PMDD: Identifying and Addressing Root Causes

What causes PMDD? In a word: inflammation.

While there is still much to be learned about PMDD, there is evidence that PMDD symptoms can be driven by inflammation of the GABA receptors which makes them less adaptable to fluctuations of allopregnanolone, a metabolite of progesterone. Normally, progesterone has a calming effect on GABA receptors, but with PMDD, the effect is quite the opposite and can result in feelings of anxiety, rage, and other negative mood symptoms.

To get relief from PMDD, stabilizing the GABA receptors is imperative. To do this, SSRIs may be helpful for some, don't work for others (I was one of these unlucky ones), and may increase the risk of osteoporosis. Whether or not you use medication to manage your PMDD, it's important to understand the factors that contribute to the imbalance in the first place.

One of the factors that can drive GABA receptor inflammation and the negative mood effects that come with it is histamine, which may be why some people experience symptomatic relief when taking anti-histamine drugs or supplements. Histamine is but one potential driver of GABA receptor inflammation/PMDD symptoms, but an important one to consider. For some, eliminating high histamine foods such as cow's dairy and alcohol is enough to provide some relief.

Another major factor I've found both personally and for my clients is blood sugar balance. Why? Because blood sugar impacts histamine and estrogen levels. Elevated blood sugar levels suppress sex hormone binding globulin (SHBG), which binds to and regulates excess sex hormones like testosterone, which is how elevated blood sugar can cause PCOS. Elevated blood sugar can also increase estrogen levels and contribute to estrogen dominance.

Estrogen dominance is more and more common in the modern world due to an abundance of xenoestrogens in the environment and in products that we use, chronic stress, and high sugar diets. Estrogen dominance symptoms become more apparent during luteal phase, the 10-14 days before menstruation. As estrogen rises, so does histamine, which can then further raise estrogen levels in a vicious, inflammatory cycle. It's not uncommon for both histamine and estrogen balance to be contributing to the inflammation that can worsen PMDD symptoms.

Eating for blood sugar balance is something that I teach each and every one of my PMDD clients to do successfully. The basics? Consume protein, fat, and fiber at every single meal and snack, start the day with a savory breakfast, don't skip meals, and eat regularly. Check out my free ebook Holistic Nutrition for Endometriosis (it's relevant for PMDD and PCOS, too!) for some balanced, delicious, and healthy meal and snack options. Most of my clients think they're eating in a balanced way only to discover that they're lacking in either protein or healthy fats to stabilize their blood sugar.

A few nutrients that support clearance of histamine and can help restore balance to GABA receptors are magnesium, B6, and taurine. It's important to work with your doctor or other qualified practitioner when supplementing to insure safety and proper dosing. I have personally found magnesium glycinate to be a game changer in my life not only for PMDD but also for endometriosis pain/painful periods, my energy levels, reducing anxiety, and improving overall hormone balance.

Another potential root cause worth mentioning is gut inflammation and gut permeability. An inflamed gut can drive nervous system inflammation through the gut-brain-axis, drive nutrient deficiencies that make it harder for the body to fight inflammation, trigger the release of cortisol (the stress hormone) which also elevates blood sugar levels, and can compromise serotonin. Serotonin is a key neurotransmitter that regulates mood, and 95% of serotonin (and its receptors) is found in the gut, not the brain. Similar to how GABA receptor inflammation results in a negative response to progesterone/allopregnanolone, serotonin receptors can become inflamed and resistant, negatively impacting mood.

I have had success both personally and with my clients (check out their success stories) in relieving symptoms of PMDD by addressing the following: reducing histamine, working to improve gut health, restoring deficient nutrients, addressing GABA receptor inflammation, and managing stress. 5 different women with PMDD may each have 5 different underlying root causes, but balance can be restored with knowledge of the holistic approach. It's important to identify which factors are driving inflammation first.

Unresolved trauma is an important factor that shouldn't be ignored for those suffering with PMDD, and the experience of PMDD itself only adds more trauma. Why is addressing trauma important? Because trauma impacts everything: inflammation, nervous system regulation, gut and hormone health, blood sugar, and nutrient balance. Luckily, there are more modalities than ever to support us in processing trauma and learning to feel safe in our bodies. Personally, I've undergone EMDR for trauma processing and have explored breathwork and cold water therapy to tone my vagus nerve.

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If you are struggling with PMDD, I want you to know one thing: there is so much hope for healing! Even if you've struggled for decades and feel like you've tried all the things. I see you, I feel for you, and I've been there. PMDD almost took my life; I know how hard it can be.

Check out this post for tips on how to prepare for your luteal phase, AKA "hell week" to make it more manageable.

I suffered with PMDD for over a decade but have been able to become symptom-free and have stayed that way for the last 7 years. I now support women in getting relief from their PMDD so that they can thrive and be free from the hellish rollercoaster once and for all! If you're interested in getting support, book a free consult or check out my coaching packages here.