PMMD (premenstrual dysphoric disorder) is a condition that affects many women in the last few weeks of their cycle. Women experience these symptoms just after ovulation with some women’s symptoms feeling very severe in the last few days of the luteal phase. Once their menstrual bleed occurs symptoms ease and the cloud is lifted. PMDD has very similar symptoms to PMS, only with PMDD the symptoms become so severe that it affects many women’s relationships, career, it can lead to panic attacks and emotional darkness. 

Symptoms include: 

• Anxiety 
• Rage
• Extreme bouts of sadness 
• Suicidal thoughts 
• Being triggered by minor stressors 
• Sleep problems 
• Feeling out of control / irritability 

Studies have found that severe PMDD is due an altered response to hormone changes in the cycle. The nervous system has a heightened response to normal hormone changes, especially estrogen and progesterone. This affects the way neurotransmitters are used and recycled in the body, sufferers also have heightened response to stress in their nervous system.

Unbalance of estrogen and progesterone 

PMDD can be seen as a sign of estrogen dominance, when estrogen is dominant progesterone levels are insufficient to balance these effects leading to the PMMD symptoms. To help restore the balance; ensure estrogen is properly eliminated in the body, through liver detox pathways, lymph movement, daily bowel movements and gentle sweating.

Detox the liver

Herbs such as burdock root and dandelion detox any excess hormones that are staying in the blood stream and not being filtered through the liver. The movement of the lymph daily through movement and brisk walking/ exercise is enough to break a sweat. Also ensure there is enough fibre in the diet or supplement with psyllium husks to remove the excess hormones from the bowel. Eating one raw carrot per day can also bind up excess hormones in the bowel and move them out through the stools. 

Herbs to help PMDD symptoms 

Saffron – saffron is great for its serotonic effects, studies have found it comparable to standard SSRI treatment. Being a bright yellow in colour saffron breaks through the dark cloud of the luteal phase. As serotonin is low in the luteal phase of women with PMDD, supplementing with saffron in the luteal phase or even throughout the whole month is encouraged. 

Adaptogens and stress

Ashwaganda 

Ashwagandha is an adaptogenic herb that helps our nervous system build resilience and tolerance in times of stress. Supplementing daily with ashwagandha will help to protect the nervous system throughout the whole month in its response to stress. Take at night to help with sleep, as it will promote more deep rest as it helps to lower cortisol. It helps to sooth the nervous system by mimicking GABA and helping melatonin production, which naturally reflect our circadian rhythm.

Supplements for PMDD

• Vitamin B6 50-100mg 
• Magnesium glycinate 
• Vit D 1000iu 
• Lavender essential oil has found to help PMDD symptoms, switching the nervous system into parasympathetic mode 

TCM view of PMDD 

Chinese medicine would view PMDD as an extreme form of Liver Qi stagnation, almost like a traffic jam where the energy and Qi cannot travel and circulate around the body. This leads to build up of  emotions such as rage and extreme sadness. There is also an element where the heart spirit is unanchored, herbs will be used to clear heat and anchor the spirit in the heart

Classic formula – free and easy wonder (Xiao Yao San) 

This ancient chinese formula has been studied in clinical trials for treating PMDD, the results are significant; when women received this formula in just the luteal phase, their symptoms dramatically improved. Three months of treatment were needed.

In the study the urine metabolites were studied, it was found that this formula changed the way the nervous system was responding in the body as the people who received treatment had fewer metabolites in their urine sample.. The nervous system became better at handling hormonal fluctuations without leading to emotional dysregulation.

In a western medicine view the participants’ nervous system was blocked and inefficient biochemical flow of neurons and hormone receptor sites resulted in disrupted energy metabolism. After Xiao Yao San treatment, the neuro-energic pathways re-opened and efficient signalling began. Liver Qi stagnation can be translated to blocked or stagnated flow of neurons in the body. After treatment there was improved mitochondrial energy use, stronger neurotransmission (GABA), more stable neuron signalling and lower stress reactivity. 

This is such a significant find as this very simple but beautiful chinese formula can help to bring women out of debilitating symptoms in their luteal phase and help them to live their lives and maintain harmonious relationships with partners and family members. 

In the myth of Persephone she descends into the underworld suddenly – she is removed from the light and into the darkness. For women with PMDD this myth is mirrored in the luteal phase where there is a predictable and sudden shift in mood, perception and nervous system regulation. Everything is the same but the internal landscape changes where the nervous system moves into a state of threat and vigilance. This is where the Chinese medicine formula can free the constraint of Liver Qi, nourish the nervous system so it doesn’t feel trapped and settle the Shen/spirit.  

If you would like to start herbal medicine for any form of PMDD or PMS get in touch at jennysmithherbalist.com or fill in an apply to work with me form https://l.bttr.to/Mu6bp. Chinese medicine is highly individualised for each person, the case is reviewed regularly with the prescription changing as we go along. Treatment will last at least 3-6 months if needed.  

References 

https://www.sciencedirect.com/science/article/pii/S2667142524000423