All You Need to Know About PMDD (Premenstrual Dysphoric Disorder)

What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual Dysphoric Disorder is a severe and disabling health problem that is similar to PMS (Premenstrual Syndrome) but is more serious and causes extreme mood shifts. It is also called Late Luteal Dysphoric Disorder (LLDD). The onset of PMDD can be anytime after puberty.

Symptoms of PMDD start just a week before your menstruation and end within a few days after your periods start. Symptoms are so severe that it makes it difficult to work and maintain relationships during this time. The symptoms affect your ability to carry out daily tasks.

What are The Symptoms of PMDD?

Premenstrual Dysphoric Disorder (PMDD) has many of the same symptoms as Premenstrual Syndrome (PMS) but are more severe and have a greater impact on your life.

Symptoms of PMDD come under three types - mood changes, behavioural changes and physical symptoms.

1. Mood Changes:

• Feeling sad, depressed, worthless
• Irritability, anger
• Mood swings, suddenly feeling sad and tearful
• Increased anxiety

2. Behavioural Changes:

• Lack of energy, fatigue
• Lack of interest in daily activities
• Difficulty to concentrate
• Appetite changes like overeating or food cravings
• Changes in sleep pattern, either excessive sleep or loss of sleep
• Feeling overwhelmed

3. Physical Symptoms:

• Breast tenderness or swelling
• Joint and muscle pain
• Headaches
• Bloating
• Weight gain

Around 1.6% of women and girls have symptomatic Premenstrual Dysphoric Disorder (PMDD) – Journal of Affective Disorders.

The duration for which you experience these symptoms varies from person to person. It can last anywhere between a few days to two weeks. Symptoms usually begin 6 days before menstruation and peak at 2 days before your periods.

What Causes PMDD?

The exact cause of PMDD is unknown. Possible factors that cause PMDD are:

1. Hormone Changes:

PMDD is caused by abnormal reactions to normal hormonal changes that occur during the menstrual cycle. Some women are more sensitive to these changes than others. Possible hormones that contribute to PMDD are oestrogen, progesterone and allopregnanolone.

2. Deficiency of Serotonin:

Serotonin is a neurotransmitter produced by your intestines and brain. Serotonin levels change during your menstrual cycle. In some people, serotonin deficiency occurs, leading to PMDD.

3. Genetics:

PMDD is caused by abnormal sensitivity to oestrogen, the female sex hormone. Studies have shown that women with PMDD are more likely to have genetic variants of the gene ESR1, which causes extreme sensitivity to oestrogen. 

4. Mood Disorders:

If you have mood disorders like depression or anxiety, you are more likely to develop PMDD.

5. Early Childhood Trauma:

Women who have experienced childhood trauma are more likely to develop PMDD with more severe symptoms.

83% of women with PMDD had experienced early life trauma, with emotional abuse being the most common. – PubMed.

6. Smoking:

Women who smoke are more likely to develop PMDD than non-smokers.

How is PMDD Diagnosed?

Currently, PMDD is recognised as a psychological condition and is listed under Depressive disorders. PMDD cannot be diagnosed by just physical examinations or lab tests. Your healthcare provider diagnoses PMDD by taking into consideration your medical history, symptoms, its severity, and other mental health concerns. 

To be diagnosed with Premenstrual Dysphoric Disorder, you must:

• Have five or more symptoms of PMDD during most of your menstrual cycles for at least a year.
• The symptoms should start a week before your menstruation and stop within a few days after menstruation.
• Symptoms must be severe so as to disturb the person’s daily life, work and relationships.
• Other psychiatric disorders like depression and anxiety are ruled out to make sure the symptoms of PMDD are not part of another underlying illness.

Your doctor will also carry out a thorough physical exam (including a pelvic exam) and lab tests to rule out other health issues and confirm the diagnosis of PMDD.

How is PMDD Treated?

Living with PMDD can be difficult. Knowing how it can be treated can give you relief and enable you to take the necessary steps to manage this condition.

“In a world where the health and well-being of every individual matters, the revelation that approximately 31 million females worldwide may be silently grappling with Premenstrual Dysphoric Disorder, a condition that deeply impacts their daily lives, cannot be overlooked.” – Clare Knox, an organisational psychologist who co-authored the paper ‘The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis’ and has experienced PMDD herself.

There are different approaches to treating PMDD, like modifying your lifestyle, taking medications, and undergoing therapy.

1. Lifestyle Modifications 

Making small changes in your lifestyle can reduce the symptoms of PMDD and improve the quality of your life. Lifestyle modifications for PMDD include:

• Exercising regularly.
• Eating a healthy and well-balanced diet.
• Stress-relieving techniques like yoga and meditation.
• Taking dietary supplements.
• Including herbal remedies.
• Cultivating healthy sleeping habits.

2. Medications

Some medications used by conventional healthcare professionals to treat PMDD include -

Selective Serotonin Reuptake Inhibitors (SSRIs)

• These medicines increase serotonin levels in the brain, which improves your mood and relieves depression and anxiety.

Non Steroidal Anti Inflammatory Drugs (NSAIDs)

These medicines focus on relieving physical symptoms associated with PMDD, like muscle pains, headaches, breast discomfort and cramping.

Diuretics

• These medicines help remove excess water from the body by increasing urine output, thereby reducing symptoms like bloating, weight gain and breast swelling.

Contraceptive Pills

• Hormonal contraceptive pills (birth control pills) reduce PMDD symptoms by stopping ovulation.

