Understanding Premenstrual Disorders | You’re Not Imagining Things
We’re shedding some light on common conditions conjured by the menstrual cycle and what you can do to start supporting yourself each month. You are not alone, and you’re not imagining things.
Understanding Premenstrual Disorders: Types, Symptoms, and Management
Premenstrual disorders (PMDs) encompass a range of physical, emotional, and psychological symptoms that occur in the days or weeks leading up to menstruation. These disorders can significantly impact a person's quality of life and may require medical intervention for effective management. There are three primary types of premenstrual disorders: Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), and Premenstrual Exacerbation (PME), each with its own set of characteristics and treatment approaches. The exact cause for PMDs is still inconclusive but research is slowly revealing the link between hormone fluctuations in progesterone and estrogens with our gut/microbiome, nervous system, and immune responses.
Types of Premenstrual Disorders:
Premenstrual Syndrome (PMS):
PMS refers to a collection of physical and emotional symptoms that typically occur in the days leading up to menstruation and resolve shortly after the onset of menstruation. Over 90% of women have reported having PMS symptoms over the course of their life. The average age of women who experience PMS are in their 30’s. However, PMS symptoms can onset at any age.
Symptoms of PMS may include mood swings, irritability, fatigue, bloating, breast tenderness, headaches, acne around the jawline or forehead, and food cravings. While PMS can cause discomfort and distress, the symptoms are usually mild to moderate and do not significantly impair daily functioning.
Premenstrual Dysphoric Disorder (PMDD):
PMDD is a severe form of premenstrual disorder characterized by intense mood disturbances and physical symptoms that can significantly interfere with daily life. PMDD can appear days to weeks before menstruation and in some more severe cases continue into the first couple days of menstruation. PMDD is distinct to the menstrual cycle and can not be merely an exacerbation of symptoms of other present diagnoses such as anxiety/depression or other mood disorders.
Mental/Psychological symptoms of PMDD may include severe depression, anxiety, irritability, increased interpersonal conflicts, anger, difficulty concentrating, sense of dread/hopelessness, suicidal ideation.
Physical symptoms of PMDD can include insomnia, fatigue, significant appetite changes, bloating, cramping, constipation, headache, swelling, joint pain, and breast tenderness.
PMDD symptoms tend to be more severe than those of PMS and can disrupt relationships, work, and other areas of life. PMDD in nature is a chronic recurring condition and is classified as a disability that can impair occupational function.
Premenstrual Exacerbation (PME):
PME refers to the worsening of pre-existing conditions during the premenstrual phase of the menstrual cycle. Conditions that can worsen during the premenstrual phase are theoretically limitless but typically include psychiatric conditions, such as depression, anxiety, or bipolar disorders, seizure disorders, autoimmune conditions such as multiple sclerosis, lupus or Hashimoto’s, or inflammatory bowel diseases such as IBS or Crohn’s.
Symptoms of PME will vary per person as it is the exacerbation of symptoms from a pre-existing condition. However, it can include general increased mood swings, anxiety, or depressive episodes, during the premenstrual period.
Who’s at Risk?
PMDs can happen to anyone but there have been increased observances in those with other reproductive endocrine related conditions such as endometriosis and PCOS. Research has seen an increased risk of PMDs in those who are neurodivergent or have ADHD or ASD (Autism Spectrum Disorder). Those who have a family history of PMS are more likely to develop PMDs.
Tracking Premenstrual Disorders:
Keeping a symptom diary or using a menstrual tracking app can help individuals identify patterns in their symptoms and anticipate when they are likely to experience premenstrual symptoms. It can be reassuring to see trends and patterns form. It’s not just a figment of your imagination. PMDs are complex conditions, and symptoms can manifest differently each month, often leaving you feeling like you're experiencing a spell of amnesia after every period.
Tracking symptoms over several menstrual cycles can provide valuable information for healthcare providers and is part of how PMDs are diagnosed and managed effectively.
Treatment Options:
Treatment for premenstrual disorders may include lifestyle modifications, such as regular exercise, stress management techniques, and dietary changes. There are several holistic and nutritional recommendations that can support hormonal regulation and PMDs. Here are just a few to consider:
Chasteberry (Vitex agnus-castus): Vitex has been traditionally used to alleviate symptoms of PMS/PMDD by modulating hormone levels.
Magnesium: Magnesium supplementation has been shown to alleviate symptoms such as bloating, constipation, breast tenderness, and anxiety in women with PMDD.
Omega-3 Fatty Acids: Incorporating omega-3-rich foods such as fatty fish, flaxseeds, chia seeds, and walnuts into the diet may help reduce inflammation and improve hormonal balance.
Vitamin D: vitamin D plays several roles in the body aside from bone health. Vitamin D has interplay with our sex hormones and neurotransmitters that are crucial for our mental health. Vitamin D also has several roles in our immune function. Those with PMDs are more likely to have lower levels of vitamin D.
B-complex Vitamins: B-complex vitamins, particularly vitamin B6, have been studied for their role in mitigating PMS symptoms, including mood swings and irritability.
Outside of a diet and lifestyle approach, Cognitive-behavioral therapy (CBT) and other forms of psychotherapy may be beneficial for managing mood symptoms associated with PMDD.
Medications such as selective serotonin re-uptake inhibitors (SSRIs), hormone therapy, antihistamines, and non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate symptoms of premenstrual disorders.
It can take time to determine a correct diagnosis when it comes to PMDs, but getting an accurate diagnosis is crucial and will improve the effectiveness of a treatment plan for PMDs.
Seeking Guidance from a Professional
Premenstrual disorders can have a significant impact on the physical, emotional, and psychological well-being of individuals. Understanding the different types of premenstrual disorders, their symptoms, and treatment options is essential for effective management and improved quality of life.
The right intervention is the one that is individualized to you. 💜
Medical Disclaimer: This blog post is for informational purposes only and is not intended to diagnose, treat, or cure any medical condition. Consult with a qualified healthcare professional before making any changes to your diet or lifestyle.
Resources & References:
American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS). https://www.acog.org/womens-health/faqs/premenstrual-syndrome-pms
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 19, 2023.
Hantsoo L, Epperson CN. Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Curr Psychiatry Rep. 2015;17(11):87. doi:10.1007/s11920-015-0628-3
https://iapmd.org/pmd-2024#:~:text=Started in 2013 as PMDD,(PME)%20of%20underlying%20disorders.
Rapkin, A. J., & Mikacich, J. A. (2013). Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness. Expert review of pharmacoeconomics & outcomes research, 13(6), 799–806. https://doi.org/10.1586/14737167.2013.844125
Siminiuc R, Ţurcanu D. Impact of nutritional diet therapy on premenstrual syndrome. Front Nutr. 2023;10:1079417. Published 2023 Feb 1. doi:10.3389/fnut.2023.1079417
Tiranini L, Nappi RE. Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome. Fac Rev. 2022;11:11. Published 2022 Apr 28. doi:10.12703/r/11-11
Yonkers KA, Simoni MK. Premenstrual disorders. Am J Obstet Gynecol. 2018;218(1):68-74. doi:10.1016/j.ajog.2017.05.045
