The Brain and Premenstrual Syndrome

Premenstrual dysphoric disorder (PMDD) is characterized by emotional and somatic symptoms that recur monthly during the luteal phase of the menstrual cycle (the part of the cycle immediately prior to menstruation). Symptoms can involve increased irritability, anger, depressed mood, anxiety, poor concentration, increased sensitivity to rejection, and feeling overwhelmed or out of control (Ratkin et al, 2014). It also is associated with a multitude of somatic complaints, including fatigue, joint/muscle pains, nausea, headaches, food cravings, weight gain, decreased libido, and difficulty sleeping. PMDD has been reported to affect 2-8% of women during their reproductive years. Premenstrual syndrome, thought to be a less severe form of PMDD, is reported to affect 30-40% of women during their reproductive years (Baker et al., 2012).

What causes these symptoms? It turns out that the brain has a lot to do with it. The cause of PMS/PMDD is thought to be related to the central nervous system’s sensitivity to reproductive hormones, particularly estrogen and progesterone. These hormones are termed ‘neuroactive’ because, in addition to acting on the reproductive system, they also act on the brain’s receptors and thus influence the brain’s functions. Women with PMS/PMDD are thought to have increased sensitivity to normal hormonal fluctuations.

Functional MRI studies suggest that the brains of women with PMDD experience changes that occur during different times of the menstrual cycle. For instance, a study in 2008 showed that women with PMDD had higher activation in the amygdala (a part of the brain involved in the fear response) by negative words, and less activation of the nucleus accumbens (a part of the brain involved in goal and reward circuitry) by positive words than women without PMDD (Protopopescu et al., 2008). In other words, the brains of women with PMDD were more sensitive to negative stimuli and less sensitive to positive stimuli. This likely results in depressed mood and anxiety. Another study showed that women with PMDD has decreased activation of the fronto-cingulate cortex, a deep structure in the front of the brain highly involved in emotional processing.

So now that we know that the brain’s of women with PMS/PMDD display higher sensitivity to reproductive hormones, what can you do to improve your life if you suffer from PMDD or PMS?

Here are five tips to not only help reduce your PMS/PMDD symptoms, but also improve the health of your reproductive system and the brain networks involved.

1. Avoid chemicals that interfere with your reproductive system 

We encounter a multitude of hormone-disrupting chemicals unknowingly every day through use of products. Identifying these chemicals can help you avoid exposure and thus improve your reproductive and neurological health and thus minimize PMS/PMDD symptoms.

Research has shown that chemicals used in common products can interfere with hormonal cycles and therefore potentially interfere with the reproductive cycle. This can throw your body out of wack and lead to abnormal periods, difficulty conceiving, and also worsen PMDD and PMS. Since the list of chemicals is too long to mention in this post, here is a helpful article that I have used to educate myself on what to avoid. Also, below is a link to an informative book that examines how synthetic chemicals interfere with hormonal messages involved in the reproductive cycle. 


2. Transcranial Direct Current Stimulation

Depressive symptoms and anxiety are a hallmark of PMS and PMDD. Therefore, targeting these symptoms alone may be enough to relieve much suffering from those with PMS/PMDD. Non-invasive brain stimulation devices that apply low currents of electricity to the brain, such as transcranial direct current stimulation (tDCS), have been shown to be effective in treating depressive symptoms. TDCS also show promising results for insomnia, chronic pain, as well as other neurological and psychiatric symptoms (What is tDCS?). TDCS is thought to work by externally influencing the neural circuitry involved in mood. TDCS appears to be effective, safe, and usually painless. If you are interested in learning more about tDCS devices, please see my post on the best tDCS devices of 2018.

3. Lower systemic inflammation levels

Chronic inflammation has been correlated to depressive symptoms and chronic stress. Moreover, research at UC Davis found that women who experience PMS have higher levels of an inflammatory marker, called C-reactive protein. Effective strategies to lower inflammation include: limiting simple carbohydrates and processed foods in your diet, getting enough sleep, and exercising. Certain diets, such as the ketogenic diet and the relatively new carnivore diet (thought to be a modified version of the ketogenic diet) are diets that are shown to decrease levels of systemic inflammation, and therefore might help with PMS/PMDD symptoms. See my video on the carnivore diet for more information.

Turmeric, a spice that has been used for hundreds of years for its medicinal properties, has also been shown to exhibit potent anti-inflammatory properties, and has been shown to be safe in multiple studies. I personally enjoy Numi Turmeric Tea on a daily basis, as a substitute to coffee in the afternoons.



4. Minimize stress

Chronic stress has been linked to deregulation of neuroactive hormones involved in the reproductive cycle. The areas of the brain that are involved in the reproductive cycle as well as the stress response are the hypothalamus and the pituitary gland (collectively called the hypothalamic-pituitary axis (HPA)).  Women with PMDD have been shown to have altered HPA axis function, including higher baseline cortisol (the key hormone involved in stress) levels during the luteal phase compared to women without PMDD. You can minimize stress by:

  • Exercising – physical activity has been shown to improve depressive symptoms and induce overall well being.

  • Eating – avoid alcohol, caffeine, and sweets.

  • Get enough rest – The National Sleep Foundation recommends 7-9 hours of sleep for adults over 18 years of age. Sleep is thought to serve in healing and repair of the body’s cells, including the neurons in your brain.

5. Oral Supplements

While the FDA has not approved any herbal supplements for the treatment of PMS or PMDD, research has shown that certain supplements may be beneficial. These include:

 
 

Resources:

Chocano-Bedoya, P. O., Manson, J. E., Hankinson, S. E., Willett, W. C., Johnson, S. R., Chasan-Taber, L., … Bertone-Johnson, E. R. (2011). Dietary B vitamin intake and incident premenstrual syndrome. The American Journal of Clinical Nutrition93(5), 1080–1086. http://doi.org/10.3945/ajcn.110.009530

Carlomagno, G., Unfer, V., Buffo, S. and D'Ambrosio, F. (2011), Myo-inositol in the treatment of premenstrual dysphoric disorder. Myo-inositol in the treatment of PMDD, 26: 526–530. doi:10.1002/hup.1241

Direkvand-Moghadam, A., Sayehmiri, K., Delpisheh, A., & Kaikhavandi, S. (2014). Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. Journal of Clinical and Diagnostic Research : JCDR8(2), 106–109. http://doi.org/10.7860/JCDR/2014/8024.4021

EPPERSON, C. N. (2013). Premenstrual Dysphoric Disorder and the Brain. The American Journal of Psychiatry170(3), 248–252. http://doi.org/10.1176/appi.ajp.2012.12121555

Fathizadeh, N., Ebrahimi, E., Valiani, M., Tavakoli, N., & Yar, M. H. (2010). Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iranian Journal of Nursing and Midwifery Research15(Suppl1), 401–405.

Grosso G, Pajak A, Marventano S, Castellano S, Galvano F, Bucolo C, et al. (2014) Role of Omega-3 Fatty Acids in the Treatment of Depressive Disorders: A Comprehensive Meta-Analysis of Randomized Clinical Trials. PLoS ONE 9(5): e96905. https://doi.org/10.1371/journal.pone.0096905

Kai-Lin Huang, M.D., Shih-Jen Tsai, M.D. St. John's wort (Hypericum perforatum) as a treatment for premenstrual dysphoric disorder: case report.Int J Psychiatry Med. 2003;33(3):295-7.