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Finding the Root Cause of PMDD

Updated: Feb 15

Pre-Menstrual Dysphoric Disorder or PMDD is a severe and debilitating form of PMS that affects anywhere from 5-10% of menstruating women. This number may be underestimated due to women who are never diagnosed.


Symptoms these women experience are significantly worse than PMS and affect their ability to perform, do their job, or even take care of their family.


Mood changes may include:

  • Agitation/Nervousness

  • Anger

  • Crying spells

  • Panic Attacks

  • Feeling out of control

  • Paranoia

  • Suicidal thoughts or ideations

  • Loss of interest in acitivities/relationships

Physical changes can also be significant:

  • Acne (often cystic on the chin/jaw and maybe upper back)

  • Breast tenderness

  • Dizziness/lightheadedness

  • Heart palpitations

  • Cramps

  • GI issues

  • Increased muscle/joint pain

  • Low sex drive

  • Painful periods


What Causes this to occur?


Abnormalities in Estrogen:Progesterone

Abnormalities in estrogen to progesterone ratios may contribute to this. If progesterone levels are too low, they may make estrogen levels appear elevated. OR, estrogen levels may be elevated and progesterone levels are normal.

In the picture above, we can see that progesterone levels are higher in the second half of the cycle (dashed line). Estrogen levels rise, but do not pass progesterone (red line). This is what a NORMAL cycle should look like.


If ratios of progesterone to estrogen are unbalanced, we may see symptoms of excess estrogen.



Changes in Neurotransmitters


Serotonin

Estrogen stimulates expression of serotonin receptors. Serotonin is the neurotransmitter that helps us feel happy, joyful, and connected. SSRIs (antidepressants) increase serotonin production. If levels of estrogen are off, this can affect receptor expression (1).


What this means is, if your estrogen levels are abnormal, this can cause abnormal expression of serotonin receptors- making you more susceptible to depression.



GABA

Progesterone stimulates the expression of GABA receptors. GABA is an inhibitory neurotransmitter. This helps to "turn down" the noise in your brain, inhibiting excess thoughts and helping you feel more calm and less stressed.


Progesterone is broken down into Allopregnanolone, which binds to these GABA receptors (2). In some women, when allopregnanolone binds to GABA, it creates a calming effect. However, if levels of allopregnanolone are too high, they can create MORE stress.



Which brings us to the pesky metabolite!



Allopregnanolone- the sneaky side of progesterone!

Allopregnanolone levels rise with progesterone. Research has shown that allopregnanolone levels typical of the luteal phase (top of the inverted U curve) trigger adverse symptoms in women with PMDD (3).

In the picture to the right, we can see that the top of the U-Curve is where PMDD symptoms are worst. Several studies (4) have given women medications to block conversion of progesterone into allopregnanolone. This decreases allopregnanolone levels while keeping progesterone levels the same. These women report significant improvements of their symptoms. This tells us that levels of allopregnanolone may be more impactful than progesterone alone.



And to address the poor sleep you may be having...



Women with PMDD often report poor or disrupted sleep. This is due to disruptions with Circadian Rhythms. Women with PMDD show a decreased response to melatonin in their luteal phase (5).

These women had lower levels of melatonin throughout the night compared to women who do not have PMDD. Lower levels of melatonin lead to poor sleep, light sleep, waking easily, having difficulty falling back to sleep, and maybe insomnia.


Since the Circadian Rhythm regulates the sleep-wake cycle, issues with melatonin production can start to affect day to day activity as well. This can disruptions in cortisol production which can cause you to be more anxious/stressed throughout the day, more fatigued, and may cause you to gain weight.



Always seek help.

If you feel something is wrong in your body, there probably is. Listening to signs that your body gives you can help you address a problem before it becomes impossible to deal with. I have helped many women with PMDD who thought their lives were over. This diagnosis doesn't define you, and doesn't mean you need to live this way forever.


If you are feeling suicidal, thinking about hurting yourself, or are concerned that someone you know may be in danger of hurting himself or herself, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). It is available 24 hours a day, 7 days a week and is staffed by certified crisis response professionals.


 


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About Dr. Zaremba

Dr. Zaremba received her bachelor's degree from Western Michigan University in Biomedical Sciences and minored in Chemistry and Psychology. She completed her doctoral training at Palmer College of Chiropractic. During her time in school, she took post-doctoral training through The Clinic on Disease and Internal Disorders (CDID) earning her a Diplomate from the American Board of Chiropractic Internists (DABCI).


 

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Work Cited:

1. DOI: 10.1016/0960-0760(95)00075-b

2. DOI: 10.1111/jne.12553

3. https://www.zrtlab.com/blog/archive/your-guide-to-pmdd-causes-and-treatment/


Images:

2. Copyright Dr. Katie Zaremba LLC

3. https://www.zrtlab.com/blog/archive/your-guide-to-pmdd-causes-and-treatment/





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