Understanding Your Treatment Options for Premenstrual Dysphoric Disorder (PMDD)
If you or a loved one are experiencing insomnia, anxiety, and/or severe fatigue before your period starts, and those symptoms come with vomiting, acne, or heart palpitations, among other things, you may be suffering from premenstrual dysphoric disorder (PMDD) and considering to try functional medicine approach in Tampa, FL.
Premenstrual dysphoric disorder (PMDD) is a health condition similar to, but more serious than, premenstrual syndrome (PMS).
Symptoms of PMDD — which tend to occur one to two weeks before a period starts and end two to three days after a period starts — fall into broad categories, including psychological, gastrointestinal, respiratory, dermatological, vascular, and neurologic.
Conventional medical treatments for PMDD include antidepressants, birth control pills, pain relievers, and, believe it or not, hysterectomies.
However, these typically provide only partial or temporary relief at best and often cause other health issues, including sexual dysfunction, female cancers, liver disease, and blood clots.
To add insult to injury, when all these treatments fall short, women are left with the mistaken belief that they have “tried everything” when, in fact, safer, more effective treatments are available.
This BioDesign Wellness Center blog post presents the case against conventional medical treatments for PMDD and reveals safer, more effective personalized treatment protocols available through functional medicine.
Understanding Conventional Medical Treatments for PMDD
Conventional medicine offers a number of treatments for PMDD, but here at BioDesign, we believe these treatments provide only partial or temporary relief. Worse yet, they carry potential side effects and risks, some of which can be serious or even fatal:
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Over-the-counter pain relievers, including acetaminophen (Tylenol) and ibuprofen (Advil), are generally safe when taken as directed for short-term pain relief. They are associated with a long list of minor side effects, but long-term use is associated with liver disease, especially in the case of acetaminophen.
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Selective serotonin reuptake inhibitor (SSRI) antidepressants include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox).
They are commonly used to treat depression and sometimes anxiety but can cause undesirable side effects, including these:
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- Anxiety/agitation
- Diarrhea or constipation
- Headaches
- Blurred vision
- Indigestion, nausea, vomiting
- Weight issues
- Poor sleep
- Excessive sweating
- Dry mouth
- Sexual dysfunction
- “Unmasking” of bipolar disorder in patients who have a genetic susceptibility to it
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Oral contraceptives (birth control pills) are synthetic hormones (estrogen and progesterone) commonly used to alleviate symptoms of PMS, including cramps, menstrual dysregulation or pain, acne, and endometriosis.
However, they can be associated with the following negative side effects and health risks (see our previous post “Exploring the Unintended Side Effects of Birth Control Pills” for details):
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- Spotting between periods
- Nausea
- Breast tenderness
- Headaches or migraines
- Weight gain or difficulty losing weight
- Mood changes
- Missed periods
- Decreased libido
- Vaginal discharge
- Changes in vision or discomfort wearing contact lenses
- Increased risk of blood clots
- Increased risk of estrogen-dependent cancers, such as breast, ovarian, and endometrial (uterine) cancers
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Gonadotrophin-releasing hormone (GnRH) agonists, such as Leuprolide and Danazol, are medications that suppress the release of estrogen from the ovaries, causing temporary, reversible menopause — which means you stop having periods.
Not surprisingly, GnRH analogs can cause menopausal symptoms, including:
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Hysterectomy or bilateral salpingo-oopherectomy (removal of the uterus, fallopian tubes, and ovaries) results in a complete cessation of ovarian function, which causes the aforementioned menopausal symptoms.
Hormone add-back therapy is usually provided to address the loss of hormones (and resulting bone loss), but synthetic hormones are typically used, presenting the same potential side effects as birth control pills.
In addition, hysterectomy and bilateral salpingo-oopherectomy are major abdominal surgeries that carry a risk of bleeding, infection, and death. These risks increase if you have a history of other medical conditions (heart, lung, liver, or kidney disease, obesity, or diabetes).
Other conventional treatments for PMS and PMDD include lifestyle and dietary modification, stress management, cognitive behavioral therapies, meditation, and breathing exercise.
Although these are by no means first-line therapies, studies have shown that stress management, along with changes to diet and lifestyle can help. Based on our clinical experience, many patients respond favorably when provided with the right guidance.
The Functional Medicine Approach to Diagnosing and Treating PMDD
Here at BioDesign Wellness Center, many of the patients we see with a PMS or PMDD diagnosis have used SSRIs, oral contraceptives, hormone replacement therapy (HRT), ovulation-suppressing medications, and/or have had hysterectomies.
They come to us when they have exhausted all conventional treatment options. It’s not their fault. Their options were limited to what their doctors had at their disposal — band-aid attempts to control the menstrual cycle and suppress symptoms.
