A vast number of women experience what’s known as premenstrual syndrome or PMS which can include symptoms such as mood swings, anxiety, irritability, low energy, stomach cramps, bloating, breast tenderness, and headaches. To be diagnosed as PMS, these symptoms must happen in cycles in which ovulation has happened, they must be present sometime during the last 2 weeks of the cycle, be absent after the period, and before ovulation, and cause significant impairment to daily life.


What is Premenstrual Dysphoric Disorder (PMDD)?


A subset of those women suffer from a condition known as premenstrual dysphoric disorder, which takes the mood changes aspect of PMS to an extreme degree. Though common, PMS symptoms that impair one’s ability to participate in daily activities are not normal. And certainly, more severe symptoms such as those under the PMDD diagnosis, are a sign that something is off in the body. But what?


The Role of Estrogen and Progesterone


It makes sense that we would blame the hormones most closely associated with the menstrual cycle- estrogen and progesterone- and though they are involved, they might not actually be the biggest culprits. Research indicates that estrogen and progesterone are often cycling normally but these women have become intolerant to the changes. A main theory as to why this is, is an alteration in the stress response associated with the cycle. These women may be extra sensitive to the hormonal changes taking place because their nervous system has learned that these changes act as a stressor which sets off abnormal symptoms in other areas, leading to the symptoms listed above.


The Connection Between Stress and Hormonal Changes


How does this abnormal connection between the menstrual cycle and the stress response happen in the first place? It appears that women who have gone through highly stressful or traumatic events during hormonally-sensitive times in their lives are at higher risk for developing PMS and PMDD. Hormonally-sensitive times could include: puberty, pregnancy, postpartum, and menopause. Highly stressful events could include: child abuse, trauma during labour and delivery, and postpartum depression.


Assessing the Symptoms


Note that there are many conditions that can seem “hormonal” but are actually caused by something else and exacerbated by the cyclical changes. Some examples may include: acne, anxiety, depression. Hint: if it happens throughout your cycle and worsens before your period, it may not be PMS. Assessment should be aimed at ruling out other possible causes for the presenting symptoms, such as hypothyroidism, iron deficiency, perimenopause, and vitamin D deficiency, as there is no test that can diagnose PMS.


Managing PMS and PMDD Symptoms


If you’re struggling with PMS or PMDD, the first step is to start tracking your symptoms if you’re not already. This can provide a lot of clarity to your provider around whether it is truly PMS/PMDD or something else that is exacerbated with the cyclical hormonal fluctuations. Don’t worry though, often you can start treatment without having a few cycles tracked. Many positive studies have been done on several nutrients and herbs that can help manage both the mental and emotional symptoms of PMS/PMDD- book in with one of our naturopathic doctors for a plan that is tailored to you.