Top 3 Supplements for PMDD
Premenstrual Dysphoric Disorder (PMDD) is a mood disorder which presents with a variety of symptoms that arise during the luteal phase of the menstrual cycle and usually subside within a few days of menstruation. PMDD is a severe and more debilitating form of premenstrual syndrome (PMS).
PMDD encompasses physical, psychological and behavioural symptoms which can include:
feelings of hopelessness
depression
irritability
anxiety
fatigue
changes in appetite (overeating or craving specific foods)
breast tenderness
bloating
altered sleep habits
joint or muscle pain
headaches
There are many misconceptions about this condition, however, it is important to note that PMDD is not caused by a hormone imbalance, even though it is directly connected to the menstrual cycle. In PMDD, there appears to be an abnormal response of the brain to normal fluctuations in oestrogen and progesterone during the luteal phase of the cycle. There is likely not one single mechanism to explain PMS and PMDD, but instead there are several different causes which is why different treatments work for different women.
We know that PMDD is partially driven by the brains sensitivity to oestrogen & progesterone and their subsequent action on neurotransmitters such as serotonin (our feel-good hormone), dopamine (our motivation/pleasure hormone) and gamma-aminobutyric acid (GABA) (our calming hormone). Altered serotonin activity, which is mostly driven by oestradiol withdrawal during the luteal phase, has been demonstrated in women with PMDD and contributes to mood disturbances. Additionally, a sensitivity to rising levels of progesterone during the luteal phase also plays a role in these adverse effects on mood. This article highlights three of my go-to supplements to address symptoms associated with PMDD and support clients throughout their monthly cycles.
Calcium
It has been observed that women with PMDD have altered calcium homeostasis during the menstrual cycle. Calcium channels are involved in the release of neurotransmitters such as serotonin and dopamine. It has been theorised that dysregulated calcium levels during the luteal phase may promote dysfunction of neurotransmitter release. Research has also demonstrated a link between calcium deficiency during the luteal phase of the menstrual cycle and an exacerbation of PMS symptoms such as restlessness and depression. A randomised control trial including 466 women with PMDD reported that calcium was superior to placebo for many of their physical and emotional premenstrual symptoms.
Supplementation dosage: calcium citrate 600 mg/twice daily (during luteal phase)
Magnesium
Magnesium has a calming effect on the nervous system and plays a key role in mood regulation and improving sleep quality as this vital nutrient is a cofactor for dopamine, serotonin and melatonin synthesis. Magnesium levels have been found to be lower in women with PMS. A 2017 literature review included several studies which investigated the effects of magnesium compared to placebo for relief of PMS. The results of these studies highlighted the efficacy of using magnesium to reduce PMS symptoms such as irritability, depression, anxiety, fatigue, breast tenderness, and bloating. One study also found that magnesium supplementation in combination with vitamin B6 was more effective at reducing PMS symptoms then magnesium alone. Magnesium is also a smooth muscle relaxant therefore supplementation may be beneficial during the luteal phase to assist in preventing or relieving menstrual cramps.
Supplementation dosage: magnesium citrate or glycinate 400 mg/day (throughout entire cycle)
Vitamin B6
Vitamin B6, also known as pyridoxine, demonstrates a significant impact on serotonin and GABA production. A 2016 study investigated the effects of vitamin B6 on PMS and found significant reductions in both physical and psychological symptoms in the participants prescribed vitamin B6. In addition, low levels of vitamin B6 has been associated with increased prolactin levels which can result in greater psychological symptoms such as anxiety, irritability and depressed mood leading into menstruation. In the UK, vitamin B6 is included among the first-line interventions for PMDD in the Royal College of Obstetrician and Gynaecologists (RCOG) guidelines alongside other treatments.
Supplementation dosage: 30-60mg/day of vitamin B6 (throughout entire cycle )
