Finding Relief from PMDD with a Root-cause Holistic Approach

 When I was first diagnosed with PMDD, I tried everything. I went to multiple doctors. I played "medication Russian Roulette", randomly trying different types of birth control and antidepressants. Plus, I felt like I was on the mental health equivalent of the Bachelorette, speed dating therapists searching for the right fit. 

 

Exhausted, she turned to us for specialized support. What FINALLY made the difference that got her 97% symptom reduction in just 3 months? 

 

Keep reading to explore:

• Why a large percent of people like Diane don't respond to first-line conventional PMDD treatments and even one-size-fits-all natural solutions.
• The approach that made all the difference for Diane and hundreds of other clients of the Reveal Method^TM

 

What causes Premenstrual Dysphoric Disorder (PMDD)? 

Premenstrual Dysphoric Disorder (PMDD) is a hormone-based mood disorder with psychological and physical symptoms occurring during the luteal phase of the menstrual cycle. PMDD affects 3-8% of people who menstruate.  However, it may be even more common than that.  There may be an additional 7-13% that have milder PMDD symptoms that still significantly interfere with their quality of life. 

 

Keep in mind, PMS is different than PMDD and it's more common, affecting 75% of menstruators.

PMDD is NOT PMS. They are different in both their severity, impact, and the cause.   

 

PMDD is suspected to be a hormone sensitivity in the brain. It is caused by a negative reaction in the brain to the normal rise and fall of hormones throughout the cycle. Each person with PMDD has a unique set of factors that contribute to or trigger symptoms. Genetics, structural brain differences, inflammation, and stress response may all play a role. This is happening at the CELLULAR level.

 

PMDD is real with a biological basis. It’s not your fault or all in your head.  "It's biology, not a behavior choice." (1)

 

Read that again. It's important to acknowledge the biological basis of PMDD so we can strip away the shame and stigma that often accompanies the diagnosis.

 

Why isn't my PMDD treatment working?

If the PMDD treatments you've explored either have not worked for you, have not resulted in relief, or have even made things worse, you're not alone. It's not your fault; there's something bigger at play here. 

 

First-line conventional treatments often include oral contraceptives and antidepressants (2). While they work for some, at least 40% of people with PMDD do not respond to first-line options and are considered "treatment-resistant"(3).  40% is a big number. That leaves a lot of us suffering. (I was in that 40%. Perhaps you're reading this because you are too?)

 

So why do these first-line PMDD treatments work for some and not others? Let's explore 5 potential reasons:

 

#1. There may be different types of PMDD.

If PMDD is caused by a sensitivity to hormonal fluctuations, why is there such a high percent of people who do not respond to treatments to suppress those fluctuations? This suggests there might be something else going on.

 

Researchers set out to answer this question. A 2020 study identified that there may be at least 3 distinct subtypes of PMDD based on when symptoms start and stop throughout the menstrual cycle (4). These different subtypes may point to unique biological causes or pathways.

 

“One limiting factor for treatment development is the implicit assumption that PMDD represents a singular disorder with one pathophysiology.” -Tory Eisenlohr-Moul (4)

In other words, thinking of PMDD as a single diagnosis with a single cause may be standing in the way of finding a more individualized approach. More research is needed to determine the distinct CAUSES for each subtype and what that would mean for more individualized treatment.

 

#2. It may be more than just PMDD.

60% of menstrual mood disorders are more likely to be Premenstrual Exacerbation (PME) of other co-occurring conditions (5). PME refers to the worsening of symptoms of another condition, like depression and anxiety, in certain phases of the menstrual cycles.

 

If you have PME of another condition, rather than PMDD by itself, this may be impacting how you respond to the treatments you've tried. Several randomized controlled trials indicate that people with PME don't respond as well to first-line PMDD treatments like birth control, antidepressants, or even hormonal suppression through GNRA agonists (5, 6, 7).

 

60% is another big number. (I was in that 60%, too. How about you?) This means that for many of us, especially those with PME, the standard options offered at the doctor's office will fall flat. 

 

#3. It could be your genetics.

