthly hormonal changes. But what about when the symptoms get more severe? Up to 40 percent of women experience moderate to severe premenstrual symptoms (PMS). While more complex, premenstrual dysphoric disorder (PMDD) is beginning to affect more and more women with reported rates up to 8 percent.   In my opinion, natural treatments for PMDD should be your first line of therapy prior to medications or surgery.

PMS vs PMDD

The main differentiator in the diagnosis of PMS vs PMDD is whether or not the symptoms disrupt your ability to perform daily functions.  There is a bit of subjectivity (your own opinion) in the diagnosis as some individuals can perceive pain differently than others.

PMDD Diagnosis

In order to be diagnosed with PMDD, according to current standards, you must experience a combination of symptoms that may include:

  • Marked mood changes (including anxiety, depression, sadness, weepiness, hopelessness)
  • Decreased interest in usual activities
  • Fatigue or leathargy
  • Hypersomnia or insomnia
  • Sense of overwhelm
  • Physical symptoms (breast tenderness or swelling, joint/muscle pain, bloating, weight gain)
  • Changes in appetite and/or cravings

The key factor in the diagnosis of PMDD is that it creates significant distress and interferes with work, school, typical social activities or relationships with others.

Traditional Treatment of PMDD (with natural commentary)

Medication (SSRIs) – Anti-depressant medications are often used in PMDD cases. While this can provide symptomatic relief, one of the primary symptoms in the diagnosis of PMDD is that they symptoms begin to resolve after menstruation begins. This indicates that it is not a permanent serotonin alteration but rather a temporary change. From a holistic perspective, you should use medication if needed, but to go on a permanent medication for a temporary condition is not advised. If you have started taking an SSRI for PMDD you should take with your prescribing physician about how to get off safely as you begin to address the causes of PMDD from a lifestyle and nutrition basis.

Birth Control – Birth control is nearly always the most common treatment for PMDD. The catch is that some women that experience PMDD can react poorly and have an exacerbation of symptoms. The other catch is that many women with PMDD are already on birth control. When trying a natural approach to the treatment of PMDD it is best (if possible) to stop all birth control in order to give yourself and your doctor a clear picture of your symptoms, their length and their intensity.

HRT – Bioidentical hormone replacement therapy for PMDD is another common “natural” treatment for PMDD though I don’t personally consider it natural. At a minimum when considering PMDD you should consider your age and your ability to product hormones on your own. Health is a long-term game. In general, HRT should not be considered in younger females as the optimal option would be to figure out the underlying problems and resolve those so that you can enjoy optimal hormonal health for years to come. 

Psychotherapy – Psychotherapy can be a great treatment option as depression and anxiety aren’t things that can always be handled alone. They can be overwhelming. Cognitive behavioral therapy, with an action-oriented approach has been shown to be effective. BUT…as I always say to my patients, “Wouldn’t you rather not have anxiety or depression at all?” So, in general when you treat the underlying root causes of PMDD most people experience a lifting of the severity of psychiatric symptoms and do not have to undergo long-term psychotherapy.

Surgery – Hysterectomies for endometriosis, PCOS and PMDD have become common place. While this can help in some cases (not very many from my clinical experience) I believe it is one of the worst surgeries to perform for women. I believe the traditional medical community is doing a great disservice to women by treating them like a broken car and just removing parts. I would even go as far as to say this act of removing either or one or both of the ovaries and uterus is discriminatory based upon clinicians poor understanding of integrated physiology. (An entire article will come on this later.)

The PMDD Puzzle

 The problem with the diagnosis of PMDD is that currently it is treated as a “condition” that one has rather than a “collection of symptoms” which is what it truly is. This is not to negate the severity of the symptoms, but rather an understanding that PMDD is not a permanent curse and while a “cure for PMDD” is not the way to talk about it, there is a lot of underlying root causes that we can address.

Understanding health in general and PMDD as a puzzle will help you to understand that once you put the pieces together it can be a beautiful picture, but it does require putting each and every piece of the puzzle together.

Natural Treatments for PMDD (premenstrual dysphoric disorder)

Before you start looking at natural treatments for PMDD, it will greatly help if you analyze what is happening during your menstrual cycle to determine exactly what could be at the root of your symptoms.

