PMDD – Why is this happening to me?

As a Clinical Nutritionist, I’ve always been fascinated by the intricate ways our bodies communicate with us. But nothing quite prepared me for the complex world of Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). These aren’t just medical terms—they’re lived experiences that affect millions of women worldwide.

PMDD is more than just ‘being emotional’

When I first started diving into research, I was struck by how little most people understand about these conditions. They’re not just “bad days” or “being emotional.” These are real, physiological experiences that can completely disrupt a person’s life.

Let me break it down. PMS affects up to 75% of menstruating women. It’s like a monthly challenge that brings mood fluctuations, physical discomfort, unpredictable emotions, and energy dips.

And PMDD?  That’s a whole different level of intensity. Affecting about 3-8% of women, it’s like PMS on crack.

Premenstrual Dysphoric Disorder (PMDD) is a cyclical mood disorder linked to the menstrual cycle, with symptoms typically appearing in the luteal phase (the time leading up to menstruation) and subsiding within a few days after the onset of menstruation.

It affects approximately 5.5% of women and AFAB individuals of reproductive age. While PMDD is closely tied to hormonal fluctuations, it is not caused by a hormone imbalance. Instead, it results from an intense neurological response in the brain to the natural rise and fall of oestrogen and progesterone levels.

Risk Factors for PMDD

PMDD, officially recognised as a psychological condition in the DSM-5 since 2013, has several identified risk factors:

• Hormonal sensitivity: Individuals with PMDD are susceptible to normal hormonal fluctuations during the menstrual cycle.
• Serotonin deficiency: Low levels of serotonin, a neurotransmitter that regulates mood, are linked to PMDD.
• Genetics: A family history of PMDD may increase susceptibility.
• Mood disorders: A personal or family history of conditions like depression or anxiety raises the likelihood of PMDD.
• Smoking: While evidence is limited, smoking may contribute to higher risk.
• Early trauma: Research shows 83% of Australians with PMDD experienced early-life trauma, including abuse or neglect.
• Gender dysphoria: Those with gender dysphoria face a higher risk of PMDD.

Why PMDD Goes Unnoticed in Perimenopause

PMDD can often slip under the radar in perimenopause because its symptoms—mood swings, irritability, and fatigue—are frequently mistaken for stress, depression, or typical PMS. During perimenopause, hormonal fluctuations intensify, making the cyclical pattern more apparent and often prompting individuals to seek medical attention.

 

How Nutrition Can Help Manage PMDD Symptoms

Nutrition is crucial in managing PMDD because it can influence the hormonal, neurotransmitter, and inflammatory pathways involved. A diet rich in complex carbohydrates can help stabilise blood sugar levels and support serotonin production, which may alleviate mood swings and irritability. Similarly, consuming foods high in magnesium (leafy greens and 80% dark chocolate), calcium (dairy products and chia seeds), and vitamin B6 (chickpeas and chicken breast has been linked to reduced severity of PMDD symptoms, as these nutrients play a role in hormone regulation and stress response.

Additionally, reducing pro-inflammatory foods like processed sugars and trans fats while increasing omega-3 fatty acids (found in fatty fish, flaxseeds, and walnuts) may help lower inflammation associated with PMDD.

Supporting gut health with fibre-rich foods and probiotics can further enhance mood by improving the gut-brain axis and serotonin production. By addressing underlying drivers like blood sugar imbalance, nutrient deficiencies, and inflammation, a well-rounded diet can make a significant difference for individuals experiencing PMDD.

What is the next step?

Book in a free discovery call with me, Dani terHaar. Together we can explore what individualised dietary and supplement adivce is right for you, helping you to break free from PMDD.

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