Cassandra Wilder is a hormone expert and Naturopathic Doctor who specializes in cyclical health and menstruation. She aims to share a holistic perspective on naturally managing a wide range of cycle related symptoms.  

Your Empowered Guide to PMDD

It’s a common search query on online search engines: Do I have PMS or PMDD?

While the two are similar in many ways, there are also key differences to consider.

How are PMS and PMDD different?

PMS, or Premenstrual Syndrome, is a combination of physical and emotional symptoms that coincide with the luteal phase of a woman’s menstrual cycle. Up to 3 in 4 women are affected by PMS in the 7 or so days before their period starts. Symptoms may include irritability, bloating, breast tenderness, fatigue, and food cravings. A key thing to note with PMS is that symptoms usually disappear by the end of the menstrual cycle.

PMDD, on the other hand, is a more severe and often debilitating form of PMS. Premenstrual Dysphoric Disorder affects up to 5% of women and is characterized by symptoms like grief, depression, crying spells, insomnia, trouble with focusing, and a loss of interest in hobbies. While PMS is often only present in the few days leading up to a period, PMDD can feel like a heavy cloud that is present for nearly half of the month through the entire luteal phase, spanning up to 14 days in length. PMDD usually resolves with the onset of menstruation, a notable difference to PMS. 

It’s fair to state that PMS can create disturbances in your life, while PMDD deteriorates your quality of life and ability to perform basic life activities. This is why it’s so important to work with a professional to determine whether you have PMDD and, if diagnosed, establish a healing regimen that is tailored to the root of your symptoms.

Keep reading: Why PMS Could Be Good for You

What Causes PMDD?

While there isn’t an exact known cause of PMDD, many experts agree that it is connected to the fluctuation in hormone levels during the luteal phase of the menstrual cycle. The luteal phase of a woman’s cycle is an intricate time of surging and dropping hormones. Progesterone surges in the luteal phase after ovulation, and estrogen slowly builds its way back up before the onset of menstruation. 

Serotonin, the hormone of mood stabilization and happiness, also largely plays off of estrogen. It’s suggested that imbalanced levels of estrogen and progesterone during the luteal phase can influence serotonin levels. 

It is also known that stress can largely influence PMDD symptoms as shown in this study here.

How is PMDD Diagnosed? 

While there isn’t one specific test that can confirm PMDD, it’s recommended to create a comprehensive list of symptoms and patterns noticed throughout the month. Based on the symptoms you’re presenting, your doctor may diagnose you with PMDD. 

In general, a patient must experience at least five of the following symptoms to receive a PMDD diagnosis:

• Depressed mood
• Anger and irritability
• Mood swings
• Anxiety
• Lack of interest in hobbies or friends
• Feelings of hopelessness
• Low energy and fatigue
• Appetite changes
• Difficulty concentrating
• Feeling out of control
• Irregular sleep patterns; either insomnia or a desire to sleep more than needed
• Physical symptoms like bloating, headaches, or breast tenderness
  

Managing PMDD Symptoms

Medical treatments often include prescription antidepressants and hormone medications like birth control. In recent years, suggestions like therapy, quality time in nature, and regular exercise have also become common recommendations from doctors. With PMDD growing in awareness, the demand continues to rise for quality care and support in managing some major and sometimes debilitating symptoms. 

From a holistic perspective, it’s important to address some of the hormone fluctuations mentioned earlier. With our cyclical bodies, these hormonal ebbs and flows are naturally occurring each month and generally shouldn’t be accompanied with severe symptoms. 

In looking at how our hormones change throughout the month, it’s imperative to look at the process of ovulation. As the most important event of the menstrual cycle for hormone balance, ovulation enables the body to make progesterone during the luteal phase. It’s then worth considering that anovulatory (lack of ovulation) menstrual cycles could lead to low progesterone levels, which in turn is associated with mood disturbances, depression, and tender breasts.

Options for Holistic Support

Managing PMDD symptoms can be life changing for those who suffer from PMDD. Here are some of the most important places to start. 

1. Encourage Healthy Progesterone Levels

Progesterone works as a soothing hormone in the luteal phase, so by encouraging healthy progesterone levels, some symptoms may be eased. One of the best ways to support healthy progesterone levels is through confirmed ovulation every month. Remember, ovulation is vital for progesterone production in the luteal phase. 

