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What is PMDD and Why Do Women Experience It?

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PMDD- What is it?

Premenstrual dysphoric disorder (PMDD), a severe mood disorder, is characterised by cognitive–affective and physical symptoms in the week before menses and affects millions of women worldwide 

Recognised in the DSM-5, the criteria for which includes symptoms such as:

  • Irritability or anger, often with increased interpersonal conflicts
  • Depressed mood, hopelessness, or self-deprecating thoughts
  • Anxiety, tension or feeling on edge
  • Mood swings, tearfulness, sensitivity to rejection
  • Sense of feeling overwhelmed or out of control
  • Other symptoms can include loss of interest in usual activity, fatigue, sleep and appetite changes, as well as symptoms often associated with PMS such as breast tenderness, swelling or bloating.

To be diagnosed with PMDD symptoms a minimum number of these symptoms must have been present for the majority of menstrual cycles in the past year, and greatest severity of symptoms must be present from 3-4 days prior to menses onset, and up to three days post-menses onset.   Symptoms must be absent in the post-menstrual week.  Other psychiatric diagnoses must be excluded.

What causes PMDD?

Potential initiating factors include central nervous system sensitivity to reproductive hormones, genetic factors, stress and a history of trauma.    It appears that PMDD occurs not due to differences in hormones between women with PMDD and those without, but more altered sensitivity to normal fluctuations of estrogen and progesterone.

Progesterone and allopregnanolone

Progesterone and allopregnanolone increase in the luteal (post-ovulatory) phase of the cycle and decrease rapidly around menses; exposure followed by rapid withdrawal may be a central factor in PMDD, due to the impact of allopregnanolone on GABA(A) receptor function.

Estrogen

Estradiol overall enhances serotonergic function, and the symptoms of low mood, food cravings, irritability, anger and impaired cognitive functions are all things which are influenced by serotonin.  Low oestrogen states are associated with decreased serotonin transporter gene expression, lower monoamine oxidase A and catechol-O-methyltrasnferase expression, and may impact brain-derived neurotrophic factor.


Women with PMDD may be more sensitive to the effects of estrogen’s effects on serotonin, and consequently show serotonin abnormalities in the luteal phase of the cycle as estrogen levels decline.

BDNF

Lower BDNF levels and the Met allele for the BDNF Val66Met polymorphism have been associated with greater risk for depression and other neuropsychiatric conditions.  BDNF levels are upregulated by serotonergic antidepressants, modified by estradiol and shown variance through the menstrual cycle.  Women with PMDD have been shown to have significantly higher serum BDNF in the luteal phase than control groups, with significantly higher serum BDNF in the lute phase compared to the follicular phase. However, interestingly the reverse was shown in women with PMS.

History of trauma or stress

History of trauma and significant stress exposure, including emotional and physical abuse has been strongly associated with moderate to severe PMS and PMDD in multiple studies, though not all corroborate this association.  PTSD and PMDD have likewise been strongly associated comorbidities.  A potential mechanism leading to heightened PMDD in women with history of chronic stress and trauma is due to the blunting of allopregnenaole, which has been shown to occur in animal models after exposure to repeated or chronic stress.  Administration of exogenous allopregnenalone has been shown in preclinical research to correct Hypothalamic-Pituitary-Adrenal axis function and reduce chronic stress-induced depressive and anxiety-like behaviour.

Immune Activation and Inflammation

Inflammation may be associated with PMDD’s pathophysiology, with the luteal phase associate with increased production of sIL-6R and TNF-α compared to the early follicular phase, and upregulated IL-6 gene expression in the luteal compared to follicular phase.  Serum hs-CRP was positively associated with elevated menstrual symptom scores in health women, independently of differences in sex steroid hormone levels. 