We take a functional medicine approach with a focus on identifying the root cause of an illness and treating it with the least invasive, safest, and most effective natural remedies available. Many of the tests, medications, supplements and alternative treatments we use are not in the wheelhouse of conventional medicine practitioners.
Our approach at BioDesign Wellness Center — a Tampa Functional Medicine practice — is different, safer, and more effective.
Test First
When we see a patient for the first time, we don’t know what’s going on below the surface, so we conduct a thorough exam, including a physical exam and an assessment of the patient’s medical history and health history.
We also listen carefully and ask questions to obtain a thorough understanding of each patient’s major health concerns and goals. Then, we order lab tests in order to gather additional clues for solving the mystery.
In the case of PMS or PMDD, we order a full serum hormone panel, including estrogen, cortisol, and thyroid testing. Each of these hormones can influence the female cycle and should be considered separately and as a whole. It’s not just the level of each hormone that’s important but also the balance among them.
When appropriate, we also order a DUTCH test to check the metabolites of cortisol, progesterone, estrogen, and testosterone to gain insight into the patient’s hypothalamic-pituitary-adrenal (HPA) axis function, which is responsible for the stress response.
DUTCH testing also gives us a window into not only the levels of hormones but how well they are being metabolized. Hormone metabolism is key to the hormones’ influence in the body.
Some research shows that the metabolism of progesterone to allopregnanolone can alter moods.
Treating PMDD: Conventional versus Functional Medicine
It is one thing to say that functional medicine is safer and more effective at treating PMDD than conventional medicine and quite another to explain why that is the case.
Here, we take a deeper dive into why our approach is safer and more effective than what conventional medicine has to offer.
Treating PMDD versus Restoring Health
Functional medicine focuses on treating people, not illnesses and not just symptoms. Your body functions as an organic whole. Illness or dysfunction in any part of your body negatively impacts your overall health and well-being.
You could have genetic vulnerabilities, nutrient deficiencies, food intolerances or sensitivities, hidden infections, toxins, and other issues that are disrupting your hormonal balance.
Our goal is to restore health and function to all systems of your body. We can then fine-tune your treatment to focus on specific medical conditions and optimize your health and fitness to meet your goals.
Progestin versus Natural Progesterone
Conventional treatments for PMDD often exclude natural progesterone. They typically focus on estrogen replacement and, in some cases, progestins. Progesterone and progestins are not the same.
They are metabolized differently by the body, and this appears to make a tremendous difference in treatment outcomes, not all of which are fully understood. Conventional medicine has frowned upon the use of progesterone because a few studies of synthetic progestins (not progesterone) failed to show any benefit.
We often prescribe natural progesterone to women to support healthy ovulation and the reduction of PMDD symptoms.
Among our patients, menstruating or post-menopausal women taking doses as low as 5mg and high as 200mg have experienced resolution or significant reduction of the following symptoms:
Using progesterone as part of a comprehensive, personalized treatment plan involves making dietary changes to balance blood sugar and support healthy ovulation.
This includes reducing anti-inflammatory foods, eating healthy fats (Mediterranean diet), and eating according to a schedule that maintains balanced cortisol levels.
Cortisol levels can fluctuate with intermittent fasting, so we often advise avoiding this type of diet in women experiencing PMDD.
SSRIs versus Natural Antidepressants
Depression and anxiety are serious health conditions, but SSRI antidepressants can cause what we deem to be unacceptable side effects, including sexual dysfunction.
Instead, we like to use a more natural approach to balancing serotonin that works just as well in most cases. Some women with mental health diagnoses will benefit from pharmaceutical medications to influence brain chemistry, but those medications are not the best solution for all women.
Sometimes, a combination of natural progesterone, diet and lifestyle changes, nutritional supplements, stress reduction, and other natural interventions is sufficient for alleviating depression.
If those interventions are not enough, we can try natural supplements for balancing serotonin levels, such as SAM-e or St. John’s Wort.
Surgery as a Last Resort
In both conventional and functional medicine, a hysterectomy is a last resort after all other treatment options have failed. What makes functional medicine different is that we have more and better treatment options. If you have PMDD and have exhausted all conventional options, know this: You have not exhausted all your options.
Functional medicine has more to offer. In fact, if you have just been diagnosed with PMS or PMDD, we strongly encourage you to make functional medicine your first choice.
If you or a loved one are experiencing any of the health issues described in this post about premenstrual dysphoric disorder, we encourage you to consult with a functional medicine-focused healthcare provider like us to have your symptoms properly diagnosed and treated.
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Disclaimer: The information in this blog post about the premenstrual dysphoric disorder is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from the medical staff at BioDesign Wellness Center, Inc., nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.