Natural treatments for PMDD

QUANTITY

If we start at the left side of the graph of a menstrual cycle, the time when someone who suffers from PMDD feels the best is usually between days 0 and 7 of their menstrual cycle. If you block out all of the fluctuations in the hormones that can confuse you, you will notice that at the beginning of your cycle, during menses, all hormones are at their lowest point.

So if you were trying to replicate your “good days” then having lower and more stable hormones is essentially the secret that is not so secret when you look at the chart.  Many people get scared when I say “low” hormones, but we are talking about a healthy normal low point that everyone should achieve each month during menses.

Another common presentation is that not only do you have symptoms during menses, but also during ovulation when hormones spike.

THE KEY TO UNLOCK THE CURE TO PMDD

The simple key to restoring your life when suffering from PMDD is to balance your hormones properly while avoiding any and all triggers of inflammation. (Easier said than done.) Its really can be that simple in most cases. The difficult part lies in the fact that lifestyle plays a huge role in hormone balancing and you likely will have to make some lifestyle and nutritional changes. Medications, including birth control, extreme work situations and complicated relationships can make the natural healing process more difficult.  

QUALITY & QUANTITY (aka ratios)

The most common quality or ratio problem that women run in to is a hormonal condition called estrogen dominance. Estrogen dominance can come in either an “absolute” form or a “relative” form.

The best way to imagine absolute estrogen dominance is if you picture a cup with water in it. To keep it simple, that cup has to hold estrogen and progesterone. That cup is perfectly full to the brim and the high level of estrogen has started pushing progesterone out of the cup. So, you still have a cup that is 100% full, but it is more estrogen than progesterone. The creates an altered estrogen to progesterone ratio that can have you missing all the benefits of progesterone while experiencing all the downsides of elevated estrogen.

Relative estrogen dominance is more like a cup that is half full. The progesterone to estrogen ratio will still be skewed, but there is room in the cup to add to it. In this scenario, herbs that help to support estrogen production and nutrition to support progesterone production can be very beneficial. The typical person in this scenario is underweight, malnourished and/or well in to menopause. There are very few exceptions.

THE #1 ERROR IN BALANCING HORMONES TO IMPROVE PMDD IS THINKING YOU ARE IN RELATIVE ESTROGEN DOMINANCE WHEN YOU REALLY ARE IN ABSOLUTE ESTROGEN DOMINANCE. This leads to the wrong treatment and poor clinical results.

Absolute Estrogen Dominance vs. Relative Estrogen Dominance

  1. Do you have a BMI over 25? You likely have absolute estrogen dominance.
  2. Do you eat more than 75 grams of carbohydrates per day? You likely have absolute estrogen dominance.
  3. Are you a vegetarian, vegan or don’t like the taste of protein? You likely have absolute estrogen dominance.
  4. Do you exercise with weights less than 5 days a week? You likely have absolute estrogen dominance.
  5. Do you eat more than 1500 calories per day? You likely have absolute estrogen dominance.
  6. Do you eat fast food, candy or sugar? You likely have absolute estrogen dominance.
  7. Does your blood lab test say you have “low hormones”? You likely have absolute estrogen dominance.

Are you getting the point? 98 percent of women with PMDD have absolute estrogen dominance while 1 to 2 percent of women have relative.  Here are a few clues that you may have relative estrogen dominance.

  • You eat fewer than 1000 calories per day.
  • You exercise more than 10 times per week.
  • You have a BMI under 19.
  • You are over the age of 65.
  • You have been under 50 grams of carbohydrates for years.

Those are some of the typical individuals that may have hormonal symptoms of PMDD though they are actually deficient in overall hormone production.

Because most cases of PMDD have the main contributing factor of estrogen dominance, I will focus on how to reverse PMDD by balancing your hormones properly.

CAUSES OF HIGH ESTROGEN IN OF PMDD

When we look at what we can do with nutrition and lifestyle to decrease the treat PMDD naturally, we run into 2 simple problems. One, your body is creating too much estrogen or two, your body is not adequately detoxifying estrogen. In most patients it is a combination of the two.   

Blood Sugar

Spikes in blood sugar or consistently elevated blood sugar promotes estrogen production over progesterone, which leads to more PMDD symptoms. A diet focused on whole foods and less processed and refined carbohydrates is the starting point. 

Next adding weight-bearing exercise to your daily regimen is key. If you can only do yoga, that is a good starting point, but for blood sugar regulation, lifting weights is the best way to improve your insulin and blood sugar control.

