Premenstrual syndrome (PMS) is something most women experience at some point in their reproductive years. The symptoms can range from mild irritability to bloating and fatigue. But what if your premenstrual symptoms are severe enough to disrupt your life? If your mood swings, anxiety, or depression feel overwhelming in the weeks leading up to your period, it’s important to consider you might be dealing with something more than just PMS—premenstrual dysphoric disorder (PMDD).
In this article, we’ll explore what PMDD is, how it differs from PMS, the signs and symptoms, how it’s diagnosed, common treatments, and the functional medicine approach to relieving PMDD.
What Is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that significantly impacts a woman’s emotional, mental, and physical well-being. While PMS can cause discomfort, PMDD is debilitating, affecting daily activities, relationships, and overall quality of life. It is classified as a mood disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and is believed to be triggered by an extreme sensitivity to the natural hormonal fluctuations that occur during the menstrual cycle.
PMDD affects approximately 3-8% of menstruating women and is often underdiagnosed or mistaken for other mood disorders, such as depression or anxiety. The symptoms typically emerge in the luteal phase (the two weeks before menstruation) and resolve shortly after the period starts.
Signs & Symptoms of PMDD
PMDD symptoms can be intense and disruptive. The key distinction from PMS is the severity of symptoms and the extent to which they interfere with daily life. Some of the most common symptoms include:
Emotional Symptoms:
- Severe mood swings
- Irritability or anger that impacts relationships
- Depression, hopelessness, or suicidal thoughts
- Severe anxiety or panic attacks
- Feeling overwhelmed or out of control
Physical Symptoms:
- Extreme fatigue or lack of energy
- Sleep disturbances (insomnia or excessive sleep)
- Muscle or joint pain
- Headaches
- Bloating, weight gain, and digestive issues
Behavioral & Cognitive Symptoms:
- Difficulty concentrating
- Increased sensitivity to rejection or criticism
- Loss of interest in daily activities
- Social withdrawal
- Increased cravings for food, particularly carbohydrates
How Is PMDD Diagnosed?
PMDD is diagnosed using specific criteria set by the DSM-5. To receive a diagnosis, a woman must experience at least five of the following symptoms during most menstrual cycles in the past year, with at least one being an emotional symptom:
- Mood swings (sudden sadness or increased sensitivity to rejection)
- Irritability or anger
- Depressed mood or feelings of hopelessness
- Anxiety or tension
- Decreased interest in usual activities
- Difficulty concentrating
- Fatigue or lack of energy
- Appetite changes or cravings
- Sleep disturbances
- Physical symptoms (bloating, joint/muscle pain, breast tenderness, etc.)
These symptoms must occur in the luteal phase, resolve shortly after menstruation begins, and significantly interfere with work, school, social life, or relationships. A healthcare provider will typically ask patients to track their symptoms over several months to confirm the diagnosis.
Conventional Treatments for PMDD
The standard medical approach to PMDD primarily focuses on symptom management. Here are some of the most commonly prescribed treatments:
1. Antidepressants (SSRIs & SNRIs)
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are commonly prescribed to help regulate mood and reduce emotional symptoms of PMDD. These medications can be taken continuously or only during the luteal phase.
2. Hormonal Birth Control
Birth control pills that contain drospirenone and ethinyl estradiol (like Yaz) may help alleviate symptoms by suppressing ovulation and stabilizing hormone levels.
3. GnRH Agonists
Gonadotropin-releasing hormone (GnRH) agonists induce temporary menopause by shutting down ovarian function. These are typically used in severe cases when other treatments fail.
4. Lifestyle Modifications
Doctors often recommend regular exercise, stress management techniques, and quality sleep to support overall well-being.
The Functional Medicine Approach to PMDD
Functional medicine takes a root-cause approach to PMDD by looking at the underlying imbalances contributing to symptoms rather than just treating them. This approach recognizes that PMDD may be influenced by factors such as hormone fluctuations, neurotransmitter imbalances, and inflammatory responses.
1. Identifying Hormonal Imbalances
Functional medicine practitioners often assess estrogen, progesterone, and cortisol levels to determine if hormone imbalances are playing a role in PMDD. Hormonal testing can help provide a clearer picture of fluctuations that may be exacerbating symptoms. Identifying whether estrogen dominance, progesterone deficiency, or cortisol dysregulation is involved can help guide a more personalized approach to symptom management.
2. Addressing Neurotransmitter Dysregulation
Since serotonin plays a crucial role in mood regulation, functional medicine may explore ways to support serotonin balance. This can include evaluating whether there are deficiencies in neurotransmitter production and looking at lifestyle factors that influence serotonin levels, such as stress, sleep, and gut health. Dopamine and GABA levels may also be assessed, as imbalances in these neurotransmitters can contribute to the anxiety and mood instability seen in PMDD.
3. Managing Stress & Supporting the Nervous System
Chronic stress can exacerbate PMDD symptoms by impacting cortisol levels and nervous system regulation. Functional medicine often incorporates stress-reduction techniques such as mindfulness, relaxation exercises, and proper sleep hygiene. Supporting the adrenal glands and improving resilience to stress can play a significant role in reducing PMDD severity.
4. Evaluating Gut Health & Inflammation
Emerging research suggests that gut health may influence hormonal balance and neurotransmitter function. The gut microbiome plays a key role in estrogen metabolism, serotonin production, and inflammation levels. Functional medicine may explore gut health assessments to identify imbalances in gut bacteria or inflammation that could be contributing to PMDD symptoms. Chronic inflammation has been linked to mood disorders and hormonal imbalances, so addressing sources of inflammation in the body is often part of a holistic treatment plan.
5. Assessing Environmental & Lifestyle Factors
Functional medicine also considers external factors that may be contributing to PMDD symptoms. Exposure to endocrine-disrupting chemicals (found in plastics, personal care products, and household cleaners) can interfere with hormone balance. Identifying and reducing exposure to these chemicals may help regulate hormonal function. Additionally, lifestyle factors such as sleep quality, movement, and stress resilience techniques are considered essential components in managing PMDD from a root-cause perspective.
What to Do Next if You Suspect PMDD
If you resonate with the symptoms described, consider tracking your cycle and symptoms. Then, consult a healthcare provider who understands PMDD and can guide you on the next steps. Whether you choose conventional treatment or a combination of approaches, know that relief is possible.
- Track Your Symptoms: Use a period tracking app or journal to identify symptom patterns.
- Get Functional Lab Testing: Testing hormone levels, blood sugar, gut health, and nutrient deficiencies can provide insight into the root cause of PMDD.
- Work with a Functional Nutritionist or Practitioner: Personalized nutrition and lifestyle strategies can make a significant impact on managing symptoms.
- Consider Lifestyle and Dietary Changes: Implementing blood sugar balance, nutrient support, and nervous system regulation can lead to noticeable relief.
PMDD can feel overwhelming, but with the right support and strategies, you can regain control over your mood, energy, and overall well-being. Healing is possible, and you don’t have to navigate it alone!