Confusion City

This post was completely updated September 23, 2015

One of the main problems I find in researching PMDD is that every woman’s hormones fluctuate daily in concert with her menstrual cycle, so it’s hard to separate what’s caused by normal female hormonal fluctuations and what’s caused by PMS or PMDD. To be clear: PMS and PMDD are not the same. PMDD is *not* PMS on steroids, although it can feel like it when you’re having an episode.

There is a definite brain component to PMDD that is not present in PMS. PMS mostly deals with physical symptoms (aches, pains, tenderness, cramps, bloating, etc.), with some minor mood fluctuations…a little irritability, a lack of energy or motivation, some weepiness, maybe more anxiety than usual.

PMDD ratchets these symptoms up a few hundred notches, to the point that these mood disturbances affect your ability to function and maintain stable relationships.

A lot of books and websites discuss the more mild symptoms of PMS, and then simply transfer the same thoughts and theories to PMDD. A lot of these sources even call PMDD a more severe version of PMS. This is not true. They are two separate conditions that unfortunately have enough in common to confuse everybody. But in the end, they take two different paths.

However, since they are often treated as similar, even interchangeable, by many media, for years I thought I had PMS, and couldn’t figure out why—if more than 80% of all women experience some form of PMS—why couldn’t I cope like everyone else did?

Because it wasn’t the same thing, and I didn’t know that.

So, while PMS affects (mostly) your body and (mildly) your mind on more or less a regular cycle, with more or less the same cluster of mind/body symptoms each month (specific to you as an individual), PMDD affects your brain’s ability to regulate itself, and therefore affects just about every other hormone in your body, too.

This is why you often feel as if something or someone else has taken over your body. You think one thing, and something totally different comes out of your mouth. You think you’re eating right, getting enough sleep and exercise, and suddenly one day you have no energy and your body simply won’t cooperate. There’s a missed connection there, and while it’s not “all in your head,” as many friends, relatives, co-workers, and even medical personnel would have you believe, it is happening in your brain.

So what are some of these hormones, and what do they do?

Here (in alphabetic order) are the ones most likely to affect your levels of PMDD.

Aldosterone – Never heard of it? Doesn’t matter. It still contributes to excess water weight gain when your progesterone levels are high, like in the second half of your menstrual cycle, when you feel all fat and bloated. Now you know (in part) why you get that way, and why (short of diuretics) there’s really nothing you can do about it but avoid salt, celebrate the fact that you’re a woman, and know that this, too, shall pass…

Androgens (DHEA and others) – When levels of these are too high they enhance your sex drive and aggressive tendencies, produce unwanted facial hair and apple vs. pear-shaped bodies in women, stimulate your appetite and contribute to waistline weight gain.

Cortisol – This affects your metabolism and tells your body to store more (more! more!) body fat, and is produced in even higher amounts under stress. (Remember, a woman with PMDD is more sensitive to stress to start with, so don’t be surprised if your levels are off the charts.)

Think about this: Our bodies have not changed much biologically since prehistoric times, and so are designed to respond to stress in a certain way that back then was perfectly normal and balanced. But stress back then might be due to a natural disaster, imminent death or starvation, attack by a wild animal, or, in later times, attack from a warring tribe.

Now our stress comes from sources like electronic devices, over-commitment, dashed hopes and unmet expectations, financial strain, unsafe drivers, emotional upsets, and major life changes like birth, death, marriage, divorce, surgery, change in employment or living location, to name just a few.

But our bodies still react in the same way they did in prehistoric times to these threats and upsets—as if we were literally under physical attack.

So up goes your cortisol, which, among other things, suppresses your normal immune functions, leaving you susceptible to every cold and flu that comes your way. In time your body can get so run down that you develop something serious, even terminal.

The Estrogens – Estradiol, Estrone, and Estriol These three wonder hormones are involved in over 400 crucial functions throughout your body and brain, including your metabolism, moods, body heat regulation, insulin sensitivity, pain levels (think muscle and joint pain, and headaches), and carbohydrate tolerance. Both too much and too little estrogen are bad for you, in ways too numerous to go into here. But know this—you have estrogen receptors in your brain, bladder, bones, muscles, blood vessels, skin, breasts, uterus, eyes, heart, and colon. It’s not just about sex anymore.  With all those receptors, you can easily take in too much estrogen—or, more appropriately, too much of the WRONG kind of estrogen (aka xenoestrogens).

Insulin – Lowers your blood sugar, stimulates fat storage.

Melatonin – Regulates your sleep cycles and body rhythms, promotes fat storage for hibernation (remember those cave dwellers) and increases your appetite for carbs. Melatonin also plays a role in Seasonal Affective Disorder (SAD) syndromes that affect your energy levels, weight gain, daytime sleepiness, and depressed moods.

Norepinephrine and Epinephrine – aka your Adrenaline Hormones. These govern your “fight or flight” responses. They increase your heart rate, lift your mood (or in excess cause anxiety), increase alertness, and dilate your arteries to provide more oxygen, glucose, and nutrients to your key organs in times of distress.

Remember what I said about how our bodies were initially designed to respond to threats and the differences between threats then and threats now? Some of us are living in a nearly constant state of fight or flight simply due to the lifestyles we live. But on top of that, when a woman enters her PMDD zone, her fight or flight switch comes on, but because of some missed connection in the brain—it does not shut off. 

Until her period comes.  That can last up to three weeks in the worst cases. 

Being trapped in that fight or flight state is exhausting, to say the least. You know how you feel when you're exhausted...apply that to a woman with PMDD ten-fold and you may begin to understand her emotional instability during her episodes. 