If ovulation is not happening each month, it’s important to look at other factors like stress, sleep quality, caloric intake, and previous birth control use. 

Note: some hormonal birth control methods work by inhibiting the action of ovulation

Other tools clinically shown to help support progesterone levels: 

• Vitamin C at 600mg per day 
• Vitex (also known as Chaste Tree Berry) at 500 to 1000mg per day

An easy way to incorporate these herbs and vitamins into your daily routine is through organic, herbal supplements and formulas like Cycle Balance. Click here to take the Elix Health Assessment and see if Vitex Berry is recommended for you. 

2. Focus On Nutrient Dense Foods, Especially In the Luteal Phase

Eating nutrient dense foods and maintaining healthy blood sugar levels can also be surprisingly helpful during the luteal phase. Focusing on consistent, protein-rich meals throughout the day and ensuring adequate calorie intake can make a world of difference. One study found a correlation between irregular blood sugars and mood changes and how closely connected they really are. 

Focus on regular meals and nutrient-dense snacks that contain protein, fat, and complex carbohydrates for improved blood sugar balance. Snacks like nuts, homemade protein balls, jerky, and hard boiled eggs are all easy protein-rich options to have prepared for the luteal phase.

3. Lower stress through deep self-nourishment 

Stress is a known proliferator of nearly every imbalance in the body, but especially when it comes to PMS and PMDD. Big mood changes in the luteal phase may be linked to an imbalance between cortisol levels and progesterone. Both the stress hormone cortisol and progesterone share the same hormone precursor pregnenolone. Because they both share the same master hormone, at times they can actually work against each other. Known as the pregnenolone steal, much of the pregnenolone may be sent towards cortisol instead of other hormones like progesterone during stressful times. Without that surge of progesterone, symptoms of PMDD may also worsen. 

To avoid this hormone heist, creating consistent self care practices, boundaries, and adequate time off may be the best prevention. Especially for those who suffer with PMDD, creating as much flexibility in one’s schedule during the luteal phase may be supportive. 

Keep reading: How Stress Affects Your Cycle

4. Incorporating Adaptogens Into Your Daily Routine  

Adaptogens are powerful herbs and mushrooms that help to increase your body’s ability to deal with environmental stressors and manage cortisol levels, the stress hormone. If you are experiencing high or low levels of cortisol, an adaptogen will help your body get back to a state of equilibrium. 

Elix harnesses the power of these adaptogens in herbal formulas to help you adapt to stress, fight fatigue, balance hormones, and improve your overall mood. Some of the adaptogens in our Daily Harmony formula include: 

• Reishi Mushroom - An incredible nervous system calming herb that is excellent for people who experience irritability, nervousness, heightened emotions, sleeplessness, or general fatigue and weakness throughout your cycle.
• Astragalus - ​​A powerful adaptogen that can flexibly support our body’s ability to adapt to environmental and life stressors. 
• Chinese Foxglove - A proven antioxidant, anti-inflammatory, and antidepressant, all of which aid with PMS / PMDD symptoms. 
• White Ginseng - Often used for brain fog, fatigue, stress, and digestive issues. This popular herb is great for subduing nausea and inflammation of the colon and stomach lining. 

Elix formulas are a great option to support people with PMDD as their potent, herbal decoctions target the root cause of your symptoms. Elix’s very own Sr. Brand Associate, Stephanie, has seen major improvements in her PMDD symptoms after taking Cycle Balance and Daily Harmony—she calls these her “complete cycle care kit.”. Where Cycle Balance is a tailored formula to target symptoms during menstruation, Daily Harmony supports your mood every day of the month. Stephanie says “for the first time ever I am waking up calm, without nausea from my anxiety during my luteal phase.”

If you’ve struggled with PMDD, you know firsthand how life-altering it can be. Further hormone testing may be helpful in the long term to determine if there are other imbalances present, and beginning to regularly track and confirm ovulation is also a simple practice that can easily be implemented to gather more personal data.

Shop our Daily Harmony and Cycle Balance formulas to create a complete cycle care system that helps you live in balance all month long.

This article was reviewed by Dr. Elizabeth Fine.

Dr. Elizabeth Fine is currently the Dean of Clinical Education at Emperor’s College, the #2 ranked colleges for TCM. She has been practicing Acupuncture and Herbal Medicine for over 20 years, with a specialization in women’s reproductive health.