The Bigger Picture of PMDD

PMDD stands for Premenstrual Dysphoric Disorder. It refers to an extreme collection of symptoms that occur in the 1-2 weeks leading up to our periods, making us feel like a different person.

It is hard to imagine that our hormones can cause such extreme symptoms and changes in our personality. The reason this can happen is that PMDD is much more than a hormonal condition. It is actually a whole-body experience.

The thing about our hormones is that they can’t be compartmentalized. What this means is that they are driven by every system in our body and, in turn, impact every system in our body. While the resulting symptoms of this state might be experienced as hormonal symptoms (physical and mental symptoms in the weeks leading up to our period), their innate cause may not be purely hormonal.

Over the next few weeks, we are going to take a look at each of the individual factors that can be implicated in the presentation of PMDD. Each person is going to have a different array of factors that contribute to their presentation and the ultimate cause of PMDD. Proper treatment involves identifying your individual factors that are contributing to your PMDD and bringing them back into balance.

Where do our hormones fit into PMDD?

PMDD is a hormonal condition, yet it is much more than that. It is hormonal in nature because the symptoms of PMDD become apparent during hormonal changes and in specific parts of our cycles only.

PMDD symptoms often begin during ovulation and then continue into the luteal phase of our cycle (see my blogs for more information on our cycles and what this all means).

This means that there is a direct correlation between our hormones and the symptoms that we experience. However, the symptoms are not always the result of hormones alone. It is an interplay of interactions between our hormones and the systems in our body.

As we mentioned in previous blogs, our hormones interact with every system in our body and are influenced by every system in our body. Below are some of the interactions that can occur in our luteal phase:

Estrogen causes increases in our inflammatory marker histamine which can increase inflammation in our body and subsequently cause symptoms (more on this next week)
Progesterone typically calms down our nervous system but when we are overly stressed it can actually have the opposite impact when it interacts with our nervous system, increasing anxiety and disrupting sleep
Our stress hormone cortisol can pull resources from our reproductive hormones when we are chronically stressed preventing us from being able to produce enough progesterone in the second half of our cycle
Disrupted digestion can prevent our body from eliminating excess estrogen in the second half of our cycle causing increases in estrogen in our body resulting in symptoms
Being chronically stressed can lead to our body being unable to handle normal hormonal shifts - the change in hormones around ovulation can be too challenging for the body resulting in hormonal symptoms

These are just a few examples of the way that our hormone interactions can result in the symptoms of PMDD. In the same way these interactions can result in hormone imbalances. We must look beyond our hormones to how they are interacting with our bodies, as well as what is causing imbalances, in order to assess and treat PMDD appropriately.

Contributors to Your PMDD Picture

Immune function and PMDD

One of the things that we NEED to start talking about is the role of immune function in our overall hormone health AND how our immune system can actually contribute to our experience of PMDD.

Our immune system is in charge of fighting off pathogens in our body and keeping us safe. This means that it is always interacting with all of the systems in our body, including our hormones.

The hormones in the second half of our cycle inherently interact with our immune system to increase the amount of inflammation in our body. This is very normal and not harmful in general. Problems can arise when we already have certain imbalances in our body. When we already have higher than normal inflammatory markers, and the inflammation increases in the second half of our cycle, it can reach a level where we can't manage it, leading to the onset of symptoms.

This can occur due to:

An excess of hormones that interact with our immune system to increase inflammation.
A deficiency of hormones that decrease inflammation in the second half of our cycle.

In the second half of our cycle, estrogen interacts with our immune system to increase inflammatory markers and histamine levels. Simultaneously, inflammatory markers and histamine contribute to the elevation of estrogen levels in our body. Progesterone, the other hormone present during this phase, works to break down inflammatory markers, ensuring that when estrogen and progesterone are balanced, inflammation remains moderated and beneficial rather than pathological.

However, when there's an imbalance, such as too much estrogen, excessive baseline inflammation, or insufficient progesterone, this delicate equilibrium can be disrupted, leading to increased inflammation in the latter half of our cycle and resulting in many of the symptoms of PMDD.

Therefore, when assessing factors impacting PMDD, it's crucial to examine both hormone levels and inflammatory markers during the second half of our cycle when symptoms occur. This comprehensive approach provides insight into the interaction between our immune system and hormones, shedding light on how they collectively influence our well-being.

Cortisol and PMDD

You might have heard that "stress" is often blamed for why you're feeling a certain way. That's partially true. The reality about stress is that the prolonged impact of our stress hormones, such as cortisol, on our body can alter its functioning and affect our health. This is where the negative effects of "stress" originate. It's not that stress itself is inherently bad; rather, it's the long-term elevation of stress hormones that becomes problematic. One of the areas where we can observe these changes is in women's reproductive hormones. Our stress hormones and reproductive hormones are inherently interconnected for several reasons.

Our stress hormone cortisol serves as a biological indicator of safety within our bodies. When cortisol levels are elevated, they signal to our body that we are in an unsafe environment. From a purely biological standpoint, this message is relayed to our reproductive system, indicating that it is not an optimal time for pregnancy. Consequently, our body adjusts our reproductive hormones to decrease the likelihood of conception.

Furthermore, some of our reproductive hormones and stress hormones are synthesized from the same building blocks within our body. During prolonged periods of stress, our body redirects resources away from producing reproductive hormones towards producing stress hormones.

Chronic stress is not the natural state our body is designed to sustain. It expends additional resources to maintain this activated state, prioritizing survival over other functions. Consequently, fewer resources are available for tasks such as managing hormonal shifts, which require significant energy. When our resources are depleted due to chronic stress, managing our normal hormonal fluctuations becomes challenging.

A Final Word

Each of these scenarios contributes to our body's struggle to maintain hormonal balance and efficiency. When our body's functions are compromised, we begin to experience symptoms that detract from our overall well-being. Chronically elevated stress hormones, regardless of the underlying cause, are one of the primary factors contributing to the development of PMDD in women.

If you're interested in learning more about your individual PMDD profile, we invite you to visit us at the Clara Clinic and book a consultation with me!