Lastly, getting adequate protein is key to regulating blood sugar. As I have written before here, I ask/require my patients to get 90 grams of protein per day while they are recovering from any condition. Once you feel well, that number can be decreased.

Exogenous Hormones & Xenoestrogens

The average woman uses up to 12 beauty products and exposes herself to more than 150 chemicals each and every day. The majority of these chemicals act as xenoestrogens and can trigger symptoms such as weight gain, mood swings, anxiety, loss of sleep, acne and more.  Most conventional make-ups actually contain estrogen as a way to enhance fullness and decrease fine lines.

Women should specifically look for more natural beauty products for all personal care items from shampoos to lotions to make-ups.

Xenoestrogens in our environment include plastic water bottles, microwaveable plastic containers, canned foods, food preservatives, pesticides, herbicides, flame retardants and chlorine. Each of these can mimic or alter the metabolism of estrogen and induce hormonal changes that can lead to PMDD.

If you suffer from PMDD and you are taking bioidentical HRT or synthetic HRT then you should stop with the help of a qualified holistic doctor. It is likely you are exacerbating the symptoms and only creating more problems to come in the future. (HRT is the #1 medication that leads to hypothyroidism.)

Detoxification Of Estrogen

The detoxification of estrogen is critical in the body. By adequately producing and eliminating estrogen (and all other hormones) your brain is able to see where hormones are needed and balance them adequately. If you do not detoxify your hormones or you have excess, the brain will shut off production and thus it will not adapt to your daily demands.

Detoxification & The Gut

If you have digestive problems such as constipation, diarrhea or bloating, you will not be able to adequately detoxify estrogen. This should be addressed first. When the liver binds to estrogen to eliminate it, if you have digestive problems, the organisms in the gut are able to undo the work of the liver and you end up recycling your hormones. This means that you never detoxify your hormones and thus as mentioned above, your body will get stuck in its current state forever. You must balance the digestive tract (probiotics make this worse) in order to allow the liver to complete its job.

Liver Detoxification of Estrogen

The liver is responsible for detoxifying the majority of your hormones. Without a doubt the liver and gallbladder are the two most overlooked organs in the body. If you are going to fix your hormone imbalance associated with PMDD, you are going to have to get your liver up to speed and reduce its burden.

My clinical experience suggests that the fastest way to restore the liver to optimal function is to support a specific pathway called “glucuronidation”. In order to do this I use Artichoke Extract for its glucuronic acid content.

The gallbladder can easily get overburdened specifically by estrogen as estrogen thickens the bile in the gallbladder and decreases detoxification rates. This is one reason why so many people feel better when they do a gallbladder flush. While I am not a huge fan of aggressive gallbladder detoxification I do like to use Artichoke Extract combined with either Schisandra or Chanca Piedra in order to quickly purge the gallbladder of its built up toxins.

Once again, this allows your body to start new and begin balancing hormones again the way it was meant to be.

Is PMDD A Psychological Disorder?

According to the American Psychological Association; “researchers, physicians and psychologists debate over premenstrual dysphoric disorder.”

I want to address both sides of this so that if you battle with PMDD (whether psychological or physiological) you can have a balanced understanding of the arguments.

Some people believe the diagnosis is demeaning to women and it labels their changes in mood as being “crazy once a month.” They argue that hormonal changes in women are characterized as abnormal or a psychological problem while hormonal changes and emotional outbursts of men are accepted as normal.

On the other hand, many physicians believe that the diagnosis is warranted, not suggesting that patients are crazy, but rather that basic brain to hormone communication is in tact and does not describe the severity of the symptoms. In addition, many believe that adding the psychological component to the diagnosis helps women to get the adequate care they need.

Regardless of where you fall on the argument of the psychological nature of PMDD, it is important to note that severe depression and even suicidal tendencies can and do exist during the symptomatic time periods of PMDD. This is very serious and needs to be addressed.

From a holistic point of view, all psychological disorders can be associated with specific genes, hormonal imbalances, neurotransmitter alterations, nutrient status, environmental toxins, food sensitivities and detoxification capabilities.

The holistic or functional medicine approach to the psychological symptoms associated with PMDD is to look for the underlying root causes associated with those symptoms. In the short-term herbal therapies are often used as calming or balancing agents in order to manage symptoms, but as I will continue to go through, addressing the primary underlying cause of PMDD will naturally decrease the psychological symptoms.

