5 Symptoms of Premenstrual Dysphoric Disorder (and what you can do about it)

Disclaimer: This is not medical or personalized nutrition advice, but general education. Discuss your own nutrition needs with your healthcare provider or qualified nutritionist.

difference between PMS and PMDD

With all the free health information out there, it can be a bit overwhelming if you have some symptoms and don’t know what they mean. If you suspect that you have premenstrual dysphoric disorder (PMDD), you might be confused because many of the symptoms are the same as premenstrual syndrome (PMS). Let me clarify that for you! Basically,

PMDD is like PMS x 1000.

Many of the same symptoms are present in PMS and PMDD…but in PMDD they are much more intense. While most women (up to 85%) experience PMS to some degree, only about 5% of women have PMDD. And while mood swings, cramps, irritability, bloating, and other symptoms of PMS can be present throughout life, the average age of onset for PMDD is 26. Let’s go over the main symptoms and how they are different from PMS. These symptoms generally show up or intensify after ovulation and before your period (usually about 2 weeks), but that could vary according to your unique body. They fade away gradually or disappear a few days after your period starts.

1) intense feelings of anger and irritability

If you’ve ever experienced “period rage” you know that (in the moment) you feel very logical in your anger. With PMDD, symptoms like anger, hostility, and irritability are intense and irrational. You might be labeled “hysterical,” or feel like you can’t just let things be. And while this experience is true to some degree for most women just before their period, with PMDD it is so strong that people will remark on your mood with surprise or alarm. Or, you might notice that you are unreasonably angry and you have no explanation for it. If you find yourself repeatedly picking fights with your significant other or shaking with anger at work, that’s not normal!

2) sudden depression, anxiety, or suicidal thoughts

This one can be confusing (and really deserves its own post). Clinical depression and anxiety often intensify right before your period because your mood is linked to your reproductive hormones. This is not the same thing as PMDD. With PMDD there may be no chronic depression or anxiety. You can feel sunny, perky, and happy after your period starts and up until ovulation…and then things take a major swing downhill. You might feel sluggish and mildly irritable a week before your period, and then find yourself wondering if your family would be better off without you, only to have those feelings resolve completely after your period starts. If you are experiencing this right now, please get help! Visit suicidepreventionlifeline.org or call 1-800-273-TALK for support. You can sort out your diagnosis later.

3) changes in appetite, bloating, or weight

Are you a “normal” eater…until about a week before your period starts (and then you eat all the things)? It could be a symptom of PMDD. It’s important to note that increased appetite before your period is completely normal because your metabolic rate speeds up during this time. Some women crave foods higher in fat or carbs, or just feel hungrier than usual. With PMDD, women typically find that their hunger feels uncontrollable. This usually leads to bloating because of an increase in foods that are difficult to digest, like process carbohydrates mixed with processed fats (hello potato chips!), and can also make the scale go up a few pounds. My advice? Throw the scale out (it’s not telling you anything about your health) and accept that your weight fluctuates…and so does everyone else’s! If you feel like your hunger is abnormally high (or you have zero appetite when you normally eat well), you may want to get your hormones tested to identify the underlying cause(s). You can do that by working with a doctor or nutritionist (me!) to interpret the results and give you specific food, lifestyle, and supplement recommendations that reflect those results.

4) extreme fatigue

Most women have some fatigue before and/or during their period. The normal hormone fluctuations that occur can cause some changes in energy production, and it’s your body’s way of saying “slow down” so you can reset. With PMDD, fatigue can be severe, to the point that you can’t get out of bed, and when you do you feel like a zombie at work and you can’t seem to get anything done at home. Again, with PMDD these symptoms happen just before and/or during your period and disappear during your follicular phase. If you have ongoing fatigue, consider getting tested for iron insufficiency/malabsorption, low estrogen and/or testosterone, and thyroid dysfunction.

