My Journey with PMDD Part 2: The Treatment That Works for Me and How I Manage Day to Day
Updated: Feb 27
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To recap, The International Association for Premenstrual Disorders (IAPMD) says that 1 in 20 women are diagnosed with PMDD and 30% of those women will attempt suicide. IAPMD defines it as:
Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder with symptoms arising during the premenstrual, or luteal phase of the menstrual cycle and subsiding within a few days of menstruation. While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. PMDD is a severe negative reaction in the brain to the natural rise and fall of estrogen and progesterone. It is a suspected cellular disorder in the brain.
Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
Marked irritability or anger or increased interpersonal conflicts
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, and/or feelings of being keyed up or on edge
Decreased interest in usual activities (e.g., work, school, friends, hobbies)
Difficulty concentrating, focusing, or thinking; brain fog
Lethargy, easy fatigability, or marked lack of energy
Changes in appetite, food cravings, overeating, or binge eating
Hypersomnia (excessive sleepiness) or insomnia (trouble falling or staying asleep)
Feeling overwhelmed or out of control
Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating or weight gain
A diagnosis requires at least five of the above symptoms to be present, including one of the "core emotional symptoms" (in bold). If you missed my story refer to "My Journey with PMMD Part 1".
The treatment that works for me
Acupuncture + Custom Blended Chinese Herbs + Diet + Aerobic Exercise + Supplements
It really is a lifestyle. As I mentioned in Part 1, there is not a one size fits all solution - it is different for every woman and it's about finding what works for you.
Acupuncture and Chinese Herbs. If this is something you are interested in trying I recommend finding and acupuncturist that specializes in women's reproductive health. I go to acupuncture every other week and take herbs morning and night.
Diet. I do not touch gluten, and I stay away from refined sugars and processed food as much as possible. I try and eat a mostly a whole foods diet (this is not to say I don't indulge or bring home takeout a few times month!).
This one was totally new to me but my acupuncturist always tells me I need to be consuming warm foods and beverages - that cold is not good for me- especially in the morning. I used to have an iced matcha or something cold first thing in the morning and have been scolded for that behavior for a year. This article explains:
Colder [food and beverage] greatly increases the chances of hormonal imbalance, skin irritation, bloating, digestive sensitivity, blood stagnation, hair loss and mood disorders like depression and increased anxiety.
Now I make a hot matcha every morning, no longer put ice in my water, and am cognizant of how often I am eating or drinking something cold. My first food of the day is often eggs or oatmeal (around noon) - or something room temp. I keep seaweed snacks around all the time and often start my day with that - yes I am a weird eater.
There are also entire food plans built to balance your hormones. This is something I haven't delved into as much as I'd like - but I plan to.
Aerobic Exercise. I used to practice yoga several days a week, for like a decade. I'd go to pretty challenging classes that were heated and felt I was getting a quality workout. What I've since learned is that it's the workouts that get my heart rate UP UP UP by engaging large muscles that help most with my mental health. Spin, HIIT, and weight training have been my go to for about a year and it has been a game changer - my mind and body feel so much better.
I sprinkle in yoga and barre for variety because I do enjoy them and think they are immensely beneficial in other ways. If you are over your head in feelings and stress go to a spin class - the room is dark and incredibly loud so you can have a nice cry while you're profusely sweating and struggling to breathe - very therapeutic.
Vitamin Supplements. I sometimes mix up my vitamin routine but I always take a B-Complex, 5000 IUs of Vitamin D, Zinc, and Magnesium. I switch back and forth between this powder and this powder, and if it's too late at night to drink 8oz of water or if I am traveling I take these magnesium chews.
Other treatments (that I have not tried)
Hormone Therapies. There are a variety but they all come with side effects and manipulate the body in some way. To me this is not tending to the root cause. For example, oral contraceptives suppress ovulation (instead of the cyclical rise and fall of estrogen and progesterone levels which occurs in premenopausal women, the ovaries produce postmenopausal levels of ovarian hormones), are not consistently effective, and often worsen dysphoria.
Serotoninergic antidepressants. first-line treatment for PMDD. These can be taken daily or only during the luteal phase. Studies show that symptoms are significantly reduced.
Cognitive Behavioral therapy.
A non-exhaustive list of tools to manage PMDD
Sleep. Sleep really effects your ability to fix anything else. Quality sleep is critical to decision making, hormone regulation, managing risk of stroke, cancer and heart disease. Poor sleep can be contributing to your period problems! If you have sleep issues I recommend checking out The Sleep Doctor for resources.
Exercise. HIIT, weight lifting, spin, yoga, Beachbody program, anything that gets your heart rate up on a consistent basis!
Deep breathing and meditation. My acupuncturist had me buy The Healing Power of the Breath. I read it and use deep breathing as a tool but I have a mental block with meditation. I know I need to give it a real try - any tips? Wim Hof is also a great resource for breathing exercises and just overall a great person to follow.
Being outside. Simple but so helpful - long walks and fresh air have a huge impact.
MAGNESIUM. I used to take CBD, melatonin, or make labor intensive sleep tonics, but now I just take magnesium every night and it helps me get a great night sleep.
CBD. I don't take this as much (at the moment) but I have relied heavily on this at times for anxiety. (My anxiety is worse when I am not working out consistently).
Warm foods and beverages. It's a thing.
Staying away from birth control. This might be more of a personal thing - and I'll get into this in another blog, but birth control is not for me.
Mental Health Support. This can be huge for people suffering from PMDD. Ask your doctor to refer you to appropriate counseling or support groups of women going through the same thing. This can help you develop coping skills and develop a safety plan if you need.
Diet. There are certain foods that you might consider staying away from, like gluten. But there is also a way you can eat that actually balances your hormones and supports your cycle. Pauline Goossens is a Hormone Cycle Expert who uses food and yoga to balance hormones and rid PMS and PMDD symptoms/recover from depression post birth control. Check out her site and Instagram for resources and coaching.
Adaptogens. Adaptogens are plants, usually herbs and roots, that work to counteract the effects of stress on the body. Stress management is a really big part of PMDD. I got really into adaptogens a few years ago and don't use them as much anymore but some of my favorites that I always keep around to support calm and sleep are Reishi and Ashwagandha. I usually put them in a tumeric moon milk in the evening. Here is my recipe. I get all of my adaptogens from Sun Potion or Anima Mundi.
Since learning about PMDD I've done a lot of research and am sure you are doing the same if you are living with PMDD. Here are some sources that have helped me along the way.
SAGE Journals: Pre-menstrual Dysphoric Disorder: A Review
Beyond the Pill by Dr Jolene Brighten
Your Brain on Birth Control by Sarah Hill
Seeing Red by Kirsten Karchmer
How To Balance Your Hormones and Hack Your Cycle with Alisa Vitti - Almost 30 Podcast
What They Didn't Tell You about Hormones and Birth Control - The Blonde Files
The Doctor's Farmacy - Dr. Mark Hyman (not one specific episode)
Me v PMDD - The Warrior Blog