Other Supplements For PMDD

Essentially these supplements come in 4 categories; detoxification of estrogen, increasing progesterone, balancing inflammation and decreasing blood sugar. (I’ve linked to the brands I think work best.)

Artichoke Extract – This is by far my #1 go to supplement for PMDD. It works slowly, but each month you will generally see consistent improvement with each menstrual cycle if you are addressing your diet.

Chinese Coptis – Chinese coptis will help to lower blood sugar and decrease inflammation while you change your lifestyle habits. Other than prescription drugs, there is nothing that can overpower a horrible diet.

BCSO – Black Currant Seed Oil (different from black seed oil) helps to control inflammation by promoting healthy prostaglandins. Many women and men in my practice use this instead of over-the-counter pain medications. If taken consistently, BCSO will help to lower overall inflammation.

EPA/DHA – Fish oil is a good additive when it comes to menstrual cycles as it can thin the blood and also decrease inflammation.

Vitamin E – Vitamin E is a master female hormone supporter. It helps with inflammation and helps to regulate the control mechanism “prolactin” in the brain which can regulate the severity of hormonal fluctuations. (You can read more about the miracle of vitamin E in my other article on vitamin e and hormone balance here.)

Vitamin B6 (P5P) – B6 has been used as a remedy for female hormones menstrual cycle symptoms for centuries. The P5P version of B6 also contains phosphorus which can help with energy and relaxation of muscles. B6 is also one of the most important nutrients for mental health. It is required for all the metabolism of all neurotransmitters in the brain and can play an important role in the psychological symptoms associated with PMDD.

Magnesium – Most people know of the benefits of magnesium, but specifically for PMDD, magnesium can help to decrease mental stress as well as physical stress such as cramping and aches and pains associated with a menstrual cycle. Magnesium is depleted in high carbohydrate diets and in individuals with constant daily stress.

If you have addressed blood sugar imbalances, estrogen and toxin exposure and are detoxifying estrogen properly, then you can begin to more aggressively address progesterone production. (My article that covers supplements to promote progesterone production can be found here.)

What Else Can You Do For PMDD Symptoms?

  1. Decrease or eliminate caffeine. Caffeine is a huge stressor to the gallbladder as well as it creates blood sugar instability.
  2. Drink plenty of salt water. Drink lots of water, but add magnesium, potassium and sodium to it or take a supplement to help hydrate yourself.
  3. Avoid dairy as it can be inflammatory to nearly any condition
  4. Take a warm Epsom salt bath. The magnesium can relax muscles and relieve cramps and the sulfur from the Epsom salts can help to detoxify estrogen in the liver.
  5. Eat lots of cruciferous vegetables. When it comes to eating vegetables to create specific physiological changes, you must eat more than you think. If diet is going to be your primary choice of nutrition (some people choose not to take supplements), then I recommend 1lb of cruciferous vegetables per day. I highly recommend broccoli as the vegetable of choice.
  6. Drink 1/2 lime per day in hot water in the morning. This helps to detox the liver and gallbladder.
  7. Eat or drink beets as often as possible to detox the gallbladder.

Conclusion

In my practice with exceptionally high success rates, by reducing total estrogen load, improving blood sugar metabolism and improving nutrient deficiency status we have seen the large majority of PMDD symptoms resolve to tolerable limits or even be eradicated altogether. While the diagnosis of PMDD can provide you a starting point, it should act more as an indicator of underlying metabolism errors that need to be investigated, researched and addressed in order to provide long-lasting relief rather than short-term symptom relief. Natural treatments for PMDD can be a huge success when addressed holistically.

Post article Note: Many of the typical hormone balancing product you may find online such as evening primrose, chaste tree, milk thistle, probiotics, etc. can have a detrimental effect on healing as most act as bandaids. It is best to consult an experienced and natural expert in order to recover from severe PMDD symptoms.

Dr. Houston Anderson is a top rated functional medicine doctor with expertise in natural treatments for IBS, leaky gut, SIBO, natural hormone balancing, food allergy and food sensitivity testing. He is a board certified Chiropractic Physician with a master's degree in Nutrition and Human Performance. He provides personalized natural medicine solutions to patients across the world.