Progesterone – The jury is still out on this one. Some sources say too much progesterone can increase your appetite, increase fat storage, reduce insulin sensitivity, make you sleepy, depressed, and depress your sex drive.  Fatigue, breast tenderness, bloating, and vaginal dryness are also symptoms.  Other sources say too little progesterone can cause many of these same symptoms—in addition to anxiety attacks, insomnia, dizziness, irritability, difficulty concentrating, extreme changes in mood, muscle pain, joint pain, and urinary incontinence.

Who to believe?  All I know is progesterone supplementation is something that needs to be fine-tuned over the course of your cycle    .  I have found that, much like an upside-down U-curve, there seems—for me—to be a sort of sweet spot at the top of the curve; too little progesterone creates symptoms, too much progesterone creates symptoms.  The dosage needed can vary daily.  I have to constantly adjust and readjust my progesterone intake, using supplementation and nutrition.

So be wary of progesterone creams, especially over-the-counter brands.  Depending on what else is in them, you can get too much, too little, or none at all.  They are not regulated.  Other ingredients in the creams can also clog your pores and provide added fake estrogens if you do not read the label carefully.  Only a precious few progesterone creams perform the way they are intended to.  I use a cream when symptoms are particularly bad, but for the most part I take a 100 mg capsule of micronized progesterone daily, and double that on symptomatic days.  If you would like to know which brands I use, contact me directly. (info (at) livingwithpmdd (dot) com.)

Testosterone – It’s not just for guys. Too little testosterone can negatively affect your bone and muscle growth, metabolism, mood, energy level, and sex drive.

Thymosin – This little-known hormone plays a major role in the development of your immune system. Be good to it or be betrayed by it.

Thyroid – Affects your metabolism, nervous system, muscles and bones, energy levels, heart rate, body heat production, and brain activity. (Hello? Brain activity? Remember this.)

Okay, now I’m no doctor, but if you take the major symptoms of PMDD and bump them up against these hormones, you’ll find that too much or too little of eight of them can lead to weight gain, five of them can cause problems with your metabolism, five of them can affect mood disorders, six can cause problems with your energy levels, two can make you anxious, two can make you aggressive, three affect your sex drive, two reduce insulin sensitivity, two affect sleep cycles, two can depress your immune system, and two can affect your brain function…which can affect all of the above.

Let’s break that down into something more understandable.

Imbalances (for lack of a better word) in the following can cause weight gain:
Androgens
Cortisol
Insulin
Melatonin
Progesterone
Testosterone
Thyroid
Aldosterone (water weight gain)

Imbalances in the following can cause metabolism problems:
Cortisol
Estrogen
Testosterone
Thyroid

Imbalances in the following can cause mood disturbances:
Estrogen
Progesterone
Melatonin
Testosterone
Thyroid

Imbalances in the following can cause your energy levels to plummet:
Estrogen
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Imbalances in the following can compromise your immune system:
Cortisol
Thymosin

Imbalances in the following can reduce insulin sensitivity:
Estrogen
Progesterone

Imbalances in the following can cause problems with brain function:
Estrogen
Thyroid

Or, to cross-match it another way…

DSM-V Symptoms of PMDD affected by hormone levels:

Markedly Depressed Mood (feelings of hopelessness, or self-deprecating thoughts)
Estrogen
Progesterone
Melatonin
Testosterone
Thyroid

Marked Anxiety, Tension, Feeling Keyed-up or On Edge
DHEA
Norepinephrine
Epinephrine
Thyroid

Marked Affective Lability (feeling suddenly sad or tearful or increased sensitivity to rejection)
Estrogen
Progesterone

Persistent and Marked Anger, Irritability, or Increased Interpersonal Conflicts
DHEA and other Androgens

Testosterone
Thyroid

Decreased Interest in Usual Activities (work, school, friends, hobbies)
Estrogen
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Subjective Sense of Difficulty in Concentrating
Estrogen
Progesterone

Testosterone
Thyroid

Lethargy, Easy Fatigability, Marked Lack of Energy
Estrogen
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Marked Change in Appetite, Overeating, or Specific Food Cravings
DHEA
Cortisol
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Hypersomnia or Insomnia
Estrogen
Melatonin
Thyroid

Subjective Sense of Feeling Overwhelmed or Out of Control
Estrogen
Progesterone

Thyroid

Physical Symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.
Aldosterone (water weight gain)
Estrogen
Progesterone
Cortisol
Insulin
Melatonin
Testosterone
Thyroid

Do you see where I’m going with this? You could have PMDD, or you could have some kind of hormonal excess or deficiency that is exacerbated pre-menstrually (called Pre-Menstrual Exacerbation). It might actually be an insulin problem, or a thyroid problem, an auto-immune system problem, and not PMDD at all. Some doctors have been making great strides with theories of inflammation. Your problem might be PMDD or it might be something entirely different.

The reason to get a diagnosis of PMDD is not to brand you with the PMDD label, but rather to rule out any other treatable causes for your symptoms.

Once you get that something else identified and dealt with, you might be left with only PMS to deal with.  And wouldn't that be wonderful?

The bottom line is only you and a caring, knowledgeable, and forward-thinking medical professional will be able to identify and separate the many connected hormonal threads in your body and figure out what's working right and what is not. 

You are a beautiful, complex system of individual ups and downs, highs and lows, checks and balances.  Don’t let medical professionals simply hand you prescriptions for one-size-fits-all blanket treatments and/or try to make you feel to blame or as if you are not trying hard enough when they don't work. 

And most of all, don't let anybody tell you you’re crazy.

Because the only things out of kilter here are your hormones.

Keep searching until you find the right practitioner and answers for YOU.