Your genes can impact your brain chemistry by impacting how you make and metabolize neurotransmitters and response to certain medications. For example, a gene we look at for each PMDD client is called HTR1A. A genotype (HTR1A G/G) associated with PMDD is also associated with poor response to antidepressants or increased side effects (8, 9). Pharmacogenetic testing examines how a person's genetics affect their response and can help your psychiatrist or healthcare provider more effectively choose a medication and dosage.

 

However, your genes are never your destiny. At Reveal Functional Nutrition, we use nutrigenomic testing in a different way. Rather than using your genetic information to determine medications (because we're not doctors), we're looking at how your genes impact your brain chemistry, hormone metabolism, inflammation, and more. Understanding your genetics is powerful and can help identify more targeted nutrition and supplement changes to support mood.

 

#4. There may be metabolic barriers in the way.

If medications are worsening symptoms or becoming less effective over time, let's talk about why. (There's no med shaming for you here! If it's working for you, that's great.)

 

First, the side effects or long-term impacts of the medication may be creating other symptoms or underlying issues, creating a vicious cycle. For example, oral contraceptives can alter intestinal permeability (10), impact the gut microbiome (11), increase inflammation (12), and deplete nutrients (13). 

 

Next, some medications can lose their efficacy over time. For example, you may be experiencing what's called a "Prozac Poop Out." This refers to how antidepressants can lose their effectiveness over time, in theory due changes in receptor sensitivity, creating a sort of tolerance.

 

And last, medications do not operate in a vacuum inside your body and brain. There are countless factors that impact the efficacy of a medication such as inflammation, the gut microbiome, fatty acid balance, and nutrient levels. For our clients on medication, we address all these underlying factors to help their medication do its job better. These factors have many searching for more sustainable relief.

 

#5. It might not be addressing the true root issue.

Last but most definitely not least:

Single remedies, whether medications or natural supplements, sometimes fall short because they merely mask symptoms without addressing YOUR unique set of underlying factors to bring those systems back into balance.

Let's explore further below.

 

 

A Functional Medicine Root-cause Approach to PMDD

As you've been learning, we are not all the same. There may be unique causal factors that impact why some respond to certain interventions and others do not. This applies to both conventional medical treatments and even natural options like supplements, diet and lifestyle changes.

 

Think about it: How many times have you seen a post on PMDD forum where someone shares a medication, supplement or diet that worked magic for them? You start feeling hopeful and then check out the comments... only to see countless comments from others that they tried it, and it did NOTHING.

 

Here's the hard truth:

There's no single PMDD "protocol" that will work for everyone. 

 

But you already knew this if you've tried multiple medications, lists of supplements from Google searches, or restrictive diet changes.

We must move beyond the LABEL of the diagnosis and look at your unique set of symptoms and cycle patterns for more precise, effective, and sustainable strategies.

 

This is exactly what a functional medicine root-cause approach is all about. Each person has different interwoven factors such as genetics, brain chemistry, co-existing hormonal imbalances, nutrient insufficiencies, stress, trauma, and more.  Check out the tree graphic below.

 

Amongst the soil in the middle, you'll see genetics and other triggers.  Although these things are out of our control, this helps us identify where we need to bring things back in balance. You'll see common symptoms of PMDD at the top amongst the leaves. Your symptom patterns, along with any other seemingly unrelated symptoms, help us start to pinpoint the root-cause factors underneath. 

 

If that list feels daunting, know that you don’t need to go it alone. In fact, revealing your unique root-cause factors is built right into the Reveal Method^TM. We start by looking at your unique cycle symptom patterns and your history. That initial data serves as the launching point for where to start and which lab tests you'll benefit from most. Armed with that data, we guide you step-by-step so you can stop guessing and start taking strategic action towards PMDD relief.

 

 

  

 

A PMDD Story of Hope: Diane 

Meet Diane. Diane came to us because severe PMDD symptoms had taken over here life.  She had tried it all: medications, therapy, supplements, diet, and lifestyle changes.  She was throwing everything she could at this problem... just to feel more exhausted than when she started.  Perhaps you feel that way too?  

The Before

Diane started where you may be today. 

"In order to keep my head above water and keep my life from imploding, I had to make my life very small. Every month, for 2 entire weeks at a time, I experienced a wide range of severe symptoms that affected both my physical and mental health. I could no longer be myself."

Her world became smaller and smaller.