5) insomnia or hypersomnia

With PMDD, there is usually a serotonin insufficiency (for whatever reason), and this can lead to melatonin insufficiency. This is because melatonin requires adequate serotonin for its production. If your melatonin is low, you may have trouble falling or staying asleep. This can be intensified with PMDD because the hormone changes before your period can lower serotonin even further. Alternatively, if your fatigue is really intense, you might feel the need to sleep for 12 hours despite these changes. Either way, this sleep disruption can cause significant changes in your lifestyle for a week or two. It’s important to know that this is not normal and you don’t have to live with it!

woman researching PMDD

If you feel like this description matches your experience and has been present for more than 2 period cycles, make an appointment with your doctor to explore support with medication (if needed) and check out the natural ways you can reduce these symptoms below.

Ways to fix it:

If you have depression and/or anxiety - nutrition therapy, medication, and counseling

It’s SO important to get professional help for any health condition, including mental health. PMDD can be supported with changes in your food and lifestyle, but you may also need medication and therapy. Cognitive behavioral therapy has been shown to be effective for PMDD. With depression, a combination of medication, nutrition interventions, and therapy works better than any of these alone. If you think that you might actually have chronic depression, don’t let that stop you from getting help!

If reproductive hormones are out of balance - nutrient-dense foods, exercise, and stress management

Feel like something’s not quite right, but your mood is generally good? Balance your hormones by increasing your intake of veggies and reducing inflammatory foods. Balance your blood sugar by increasing your healthy fats and proteins and eating whole-food carbohydrates more than processed carbohydrates. Reduce stress with yoga, mediation, prayer, and walking outside. If you’d like specialized support on your own time, get on my waitlist for Hormone Rehab, a 6 week, self-paced online program that helps you get your hormones back in balance. Look for the notification sign-up form on the blog homepage!

Regardless of the cause - reduce nutritional stressors

Nutritional stressors are things that require your body to use more vitamins than it normally needs. Examples include smoking, alcohol, caffeine, psychological stress, birth control pills, cleaning chemicals, makeup, personal care products, botox, and more. While any one of these items can be safely used with proper care and nutrition (unless you are very sensitive to it), the combination of several or many increases your exposure to endocrine disruptors (chemicals that interfere with hormone production). Reduce your exposure or intake of these nutritional stressors, and switch as many cleaning and personal care products to items that do not contain endocrine disruptors.

Potential supportive supplements - work with a qualified herbalist or nutritionist

Supplements are not cure-alls, and they can cause more harm than good if used incorrectly. If you want to take a supplement for hormone support, make sure you know exactly what is in it and how the ingredients affect your body. I highly recommend working with a professional for this! There are many herb-drug interactions, so be safe! Some supplements that have been shown to be helpful for PMDD are calcium, B6, chaste tree, and magnesium. Vitamin D levels may also play a role in the calcium and hormone changes with PMDD, so be sure to get your levels checked and supplement if necessary.


References:

Reed, S. C., Levin, F. R., & Evans, S. M. (2008). Changes in Mood, Cognitive Performance and Appetite in the Late Luteal and Follicular Phases of the Menstrual Cycle in Women With and Without PMDD (Premenstrual Dysphoric Disorder). Hormones and behavior, 54 (1), 185-193.

Welse et al. (2019). Internet-Based Cognitive-Behavioural Intervention for Women with Premenstrual Dysphoric Disorder: A Randomized Controlled Trial. Psychotherapy and Psychosomatics, February 2019: 1-14. doi: 10.1159/000496237.

Lanza di Scalea, T. & Pearlstein, T. (2017). Premenstrual Dysphoric Disorder. Psychiatric Clinics of North America, 40 (2), 201-216.

Thys-Jacobs, S. McMahon, D., & Bilezikian, J. P (2007). Cyclical changes in calcium metabolism across the menstrual cycle in women with premenstrual dysphoric disorder. Journal of Clinical Endocrinology and Metabolism, 92 (8), 2952-2959.