Premenstrual syndrome (PMS) is a many-headed beast – with over 150 different symptoms attributed to PMS, many women find the days, or week, before their period to be a challenging time. But what about those women who are completely destroyed by their PMS? Who suffer with severe mood changes, insomnia and fatigue? Those women may in fact be suffering from PMDD – premenstrual dysphoric disorder. 

A Diagnosis of PMDD

PMDD is classified as a type of depressive disorder. It is not the same as clinical depression because it only occurs during the second half of the menstrual cycle, after ovulation, and it resolves within a few days of starting your period.

For the 2-6% of women who experience PMDD, it can lead to significant negative impacts on her life. Known to cause severe distress, it can impact a woman’s ability to function and to maintain her quality of life. But still many of the women don’t seek treatment and instead suffer each month with severe symptoms. 

PMDD is different from PMS in the severity of symptoms and the consequences of the mood changes. The diagnosis is made by using symptom tracking reports and needs to meet the following criteria:

Treatment of PMDD

Conventional treatment of PMDD gives women two limited options: the birth control pill, or an antidepressant. While these treatments may be effective for some women, many more women are seeking a more natural, empowered approach to managing their PMDD.

Natural Approaches to PMDD

I previously wrote an article called Ten Natural Treatments for PMS where I highlight ten of the best researched and most effective treatments for managing PMS. I suggest all women with PMDD also follow those recommendations. But for PMDD I tend to take a more aggressive approach – the symptoms are often severe enough to warrant a very targeted and bold plan. 

Vitamin B6

Used in both PMS and PMDD, vitamin B6 is necessary for the production of cortisol, progesterone and serotonin – all hormones involved in PMS and PMDD. Taking high (orthomolecular) doses of vitamin B6 can be helpful at reducing symptoms of PMS and PMDD. Vitamin B6 is usually taken all month long, but higher doses can be used in the second half of the cycle if needed. 

Calcium

Calcium has been found in studies to reduce a wide variety of symptoms associated with PMS. While I don’t generally find it to be useful on its own, in a robust protocol calcium can play a role in reducing both the mood and physical symptoms of PMS and PMDD. 

L-tryptophan and 5-HTP

Two supplements that can increase the production of serotonin in the body, L-tryptophan and 5-HTP, show a ton of promise in the treatment of PMDD.  Using a similar mechanism as antidepressants, these two treatments can support the serotonin production and response – considered to be one of the most effective means of treating PMDD.  L-tryptophan and 5-HTP are the direct precursors of serotonin and can significantly reduce mood symptoms of PMDD. These supplements are not recommended to be taken together (we choose one or the other, depending on your needs), and should not be combined with other antidepressants. Use only under the guidance of a knowledgeable and experienced Naturopathic Doctor. 

St. John’s Wort

One of the most commonly used botanical medicines, St. John’s Wort is an excellent treatment for women with PMDD. Acting on the serotonin system in the body, St. John’s Wort can reduce depressive symptoms of PMDD and improve mood. It can be taken all month long, or just during the second half of the menstrual cycle. 

Chaste Berry

Chaste berry (chaste tree, Vitex agnus-castus), which I also discussed in the PMS article, has been found to be effective for PMDD. Chaste berry can reduce anger, irritability, anxiety, mood swings, and physical symptoms associated with PMS and PMDD. My experience is that it can be moderately effective for PMDD, but often additional treatments are needed to help women feel considerably better. 

IV Micronutrient Therapy

One treatment that I offer at the Integrative Health Institute, and have found to drastically improve PMS and PMDD symptoms in women is IV micronutrient therapy (IVMT). IVMT allows us to administer doses of vitamins (like B6, calcium and magnesium) at higher doses than you would be able to take orally. IV therapy also provides an abundance of nutrients necessary for detoxification of hormones – and reducing the hormone burden in the body can greatly improve symptoms of PMDD. Not every woman is a candidate for IVMT, but talk to your Naturopath to find out if you are. 

Bio-Identical Progesterone

While we don’t know exactly what causes PMS and PMDD, one suspect in this mystery is an imbalance of estrogen and progesterone – often called estrogen dominance. When progesterone levels are unstable, or low, and estrogen levels are high, PMS and PMDD depression and mood swings can result. For some women, especially those in their 40s, bio-identical progesterone can be a lifesaver. Your ND will give you a questionnaire to identify a possible progesterone imbalance, and may also recommend hormone testing.

Reclaiming Your Life

My best recommendation to managing PMDD is to work with someone who takes your symptoms seriously, who recognizes the many ways in which PMS and PMDD can influence your quality of life, and who can help you to develop a plan that addresses your unique experience. My approach to PMDD is generally quite bold and proactive – mostly because I don’t want women to suffer unnecessarily. It can take several months to overcome the debilitating symptoms of PMDD – but trust me, they can be overcome.

Select Resources

Comprehensive Gynecology, Seventh Edition. Ed. Lobo R, Gershenson D, Lentz G. 2017; 37, 815-828.

Ferri’s Clinical Advisor. Premenstrual Dysphoric Disorder. Ed. Ferri FF. 2019

Dr. Lisa Watson believes that you don’t have to be perfect to be healthy.  Lisa encourages her patients to take a proactive approach to their health – taking meaningful steps towards achieving their goals for balanced and vibrant health.  An expert in women’s health and hormones, Lisa is a passionate advocate for women’s health and strives to educate all the women in her practice on how to achieve lifelong abundant health.  Dr. Watson practices at the Integrative Health Institute in downtown Toronto and writes regularly about women’s health on her website at www.drlisawatson.com