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Exploring the Relationship Between PMS, PMDD, Trauma and Perimenopause


Menstruation is a natural part of a woman’s life. Yet, many women are struggling with Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) and I have the feeling that it becomes more and more common, just like more and more women suffer from PCOS and Endometriosis. In my opinion, this is in part linked to prolonged toxin and hormone disruptor exposure.



PMS vs PMDD graphic overview

Common PMS symptoms include:

  • Bloating

  • Breast tenderness

  • Abdominal cramping

  • Fatigue or low energy

  • Headaches or migraines

  • Cravings, particularly for sweets or salty foods, are common.

  • Sleep disturbances: Insomnia or disrupted sleep patterns might occur.

  • Mood swings: Feelings of irritability, moodiness, or heightened emotional sensitivity.

  • Anxiety: Increased feelings of anxiety or tension.

  • Depression

  • Mental fogginess or difficulty focusing on tasks

  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating or weight gain


Premenstrual Dysphoric Disorder (PMDD): is a more severe, sometimes disabling extension of premenstrual syndrome (PMS). Although PMS and PMDD both have physical and emotional symptoms, PMDD causes more extreme mood shifts that significantly impact a woman’s quality of life. These symptoms often start a week or two before menstruation and improve within a few days after menstruation begins.


We used to think that PMS and PMDD were caused by hormone imbalances, specifically progesterone deficiency or estrogen dominance (high estrogen in relation to progesterone). And these are still true for some women or exacerbate symptoms for sure. 

We’ve come to learn though that what happens in PMS and PMDD is that women develop a sensitivity to their own hormonal fluctuations. Their hormones are doing what they're supposed to be doing, but the woman’s body develops a negative reaction to these changes. Source

 

What typically happens in PMS/PMDD is that a woman experiences a stressful event, like her parents divorcing, an accident or anything that was stressful for her, during puberty, pregnancy, etc.  Her brain essentially connects the stress response with her hormones, so it now perceives hormone fluctuations as a stressor. So, whenever her hormones change, especially before her period, her body reacts like it's facing stress again.


Other causes of PMS/PMDD:

  • Genetics – PMDD is believed to be heritable, as shown in studies on families and twins.

  • Changes in the HPA (hypothalamus-pituitary-adrenal) response

  • During the time leading up to periods, some women's brains react to one of the byproducts of progesterone (allopregnanolone), which usually helps calm and relax most women, but might have the opposite effect in PMDD.

  • Disturbances in the body's natural circadian rhythms and immune function

  • Changes in the brain’s response to serotonin fluctuations

  • Abnormal responses in the brain regions that process emotions during the luteal phase

  • Increased Histamine that can be triggered by an imbalance in your estrogen:progesterone ratio that often gets disturbed in perimenopause when hormones start to fluctuate. (Increased histamine can also be genetic).


Women with PMDD tend to have lower estrogen in the early luteal phase (that’s the time just after ovulation) compared to women without PMDD. The theory is that this low estrogen triggers the brain to struggle with elevated progesterone levels that will naturally rise during luteal phase. Decreased estrogen can also cause a decline in the neurotransmitters (acetylcholine, dopamine, and serotonin) which leads to insomnia, fatigue, and depression. 


Wow who would’ve thought right?! But if you think about the crucial role your brain plays in hormone balance (it literally is responsible for commanding the production of ALL of your hormones), it actually doesn’t sound so crazy anymore to think that trauma can cause this. 


But let’s also look at histamine as a potential trigger for PMS or PMDD:


The relationship between estrogen and histamine involves several mechanisms:

  • Histamine Release: Estrogen can stimulate the release of histamine from certain cells in the body, potentially contributing to increased histamine levels.

  • Histamine Breakdown: Fluctuations in estrogen levels may affect the activity of enzymes responsible for breaking down histamine. Lower levels of these enzymes could lead to histamine accumulation.


The delicate balance between estrogen and progesterone is crucial for regulating various bodily functions. When this balance is disrupted, such as during perimenopause or in cases of hormonal imbalance, it can impact histamine levels and the body's ability to manage histamine effectively.


Fluctuations in estrogen and progesterone levels can also impact the immune system, and hence trigger histamine release and responses to histamine in the body. This complex interplay among hormones and histamine can contribute to symptoms associated with histamine intolerance and conditions affected by hormonal fluctuations, such as PMS and PMDD.


Some tips to manage PMS/PMDD:

Diet:

  • Skip alcohol, especially during the luteal phase, as it can worsen symptoms

  • Soy protein (68 mg isoflavones) has been shown to decrease headache, swelling, breast tenderness, and cramps

  • Increasing whole grains, especially during the luteal phase, may improve symptoms

  • Reducing sodium can decrease bloating or fluid retention

  • Pay attention to high histamine foods and if you feel better when reducing them

  • Focus on foods high in omega 3 fatty acids, calcium and zinc

  • Supplement with Vitamin D3 & K2 if necessary


Hormone Therapy

Topical estrogen with a cyclical dose of progesterone may help to improve symptoms in some women.


Oral contraceptives or birth control pills have been known to worsen PMS/PMDD symptoms in some cases.


Cognitive Behavior Therapy (CBT)

While CBT has been shown to improve anxiety and depression in women with depression and anxiety disorders, there is limited research on the use of CBT in women suffering from PMS/PMDD. Some studies have shown an improvement in symptoms, so CBT may be worth exploring.

 

If you suffer from PMS or PMDD, it’s important to seek help. For more information on PMS and PMDD, visit The International Association for Premenstrual Disorders


Also consider joining our program "Perimenopause like a Boss" to learn more about your condition and symptoms and how to manage them.

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