The Brain and Premenstrual Syndrome

Premenstrual dysphoric disorder (PMDD) is a debilitating health problem that 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, a health problem that is 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? 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 altered sensitivity to normal hormonal fluctuations.

Functional MRI studies have recently shown that women with PMDD have functional 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 lower 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, which likely accounts for the symptoms of 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 the emotional processing neural network (aka limbic system).

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 a scarily informative book that examines how certain synthetic chemicals interfere with hormonal messages involved in the reproductive cycle. 

2. Lower your inflammation levels

Chronic inflammation has been correlated to depressive symptoms and chronic stress. Moreover, recent research at UC Davis found that women who suffer from 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, limiting stress, and exercising. 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 have found the product below to be very helpful for my personal use, not only to aid in premenstrual symptoms but also to aid (on a side note) in my knee joint pain (I suffer from a running addiction).

3. 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.

4. Are oral supplements effective?

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:

5. What about non-invasive brain stimulation for treating my PMDD/PMS?

Given that depressive symptoms and anxiety are a hallmark of PMS and PMDD, targeting these symptoms alone are enough to relieve much suffering from those with PMS/PMDD. Non-invasive devices using low current electricity applied to the brain, known as non-invasive brain stimulation or transcranial direct current stimulation (tDCS), have been shown to be effective in treating depressive symptoms, and also shows promising results for anxiety, insomnia, pain, as well as other neurological and psychiatric symptoms (What is tDCS?). The mechanism behind tDCS is thought to involve electrical manipulation and modulation of the neural circuitry involved in mood. Treatment is painless, safe and relatively rapid. If you are interested in using a tDCS device, check out my post on the best tDCS devices of 2017.

 

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.