PMDD and the Pill. Is there Another Way?
An ATH reader who was prescribed hormonal birth control to ease PMDD symptoms feels that it is no longer helping, wants to discontinue and asks about herbal support.
This is a great question, I’m so glad you reached out for help. While, for most women hormonal balance and rhythm is restored within three months of discontinuing hormonal contraception (HC), it can take much longer for others and many women experience troublesome symptoms like irregular periods, heavy menstrual bleeding, menstrual cramps, mood changes, and acne; nutritional status may also be affected. Women who use HC for non-contraceptive reasons like acne, dysmenorrhea, endometriosis, and in this case PMS/PMDD will likely experience a return of their original symptoms when they are discontinued.
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are defined by a broad array of somatic and emotional symptoms that occur in the luteal phase of the menstrual cycle (after ovulation and before menstruation) and resolve soon after menstruation begins. Common symptoms include:
Swelling of extremities
Joint or muscle pain
Breast tenderness or swelling
You can find the diagnostic criteria for PMS and PMDD here.
PMDD is distinguished from PMS based on number and severity of symptoms, particularly affective symptoms, but in practice, PMS and PMDD are more of a continuum rather than distinct disorders. PMS/PMDD have multifactorial etiology, meaning that there are likely many factors that interact to trigger the condition. Some of the main factors include:
Altered neurotransmitter response to naturally fluctuating hormones
Impaired endocrine stress response
Psychosocial and cultural factors
A holistic approach for this situation will address all of the relevant factors and the potential difficulties that might arise in relation to both PMDD and discontinuing HCs generally.
Study results are mixed regarding HC use and nutrient status, the one nutrient there does seem to be general consensus on is folic acid. Nevertheless, the evidence is sufficient to warrant attention to potential impacts on the status of several vitamins and minerals in HC users due to reduced absorption, increased elimination, reduced conversion to biologically active forms, altered transport within the body, and altered metabolism - depending on the specific nutrient.
Some studies have found increased biomarkers of oxidative stress and indications of impaired lipid and carbohydrate metabolism in women taking HC. Vitamins C and E, which have important antioxidant activity and are known to improve cholesterol and triglyceride profiles, are among the nutrients can be depleted in people taking HC.
In addition to addressing potential nutrient depletion, nutrition is an important way to address the inflammation and oxidative stress that may be at play in PMDD.
Be sure to eat a diet that is nutrient dense, antiinflammatory, and composed of whole foods rich in antioxidants, including five or more servings a day of brightly colored fruits and vegetables. This guide to an antiinflammatory lifestyle from University of Wisconsin Integrative Health is packed with helpful information.
Include foods that are rich in fiber, especially soluble fiber, which stimulates body’s natural detoxification and elimination processes. This supports hormonal balance by helping your body clear metabolized hormones.
Consider a high-quality multivitamin while taking HC and for several months after discontinuing.
Research indicates that supplementing with vitamin B6 may improve depressive symptoms and supplementing with magnesium may improve symptoms of pain, bloating, and anxiety that are common features of PMDD.
Lifestyle Support for PMS/PMDD
Regular exercise throughout the menstrual cycle has been shown to reduce symptoms.
Alcohol increases risk of symptoms, so reduce or eliminate alcohol intake.
Get plenty of sleep throughout your cycle.
Acupuncture may reduce symptoms.
Herbal bitters taken before each meal help improve digestion and absorption, support lipid and carbohydrate metabolism, and further support hormonal balance through your body’s natural detoxification and elimination processes. I like Urban Moonshine blends, you can read their post Which Bitters are Best for Me? here.
It may seem unlikely that a simple cup of tea could improve something as intense as PMDD but herbal nervines really do help. Consider a blend of 2 – 4 of the herbs from the list below and have it every day throughout your cycle. It’s okay to switch things up now and then and rotate new herbs in and out of your blend.
Here some favorites to consider:
Skullcap 2-4 g/day
Chamomile 4-6 g/day
Lemon Balm 2-4 g/day
Holy Basil 2 g/day
Lavender just a pinch
Rose petals just a pinch
Infuse 20 minutes in 2 cups just boiled water, strain and enjoy.
I hope this helps!
Freeman, Camille. (2020, September 14). PMS & PMDD: A Webinar for Herbalists and Nutritionists
Romm, Aviva. (2018). Botanical Medicine for Women’s Health (Second). Elsevier.
Schindler, A. E. (2013). Non-Contraceptive Benefits of Oral Hormonal Contraceptives. International Journal of Endocrinology and Metabolism, 11(1), 41–47. https://doi.org/10.5812/ijem.4158
Wakeman, M. P. (2019). A Review of the Effects of Oral Contraceptives on Nutrient Status, with Especial Consideration to Folate in UK. Journal of Advances in Medicine and Medical Research, 1–17. https://doi.org/10.9734/jammr/2019/v30i230168
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Renata is a clinical herbalist, scientist, gardener, and woodland wanderer who helps women create profound transformation in their lives through the healing power of herbal medicine and the practice of devoted self-care. She has a BS in Chemistry from University of Maryland, a MS in Therapeutic Herbalism, and a Post Masters Certificate in Clinical Herbalism from Maryland University of Integrative Health.
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