Pre-Menstrual Dysphoric Disorder (PMDD) is a mental health condition characterised by severe depression and/or anxiety that occurs in the 3-14 days before onset on menstruation and resolves within a day or two of the menstrual period commencing.

It is much more debilitating than the more widely-known Pre-Menstrual Syndrome (PMS), with symptoms often having a severe negative impact on the daily lives, mind, emotions, work and relationships of those who suffer it. It affects between 3 – 8% of women and AFAB individuals of reproductive age. Actually, I’ve seen estimates as high as 12%, and suggestions that up to 90% of sufferers are undiagnosed.


Although PMDD is connected to the menstrual cycle, it is not considered a hormone imbalance. PMDD is a severe negative reaction in the brain to the natural rise and fall of estrogen and progesterone.

Naturopathically speaking, several factors may drive a more intense experience of PMS/PMDD, including nutrient deficiency or imbalance, liver and gut health, toxicity, food allergies or intolerance, as well as genetic or epigenetic factors. I will address these in more depth in subsequent blogs.


The only way to diagnose PMDD is by recording symptoms over 2 – 3 menstrual cycles, to track the typical pattern seen in PMDD. Following is a list of common symptoms, five of which must be present to diagnose PMDD, and at least one of them must be from the core emotional symptoms (listed in bold):

Mood/emotional changes (e.g. mood swings, feeling suddenly sad or tearful)
• Irritability, anger, or increased interpersonal conflict
• Depressed mood, feelings of hopelessness, feeling worthless or guilty
• Anxiety, tension, or feelings of being on edge
• Decreased interest in usual activities (e.g., work, school, friends, hobbies)

• Rage, sudden outbursts of anger
• Brain fog, difficulty concentrating or focusing
• Tiredness or low-energy
• Insomnia or, conversely, excessive sleepiness
• Changes in appetite, food cravings, overeating, or binge eating
• Feeling overwhelmed or out of control
• Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating or weight gain

There is no pathology test or investigation that definitively diagnoses PMDD, although blood tests and the like may be used to rule out other disorders.

Medical Treatment

The main treatment prescribed by medical doctors is anti-depressant medication (usually SSRIs). Other options include birth control medication (the oral contraceptive pill, intravenous hormone therapy or implants), chemical menopause to suppress the menstrual cycle and mimic menopause, and as a last resort, surgical menopause (hysterectomy & oophectomy).

If patients find these options helpful then quite honestly, I am happy for them. However, through my research and in hearing from sufferers, they sometimes come with new problems or symptoms, often require at least a few months of trial and error and adjustment, and aren’t a “magic bullet” solution by any means.

Natural Management

As a naturopath, it will come as no surprise that I favour natural means of managing the condition.

There is ample evidence that simple dietary and lifestyle interventions benefit mood and mental health. Following are some things I have found helpful in my patients:
– Optimum nutrition (e.g. increasing plant foods, avoiding allergens & anti-nutrients)
– Stress management
– Regular exercise
– Sleep hygiene
– Herbal medicine
– Nutritional supplements
– Counselling, cognitive behaviour therapy (CBT) or other psychotherapy including Emotional Freedom Technique (EFT or ‘tapping’) and energy healing. (note that at the time of writing these therapies are not part of my skill set, but I commonly refer patients on to appropriate practitioners)

The great advantage of using natural therapies to manage PMDD is that it puts the power back into YOUR hands, rather than depending on the doctor’s prescription or the mercy of your hormones.

You come to understand your body, your mind, your emotions, and how they are affected by what you eat, what you do and what stage in your cycle you are at. Only then are you empowered to make choices with full knowledge, insight and self-awareness, with the confidence that your choices are for your highest good and with maximum benefit to your life.

There is no one-size-fits-all with Naturopathy, each person is assessed on an individual basis and so a naturopathic prescription can vary a lot from one person to the next. But ultimately it comes down to bringing your body and mind back into balance, so you can experience true calm, happiness and fulfillment in life, work and relationships

In my naturopathic practice, I implement a 90-day program, “The Natural PMDD Solution”, to help people with PMDD & severe PMS get off the emotional hormonal rollercoaster, & balance body and mind naturally so as to feel calm & confident in themselves & their relationships.

If you want to find out more about this program, book in a free chat to find out whether we are a good fit to work together.

Not quite sure? Follow me on Instagram or Facebook where I share tips and insights about managing PMDD naturally.

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