Jenny had always struggled with difficult periods. She was used to bloating, breast tenderness, cramps, and the constant feeling of irritability that seemed to make her physical pain even worse. But later, as a passionate and dedicated college athlete, Jenny experienced a shocking change. Two weeks out of every month, she lost all desire to step out onto the court. She experienced extreme mood swings during the weeks leading up to her period that left her feeling exhausted from all the emotional whiplash. Crippling migraines and uncharacteristic feelings of hopelessness became the norm.
Jenny started obsessively tracking her symptoms throughout each month. The pattern was unmistakable. During the weeks prior to the start of her period, Jenny struggled with severe depression and distressing physical symptoms that kept her from achieving her goals. She sought help from her gynecologist and discovered that her condition had a name: premenstrual dysphoric disorder (PMDD). And after a few months of experimenting with different treatments, Jenny found that bioidentical hormone replacement therapy (BHRT) helped relieve many of her worst symptoms.
PMDD affects thousands of women across the United States. While no cure has been found, treatments do exist that can help women take back their lives and live without anxiety over their menstrual cycle. For women like Jenny, that can be nothing less than transformative.
Understanding and Diagnosing PMDD
While most people are familiar with the symptoms of PMS, they may not be aware that a far more severe form of premenstrual stress exists. Because of this disconnect, many women struggle with unbearable periods and crippling mental health issues without recognizing that they have PMDD. If you experience symptoms like those described here, seek help from your doctor immediately. They’ll be able to rule out any other possible causes of your symptoms and help you find relief.
While physicians have long recognized PMDD, it was only officially classified as a mental health disorder in 2013, when it was included in the DSM-5—the paramount classification manual released by the American Psychiatric Association and used by mental health professionals across the country. According to the included criteria, women who are diagnosed with PMDD commonly experience the following symptoms during menstrual cycles throughout the year:
- Sudden changes in mood
- Irritability, anger, and increased interpersonal conflict
- Depression and suicidal ideation
- Loss of interest in everyday activities
- Confusion or difficulty concentrating
- Decreased energy
- Food cravings or appetite changes
- Insomnia or hypersomnia
- Breast tenderness
- Bloating and/or weight gain
Women who seek help for these symptoms often report that their moods disrupt every facet of their life. They can wreak havoc on relationships. They can make it impossible to maintain stability at work or school. They can produce emotional trauma and damage their sense of self. And even though symptoms can seem to vanish almost immediately after bleeding begins, this disorder can be debilitating and destructive throughout a woman’s life.
The inclusion of PMDD in the DSM-5 was a great step forward in helping to legitimize this disorder and prioritize further scientific research into its causes and treatments. Women who struggle with this disorder now have a far better chance to receive the recognition and treatment they need.
How Hormones Impact PMDD
As awareness for PMDD has grown, a healthy amount of research has been conducted to try to understand PMS, PMDD, and other experiences related to the menstrual cycle. While scientists have yet to identify a definitive cause behind the wide variety of PMDD symptoms, several potential contributing factors have been identified. Thus far, most research overwhelmingly suggests that sex hormones (which include estrogen and progesterone) are closely related to this disorder.
Many women who struggle with PMDD have apparently-normal hormone levels (compared with women who do not have PMDD). But there’s no doubt that the rise and fall of estrogen and progesterone during the luteal phase of the menstrual cycle are the clear trigger for PMDD symptoms in some women. Because these hormones interact with the brain’s neurochemical activity, resulting in mood changes, many medical professionals have designated PMDD as primarily a brain-related disorder.
Recent research by the National Institutes of Health (NIH) suggests that “PMDD is a disorder of cellular response to estrogen and progesterone.” According to this perspective, it’s likely that women who experience PMDD are more sensitive to even normal levels of these hormones due to a difference in gene expression in one particular gene complex. Women who are overweight, highly stressed, or have experienced trauma or abuse, may also be at greater risk for experiencing PMDD.
Using Bioidentical Hormones For PMDD Relief
General practitioners and psychiatrists often prescribe SSRIs (the most common type of antidepressant) to help relieve some of the symptoms of PMDD. While this treatment is effective for many women, it isn’t helpful for everyone and may come with a variety of unwanted psychological and physiological side effects. Birth control pills are also often used as a first-line treatment for PMDD, but while they can be helpful for some women, others find their symptoms exacerbated. If you’re not interested in taking antidepressants or artificial hormones and are looking for a viable alternative, or if these treatments have not worked for you, bioidentical hormone replacement therapy (BHRT) may be worth considering.
Because women with PMDD seem to react strongly to the shift in hormones that naturally occurs each month, BHRT works to create a more stable balance of hormones in the body at all times. Significantly, bioidentical hormones are chemically identical to those produced by the body and their dosage can be customized for each patient, which means they may potentially be more well-tolerated and effective than other forms of hormone therapy. As such, this treatment may provide relief for women suffering from PMDD either in combination with other therapies or when other methods have failed to produce meaningful results.
Where to Get Bioidentical Hormone Replacement Therapy
If you’re experiencing the severe premenstrual symptoms associated with PMDD, your first response should be to contact your primary care physician to begin the testing and evaluation process. In the course of treatment for PMDD, you may be referred to a psychiatrist or a gynecologist—and if bioidentical hormone replacement therapy is found to be the right treatment, you’ll eventually want to speak with a qualified expert in hormone health.
A specialist in bioidentical hormone therapy will begin by thoroughly testing your hormone levels by evaluating samples of your blood, serum, and saliva. From there, your practitioner will create a prescription for bioidentical hormones which perfectly suit your needs. They will also counsel you on ways to naturally enhance your hormone health—and possibly reduce the severity of your symptoms—through diet, exercise, supplementation, and other lifestyle choices. A hormone specialist can work in concert with your psychiatrist or any other health care practitioner you may be seeing to monitor your well-being and ensure you are getting the best care possible.
PMDD is a serious and disruptive disorder that can profoundly interfere with emotional, physical, and behavioral health. We look forward to the day when scientific research reveals a conclusive cause and establishes curative frontline treatments for this disorder and others related to the menstrual cycle. Until then, we are confident that with help from knowledgeable and compassionate healthcare practitioners, you’ll be able to reduce the severity of your symptoms and take your life back again.
Looking for the best hormone practitioners in your area? The BodyLogicMD network is made up of the nation’s most experienced specialists in bioidentical hormone replacement therapy. When you partner with a BodyLogicMD practitioner, you’ll receive a customized treatment plan that’s designed to quickly and effectively reduce your symptoms of PMDD. We’re dedicated to providing high-quality care for women who struggle with hormone-related disorders. And, because of BodylogicMD’s emphasis on holistic health and integrative medicine, we can provide you with a wellness plan that produces results for many years to come. Contact a local practitioner today to schedule an appointment and start finally feeling like yourself again. Or, take the BodyLogicMD Hormone Balance Quiz to learn more about how hormones impact the female body.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.