The 6 Possible Underlying Causes of PMDD

Since the pandemic, we’ve been seeing more and more individuals in our clinic for PMDD. Whenever we get new PMDD patients, we always find ourselves going over the importance of understanding the 6 possible underlying causes of PMDD!

The reason we put so much emphasis on understanding the root cause is that when we can start to identify your individual factors that are contributing to your experience of PMDD, that is when we can find a true diagnosis for your symptoms, start to correct these imbalances, and help you to start feeling more like yourself again.

As you’ll soon learn, there’s a lot more to PMDD than simple hormone imbalances. It’s much more complex and nuanced, and even involves some modifiable factors!

Genetics

We’ll start out with the factor that is the least subject to change – our genetics. Based on research completed to date, it’s thought that PMDD has a heritability range between 30-80%. While it can be super discouraging to think of fighting an uphill battle against our genetics, remember that genetics is only ONE component of a disease or condition expressing itself.

At our clinic, we always say that genetics loads the gun, but environment pulls the trigger. Part of good quality PMDD treatment is fostering a day-to-day environment and schedule that will help mitigate the risk of mental health concerns. This also includes supporting physiological challenges that will predispose us to mental health conditions, such as vitamin D deficiency.

Estrogen Levels & Serotonin

Although a lot more research is required here, preliminary studies have found that women with PMDD have lower luteal-phase estrogen levels compared to women without PMDD. For those of you unfamiliar with the phases of our cycle, the luteal phase is the second half of our cycle, marking ovulation to the start of our next period.

We’re so glad this has come up in the research, as high estrogen levels often get a bad rep in the PMDD world with many practitioners suggesting high estrogen levels or ‘estrogen dominance’ as the culprit behind PMDD symptoms.

From the research we have to date, this does not seem to be the case! We know estrogen affects our serotonin system and other neurotransmitter systems responsible for regulating mood, cognition, sleep, and eating patterns. Serotonin in particular is one of our main neurotransmitters contributing to our feelings of happiness; so, it makes sense that if estrogen is on the lower end in the luteal phase, this in turn reduces serotonin levels, leading to mood dysregulation.

Progesterone & Allopregnanolone Levels

This is probably where the bulk of research on PMDD lies; so, before jumping into the imbalances we see with these hormones in PMDD, it’s important to understand what these hormones do.

In the second half of our cycle, also known as our luteal phase, our hormone progesterone is released. A byproduct of progesterone is another hormone called allopregnanolone, frequently referred to as ‘allo’. Allo actually modulates GABA receptors in the brain. For those of you unfamiliar with GABA, GABA is our primary neurotransmitter that regulates our mood and helps us feel calm. So, in simpler terms, when allo is created in the body, it provides sedative, calming, and anxiety-reducing effects on our brain.

So what’s happening with progesterone, allo, GABA, and PMDD? A couple of things:

People with PMDD seem to have a disturbance in the functioning of their GABA receptors, and their GABA levels.
Research has found that in PMDD sufferers, the increase in allo that’s supposed to occur in our luteal phase simply does not happen. Further studies have found that amongst women with PMDD, those who had more severe forms of PMDD had lower levels of allo compared to those with milder forms of PMDD. In the research available, we have even seen individuals with more significant PMS symptoms, that do not qualify as PMDD, also have lower allo levels.

Checking progesterone levels in the second half of your cycle could be an easy and modifiable place to start when it comes to PMDD management. These imbalances in allo could also explain why SSRIs and progesterone treatment support symptoms of PMDD, because SSRIs and progesterone both increase GABA sensitivity and the formation of more allo in the body.

Structural & Functional Brain Differences

Similar to our genetics, structural brain differences we see in PMDD is sadly not a factor we can modify. Imaging studies have found differences in brain structure in women with PMDD, specifically in the amygdala (the brain’s fear center), and in the prefrontal cortex (the most evolved center of the brain controlling thoughts, actions, and emotions).

BUT research has also found a difference in the functionality of these brain regions as well. Some studies have found a functional difference of the amygdala’s response to stress in women with PMDD, compared to women without the condition.

Theoretically, while we can’t change or modify brain structure, we can support healthier fear and emotional responses that occur in the brain through the use of calming and adaptogenic herbs, as well as regular psychotherapy.

Altered Stress Response

While research on the stress response and PMDD is few and far between, the preliminary studies we do have on PMS point to a connection.

In women with PMS, we’ve seen altered and dysfunctional cortisol levels compared to women without PMS. Most notably, we notice elevated cortisol levels in the luteal phase, and lower cortisol levels during times of stress when our stress response should actually be activated.

In PMDD studies, we have found significant stress, trauma exposure, abuse, and or PTSD have been independently associated with PMDD.

We’re not sure why or how this all relates to the development of PMDD, but we do know supporting a healthy, calm, balanced, and appropriately activated stress response is of paramount importance when it comes to good quality PMDD treatment.

Increased Inflammation

Last but not least we have inflammation. It’s important to understand that in the luteal phase of our cycles, there is an increase in inflammatory markers, and this is normal. In PMDD however, it seems that these inflammatory markers are increased compared to women without PMDD.

Again, while we’re not completely sure why or how this relates to the development of PMDD, we always like to address inflammation so we’re supporting healthy foundations and giving you your best chance possible at symptom resolution. We always screen for inflammatory markers in our PMDD patients, and ensure the building blocks for healthy immune function, like vitamin D, are present.

Tying It Altogether

We recognize the possible underlying factors of PMDD can be a lot to take in. It can also be confusing because we often hear about a heightened sensitivity to hormonal fluctuations in PMDD sufferers, which does not seem to be part of the research completed to date.

At our clinic, we acknowledge this heightened sensitivity to hormones is present and suspect it is likely due to a combination of the underlying factors we’ve outlined above. It could be genetics, it could be an abnormal stress response, it could be inflammation, but something here is causing a heightened reaction to our normal hormone fluctuations.

The important takeaway here is that while hormones play a big role in PMDD, blaming hormones alone is a really simplistic way of looking at PMDD, and may not provide you with the relief you’re looking for. We will always investigate hormone imbalances, and the other factors listed above to help you better understand your PMDD in your very first appointment with us.

How Naturopathic Medicine Can Help

If you’re struggling with PMDD, there is so much we can do to help support you! Check out our page on PMDD to learn more about our Naturopathic approach to PMDD.

If you’re dealing with PMDD and don’t know where to start, we highly recommend working one on one with a practitioner who can help investigate these possible underlying factors, so you know you’re targeting the right obstacles and getting the care you need and deserve!

If you’re struggling with PMS or PMDD you can also book a complimentary consult with me here.