Now we’ve looked at some of the possible causes of PMDD, what can we do about it? Coming up next… 💕

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Camilla Clare Naturopathy
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Matt Gussin
Matt Gussin
16:41 22 May 21
I've had a pretty horrid time with gut and fatigue problems for over two years and in this time, I have seen countless... doctors, naturopaths, gastroenterologists, Chinese medicine practitioners and so on...Some of which told me to stop my vegan diet, so this was when I searched for a vegan Naturopath and found Camilla.Camilla has been nothing but outstanding since our first contact. She is the first person in my health journey who I feel is genuinely invested in my health and has worked tirelessly to help and provide answers. She is always quick to reply to my lengthy emails and although currently at the early stages of my treatment, every piece of advice and treatment given has been based off facts and logical reasoning.I really recommend Camilla. I have felt very comfortable with her from day one and you will get someone who is knowledgeable, passionate but most importantly, will do her utmost to help you through any problem.read more
Sophie Smith
Sophie Smith
02:36 22 May 21
I would without a doubt recommend Camilla to anyone looking for a naturopath. She is so warm, caring, knowledgable and... helpful. I sought Camilla’s help to work on my severe PMS, heavy and painful periods and PTSD and mental health. From the moment I saw her she went above and beyond and is always there to help whenever I have any questions or concerns. I have just started my treatment plan and feel confident that I will see an improvement with my concerns.Thank you so much Camila xread more
Laura Harper
Laura Harper
02:59 07 Apr 21
I have been working with Camilla for a couple of months now with the aim of treating and managing hair loss, stress,... and anxiety. Camilla's process is incredibly thorough and informative and it has been amazing to not only feel better, but learn SO much in the process. My treatment plan has been very manageable, and Camilla has always made sure I understand why we are doing things rather than just telling me. This ​has really helped me to feel more in control and kept me committed to the lifestyle changes. Prior to working with Camilla, I felt a pretty overwhelmed with information, none of which I could be certain was true or even relevant to my symptoms whereas Camilla's process is so personal, and completely tailored to the individual.Camilla has been so kind, and understanding and has made the whole experience as comfortable and easy as possible. I have been shocked by how quickly I began to feel positive changes, and cant wait to see them continue!read more
Millie Guest
Millie Guest
02:45 04 Mar 21
Camilla is an incredible naturopath. I was recommended by a friend. I was struggling with my energy levels and needed... help to figure out why. The consults were thorough and in-depth and camilla made me feel super comfortable the whole way through.I had bloods done which confirmed i was low on iron as she had predicted. She wrote me an amazing in depth treatment plan, which included when and how to take my supplements with loads of tips & tricks on how to get the most out of them and include more into my diet. She also gave me loads of great recipes to cook to help with my iron intake.It has been over a month into treatment and i feel super energetic and full of life again. It was exactly what i needed to help get back to myself.I couldn’t recommend her enough. If you’re struggling with anything her in-depth knowledge in her field will help you.Thankyou camilla.read more
Sophie Farrelly
Sophie Farrelly
03:42 29 Dec 20
Camilla is very knowledgeable, helpful and has a wonderful nature. She’s caring and goes above and beyond to help. I... can’t recommend her enough. Thank you!read more
J D
J D
02:07 06 Nov 20
Highly recommend. Camilla is a delight, very passionate and committed to getting clients back to their best!
Vivian Ruth
Vivian Ruth
09:03 28 Oct 20
I’m so grateful for the treatment that I received from Camilla. My results improved within a month!! She is very... attentive, knowledgeable and caring. I highly recommend her for everyone!!read more
Chloe Compton
Chloe Compton
10:20 24 Sep 20
I had several online consultations with Camilla. She was a pleasure to work with and very knowledgeable. Her treatment... plan has really helped me and improved my skin condition. Highly recommend.read more
Lilla Magyari
Lilla Magyari
11:16 01 Sep 20
Camilla is an amazing Naturopath! Her knowledge and enthusiasm is absolutely fantastic! She helped me a lot in the past... and still does whenever I need. You can count on her 100%. I only can recommend her!!! 💚 🌱 💚🌱💚🌱💚🌱💚read more
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