I would shut myself away for 2 weeks every month. I could no longer work and I felt like a terrible mother and partner. And the SHAME!!! Because of PMDD, I wasn't working, I couldn't consider having another child (or even a pet), and I missed important family moments.

Diane had tried everything. 

"I had thrown absolutely everything I could think of at this problem. 

• She tried antidepressants: They took the edge off but didn't make a dent in the severe PMDD days.

• She tried multiple forms of therapy, including EMDR, but still felt powerless against the PMDD symptoms.

• She tried diet and lifestyle changes but was too exhausted to keep up when she didn't even know if it was helping. (She's even a dietitian herself!)

Want more details?  Before the PMDD Revealed program, she pushed through the exhaustion to try everything she could.  

I improved my sleep hygiene and diet and committed to almost daily exercise despite the crushing exhaustion. I took up meditation and even trained as a meditation and mindfulness teacher. I learned how to knit in order to have a mindful activity that I could do to calm my nerves and help me feel a sense of productiveness and achievement. I took medication for my PMDD, trying higher doses over time. I limited or abstained from caffeine, alcohol, and sweets, while I increased my intake of certain vitamins, minerals, and nutritional supplements that may offer some relief from symptoms. I did breathing exercises. I tracked my symptoms and synced my calendar and schedule to my "good" weeks and avoided making plans or lofty goals for during my "bad" weeks. Still, this was not enough. I still had pretty severe symptoms, for too many days out of the month. I was desperate for help. I saw 3 different doctors before I turned to Mandy.  As a dietitian myself, I decided to search for an RD who specializes in Integrative and Functional Nutrition. 

How long is the list of things you've tried?  Despite how exhausted she felt from all of there efforts, she wasn't ready to give up.  She sought us out for a different approach. 

However, given all she had tried already, it initially made her nervous and hesitant about joining the program.  She decided to take the leap and invest in specialized support.  Spoiler alert: Here's what she said about that when she graduated. 

The out-of-pocket costs associated with seeking functional medicine help almost prevented me from working with Mandy. I had barely been working and felt this was a big financial investment.  However, I had a good feeling about Mandy and our ability to work together to tackle my symptoms and help me feel better. The financial investment I made to work with Mandy was 100% worth it. She has helped me get my life back. If I knew in advance the extent of the results I would see from working with Mandy, I never would have hesitated.

The Process

She joined the PMDD Revealed^TM program and followed the Reveal Method^TM.  Our 4-phase Reveal Method combines what we know from PMDD research with the data we gather on YOU.  We translate that data into actionable steps so you know WHY you're feeling like this, WHAT to do, and HOW to do it.  Then we measure and assess progress along the way so we're always tweaking and refining your plan to achieve as deep of relief as possible. 

Here's a recap of what that looked like for Diane: 

Phase 1: Reset

During the first month of the program, we covered foundational changes for quick relief.  Beyond PMDD symptoms, she was experiencing severe bloating, water retention, cravings, exhaustion, and body dysmorphia.  Given that she was already so fatigued, we took small but strategic steps that first month.  We examined her food patterns which revealed undereating and blood sugar dysregulation.  We discontinued a lot of supplements that were making her symptoms worse (including Vitex/chasteberry!) and filled in nutrient gaps with her new supplement plan.  All of this took the edge off while we prepared for testing to do the deeper root-cause work.  Just from these foundational changes, she experienced 46% symptom relief in the first month.  But we weren't done yet!  

Phase 2: Reveal

For each client, we customize which tests will be most helpful to fuel our data-driven approach.  We did comprehensive bloodwork and nutrigenomic testing.  Through her lab work, we uncovered disrupted iron and calcium patterns due to the chronic inflammation inside her body.  She had suboptimal levels of multiple nutrients and fatty acids that had a direct impact on neurotransmitter production and mood. Her genetic test revealed genes that impact inflammation status, histamine balance, and brain chemistry (like dopamine, GABA, and oxytocin).  Rather than stabbing in the dark, her data helped us be more precise with our interventions.  No more exhausting herself with things that wouldn't even make a difference in her symptoms. 

Phase 3: Rebalance 

Fueled by her lab data, we worked together to bring those systems back into balance.  Step by step, we made targeted nutrition and lifestyle changes and brought in strategic supplements to address the root-cause factors we had identified.  During this time, she also continued to explore her relationship with her cycle to create cycle and nervous system "maps" to create a personalized toolbox to navigate each phase of her cycle in the way that works best for her.  As we addressed the underlying root-cause factors, her nutrition and supplement plan got simpler; she could maintain her progress with less and less effort over time. 