Anxiolytics and Antidepressants

• These medicines help reduce severe anxiety and depression associated with PMDD. 

3. Therapy and Counselling

The mental symptoms of Premenstrual Dysphoric Disorder can be very difficult to deal with alone. But with proper support, therapy and counselling, you can find relief and improve the quality of life. You can get help either through one-on-one talks with your therapist or through online counselling. Some coping strategies are -

• Cognitive Behavioural Therapy (CBT): Reduces mood swings and irritability.
• Interpersonal Therapy (IPT): Helps to reduce the effect of PMDD on personal relationships.
• Mindfulness-Based Therapy: Improves your control over your emotions and reduces stress.

Can You Cure PMDD Naturally?

PMDD is caused by increased sensitivity of your body to hormonal shifts occurring at the time of menstruation. Throughout the reproductive age, from menarche to menopause, these hormonal changes occur naturally. If you have been diagnosed with PMDD, it is not likely to go away completely until you reach menopause. 

However, symptoms of PMDD can be treated using conventional methods, natural remedies, lifestyle changes and stress-relieving techniques.  

Ayurveda mentions specific herbs that can balance the hormones and reduce symptoms of PMDD. 

Managing PMDD Naturally at Home

Alongside medication and therapy, you can improve your overall well-being by managing PMDD using simple techniques. Including Ayurvedic herbs, following a healthy and balanced diet, exercising regularly and practising techniques to relieve stress and anxiety can reduce PMDD symptoms to a great extent. Here are some expert suggestions you can try out at home.

1. Ayurvedic Herbs for PMDD

Specific Ayurvedic herbs that regulate hormones, relieve stress and reduce pain have proven to be very beneficial in treating PMDD. Here are some expert-recommended Ayurvedic herbs that can help you:

• Ashwagandha (Indian Ginseng): Reduces anxiety and stress levels by reducing cortisol (a stress hormone) levels.
• Ashoka (Saraca asoca): Regulates hormones and relieves menstrual cramps.
• Shatavari (Wild Asparagus): Balances hormones and reduces menstrual cramps.
• Kumari (Aloe Vera): Reduces bloating and relieves menstrual cramps. 
• Brahmi (Indian Pennywort): Relieves stress and anxiety and improves mental clarity.
• Yashtimadhu (Liquorice): Reduces tiredness and mood swings. 
• Ajamoda (Celery): Helps manage menstrual cramps and reduces bloating.
• Haridra (Turmeric): Reduces bloating and joint pains associated with PMDD.
• Jatamansi (Indian Spikenard): Calms the nervous system, improves sleep and reduces irritability.

These Ayurvedic herbs can be consumed in the form of herbal teas, powders or capsules. Consult a healthcare expert to learn the right herbs and dosages according to your symptoms.

2. Diet and Exercise Tips 

Here are some useful diet recommendations and exercises you can include in your routine to manage PMDD symptoms better:

Diet for PMDD

• Include whole grains and legumes in your diet. 
• Eat more fruits like bananas and berries. 
• Include green leafy vegetables in your diet.
• Consume low-fat dairy products like milk and yoghurt.
• Eat high-protein foods like lean meat and fish.
• Consume omega-3-rich foods like walnuts, flaxseeds, mackerel and salmon.
• Reduce intake of refined and processed foods like pasta and white bread. 
• Limit intake of refined sugar, alcohol, and caffeine.
• Eat small, frequent meals to avoid bloating.
• Reduce the consumption of salty foods. 
• Include dietary supplements or fortified foods containing calcium, magnesium, vitamin E and vitamin B6.

Exercises for PMDD

Exercises for PMDD include mild aerobic exercises to keep your body healthy, ease pain and improve your overall health. Recommended exercises for PMDD are:

• Cycling
• Brisk walking
• Swimming
• Jogging
• Pilates
• Yoga

3. Stress Management Techniques

Are you curious how stress management techniques can help you manage PMDD symptoms? Try out these expert-recommended tips to manage PMDD-related stress, anxiety and depression.

Yoga for PMDD

In a study conducted on the effects of yoga on premenstrual symptoms among women in Taiwan, it was concluded that yoga can effectively reduce premenstrual symptoms, including depressive symptoms, physical symptoms, and anger/irritability, as well as their impact on daily routines, hobbies/social activities, and relationships.

Here are some simple Yoga techniques beneficial for PMDD:

• Balasana (Child’s pose)
• Shavasana (Corpse pose)
• Marjaryasana-Bitilasana (Cat-cow pose)
• Adho Mukha Svanasana (Downward Dog pose)
• Phalakasana (Plank pose)
• Bhujangasana (Cobra pose) 

Controlled Breathing Techniques

Practising Pranayama or controlled breathing can help you reduce stress and anxiety levels. It brings about calmness and balance to your mind. It also regulates hormones responsible for PMDD. It also improves the quality of sleep.

Meditation and Mindfulness

Practising meditation and mindfulness can reduce stress and anxiety, reduce pain perception, improve sleep and build self-awareness, helping you accept and manage your condition better.

To Sum Up

Premenstrual Dysphoric Disorder is a condition many women experience every month. Its symptoms, such as extreme mood shifts, hopelessness, anger, anxiety and depression, can take a toll on your personal and social life. Along with conventional treatments, following a proper diet, regular exercise, and stress management techniques can greatly reduce the symptoms and improve the quality of your life.

We understand what you are going through, and we’re here to help you manage PMDD better. Get in touch with our Ayurvedic and Yoga experts at Nirva Health for personalised support and guidance for a more balanced life.