3 Reasons Why Hormone Fluctuations Affect PMDD

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Approximately 5% of women meet the diagnostic criteria for PMDD, which comprises both psychological and somatic symptoms, including symptoms of depression, anxiety, fatigue, irritability and possibly panic attacks. It happens immediately before the menstrual period and typically ends two to three days after the menses stops. 

PMDD may not only be affected by possible hormone imbalances, but also by how your brain reacts to these hormones. It may be that a heightened sensitivity to normal cyclical hormonal changes is what causes symptoms.

Research evidence suggests that there are three main hormones that are responsible for the symptoms associated with PMDD.

Progesterone

Progesterone is the female hormone that helps prepare the body for conception and pregnancy. It is produced in the ovaries during the Luteal Phase of the menstrual cycle, starting when ovulation occurs and ending when your period starts. Women with PMDD may experience increased progesterone sensitivity during the Luteal Phase, which leads to the symptoms associated with PMDD during this time.

Having an increased sensitivity to progesterone affects the emotional centres of the brain, and increases activity in these regions. Research shows that in healthy women, raised progesterone levels serve to increase sensitivity to physical threats, in order to protect a pregnancy from danger. However, for women with PMDD, having an increased progesterone sensitivity can lead to distressing emotional and behavioural symptoms.

Allopregnanolone

Allopregnanolone is a hormone that is closely related to progesterone. Allopregnanolone is produced when progesterone is broken down in the liver during the Luteal Phase. Women with PMDD may experience an increased sensitivity to allopregnanolone.

This hormone causes emotional problems by targeting a receptor in the brain called GABA. GABA is responsible for producing a ‘calming effect’ in the brain. Allopregnanolone slows down the regeneration of GABA receptors, making them less effective and reducing the ‘calming effect’ that they have in the brain’s emotional centres. This affects mood, causing overwhelming emotional experiences including depression and anxiety.

Research has also shown that poor GABA regulation has been associated with negative effects for the stress system in our bodies, by increasing symptoms such as irritability and tiredness. PMDD symptoms improve when allopregnanolone levels decrease at the start of menstruation.

Oestrogen

Oestrogen is a collective name for a group of hormones including oestradiol, which is released from developing follicles, and reigns over the first half of your cycle with levels increasing and then falling after ovulation.

Oestrogen has also been associated with fluctuations in neurotransmitters that affect our emotional responses, namely serotonin. Serotonin is important for regulating your sleep, memory, mood and appetite. Although researchers do not understand exactly how oestrogen interacts with serotonin, women with PMDD may have an increased sensitivity to oestrogen fluctuations. These fluctuations may be associated with reduced serotonin levels, and thus result in PMDD symptoms.

Although having an increased sensitivity to fluctuations in these hormones may feel beyond your control, you can better cope with PMDD symptoms by making changes to your lifestyle, nutrition and seeking support for your emotional experiences.

Some tips that may help:

• Track your periods so you can anticipate these hormonal changes.
• During the Luteal Phase of your cycle, take special care of your time and space and learn to feel comfortable saying ‘No’, ‘I prefer not to’, or ‘Let me get back to you on that.’
• Eat regularly and do not skip meals during your Luteal Phase. Balance your blood sugar by including proteins and healthy fats at each meal.
• Cut out inflammatory foods such as wheat, sugar, alcohol and processed foods.
• A reduction in caffeine can be helpful.
• Experiment with gentle exercise – see what makes you feel better.
• Nutrients such as magnesium, Vitamin D, B vitamins, omega 3 fatty acids and specific botanicals such as Agnus castus can be helpful.
• Stress management techniques such as relaxation, meditation, yoga and breathing techniques may help to improve symptoms.

Nutritional therapy can help you improve symptoms that may be caused in part by hormone sensitivities.

Our programme, MindHealth, combines both psychotherapy and nutritional support to help you target both your psychological and somatic symptoms. A holistic approach can help you build a better relationship with your body, mind and emotions. You can find out more about our programme here.

To book a FREE 30 minute session with a therapist, a 15-minute nutrition call with our experienced nutrition team, or to find out more about our MindHealth programme, book a call with our Client Support team.