Phase 4: Reclaim 

After doing the deep work during Phase 3 to address the underlying imbalances, she was ready to graduate from the program with a streamlined protocol to sustain her progress.  We outlined exactly which nutrition and lifestyle changes were most important to sustain her progress and created a simplified maintenance supplement plan.  She graduated with clarity on how her needs change throughout the cycle and how to support each phase.  She now knows exactly how to work with her cycle, instead of against it. 

The Result

As a result of working with us through each phase of the Reveal Method, she experienced 97% reduction in PMDD symptoms, 100% reduction in severe PMDD days, and 83% reduction in total body symptoms.  Just like Tess, she experienced massive, life-changing relief.  

You can see that we measured her progress over 3 months below.  However, notice in the graph below that she experienced massive relief in the FIRST MONTH, 46% reduction and then 97% the following month.  After countless doctors, therapists, supplements, and lifestyle changes, she made progress faster than she had ever dreamed of.  

Here's what she said:

Working with Mandy provided the most DRAMATIC positive results of ANY healthcare provider I have worked with.

What FINALLY made the difference?  Our systematic data-driven 4-phase approach.  We leave no stone unturned with our root-cause exploration. 

Hear it straight from her in the video below:

The "Ripple Effect"

She gained so much more than symptom reduction.  From the relationship with her child and husband to her career, all areas of her life are forever impacted.  

The best thing that happened to me as a result of working with Mandy is that I'm able to have more fun with my son and my husband. I'm enjoying my time with my family more than I have in quite awhile and am able to do so many more activities with them now. I'm also finding myself doing many things that were too scary before. I have been looking into different professional opportunities and booking travel without fear of how PMDD symptoms might interfere. I'm actively searching for our first family dog and I hope to soon revisit the idea of having another child.

With her newfound capacity, now she's giving back.  We call that the "Ripple Effect."  It's our term for when someone can now live more fully and give back to their community while living out their purpose.  In her case, she's giving back to the PMDD community specifically. 

Things have come full circle for Diane: the student has become the teacher! She recorded a library of trauma-informed mindfulness exercises for our PMDD Revealed program that will serve others for years to come.  And she launched her own PMDD podcast, Mindfulness for PMDD.  I had the honor of being one of her first guests to discuss fresh take on why we need to think about intuitive eating differently when it comes to PMDD. 

Her life is no longer small, that's for certain.  

Finding Relief from Premenstrual Dysphoric Disorder (PMDD)

We asked Diane what she wants others with PMDD to know if they're searching for answers.  Here's what she said. 

If you're sick of throwing spaghetti at the wall to find what sticks for *your* PMDD, look into working with Mandy. Before, my biggest frustration was that I was trying so many different lifestyle modifications and supplements in a trial-an-error approach to find out what might work for me. It was very frustrating and never got me quite the level of symptom relief I was looking for. Mandy used a data-driven approach to hone in on the specific changes that would result in maximum symptom relief for me, based on my history, my lifestyle, and my lab tests. Working with Mandy provided the most dramatic positive results of any healthcare provider I have worked with. 

If you feel like you've tried it all like Diane, we got you.  We take a systematic root-cause approach that combines the science of functional medicine with the art of cycle awareness to untangle your PMDD web.  

If you're ready to experience our special sauce of personalized 1-on-1 root-cause approach combined with community & cyclical awareness, click here to set up a 1-on-1 chat to decode your PMDD type and map out a path to relief.

During this Strategy Session we will:

1. Evaluate your symptoms and cycle patterns to suss out the underlying root factors. 

2. Explore WHY what you've tried hasn't worked and identify the missing links. 

3. Map out your personalized strategy for more peaceful periods. 

Click here to snag a spot on my calendar. 

Your life doesn't have to be small, either.  It's time to stop losing days to PMDD.  

DISCLAIMER: All information is meant for education only and is not intended for the diagnosis or treatment of disease, nor does it serve as a substitute for medical treatment or advice. You should seek the advice of a physician with any questions or concerns regarding personal medical conditions.

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