The weeks before your period are never an easy time in your cycle, with hormonal fluctuations often causing symptoms of premenstrual syndrome (more commonly referred to as PMS). But what if your symptoms are more accurately described as severe PMS? Do you find that you’re experiencing more extreme mood swings, feelings of hopelessness, fatigue, difficulty concentrating, and maybe even severe bloating and decreased appetite? If any of this sounds familiar, you may actually be experiencing PMDD symptoms.
The great news here is that PMDD can be improved with natural remedies you can incorporate at home. You can feel like yourself again and take control of your cycles—all you need are the right tools. So, let’s talk all about PMDD: what it is, how it’s diagnosed, and what you can do about it!
If you’re a woman of reproductive age, chances are pretty high that you’re familiar with PMS, or premenstrual syndrome.
In fact, about 70 to 90 percent of menstruating women in the U.S. have at least some premenstrual symptoms, such as the physical symptoms of bloating, fatigue, breast tenderness, cramping, and backache. Thirty percent of this group meets the requirements for PMS. And of that 30 percent, about 3 percent to 8 percent have symptoms of PMS that are debilitating enough for a diagnosis of PMDD. 
PMDD stands for “premenstrual dysphoric disorder.” Premenstrual dysphoric disorder symptoms are more extreme than “regular” PMS and include a combination of physical (somatic), behavioral, and mood symptoms.
The emotional and psychological symptoms are key to a diagnosis of PMDD. In fact, PMDD is technically considered a type of mental health or mood disorder and is included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), the manual used by psychiatrists and healthcare professionals to diagnose patients. 
So, how do you tell the difference between “regular” PMS and PMDD? There is no blood test—and, in many ways, it’s subjective. However, there are important diagnostic distinctions made between PMS and PMDD. First, let’s take a closer look at the causes of PMS and PMDD.
Researchers continue to work on unraveling the particular cause(s) behind PMS and PMDD. The general understanding is that there is a connection between a woman’s hormonal balance and whether or not she experiences PMS or PMDD.
Many factors can impact hormone balance, including: stress, diet, lifestyle, medications, hydration, and genetics. With numerous factors at play, I’ve found that it can be difficult to pinpoint the actual cause because each woman is so different from the next.
I’ve also discovered that many women who struggle with PMS and PMDD often have a hormonal imbalance between estrogen and progesterone. This means that levels of estrogen are out of balance with progesterone—and, oftentimes, this is due to higher levels of estrogen, known as estrogen dominance.
Many other health conditions are also related to estrogen dominance, such as PCOS, heavy menstrual cycles, headaches, ovarian cysts, and mood changes. PMS and PMDD can also occur when both levels of hormones are too high, perhaps from a sluggish liver.
You may be surprised to learn that all hormones must move through the liver to be removed from the body. Often, during the week before your cycle, your bowels slow, making liver detoxification a bit slower as well. When you add any external stress, or adrenal fatigue, to this scenario, you wind up with higher-than-usual hormone levels. As you may know, this can make you feel quite irritable and possibly even depressed.
While more research is needed to better understand the causes of PMDD, researchers have found a few key potential links between PMDD and an imbalance in neurotransmitters (your body’s “chemical messengers”). [3, 4]
The difference between women who struggle with PMS and those who suffer from PMDD has been linked to a potential imbalance in neurotransmitters among women with PMDD.
This neurotransmitter imbalance appears to cause heightened nervous system sensitivity and more severe mood swings and emotional disturbances during the menstrual cycle. Why? Neurotransmitters control how you feel. Each neurotransmitter is delicately balanced by another to help keep you feeling “even-keeled.” Serotonin and dopamine are two opposite neurotransmitters. So, if serotonin levels are low, dopamine will be higher.
How does this impact PMS and PMDD? If you are in primary stages of adrenal fatigue (i.e., in a constant or fluctuating “fight-or-flight” state), you will feel more anxious, experience insomnia, struggle with digestive difficulties, have possible heart palpitations, and may even experience feelings of fear, agitation, and anger. These are due to having excess epinephrine and norepinephrine and lower levels of the calming neurotransmitter GABA.
It’s a mistake to treat these systems independently, rather than holistically, as all of your hormones and neurotransmitters rely on each other for balance. And guess what? If you are out of balance, you will feel unstable and imbalanced as well.
There are a number of possible signs of PMDD, ranging from physical to emotional and behavioral symptoms.
Some PMDD symptoms are very similar to other conditions, such as thyroid disorders, mood disorders, or gastrointestinal conditions. Because of this, it’s important to see your healthcare practitioner to rule out other health conditions that might be worsening your PMDD symptoms.
Here are some common PMDD symptoms, divided into physical and psychological symptoms: 
If you’re experiencing several of these symptoms and you find that your menstrual cycle is an ordeal, you may want to see your doctor to discuss your symptoms. Visiting your doctor can also help you rule out any other possible causes.
PMDD is a syndrome, meaning diagnosis relies on identifying a collection of varying symptoms. Therefore, it can be highly subjective and difficult to pinpoint.
Traditionally, in order to make a diagnosis of PMDD, certain severe PMS symptoms must be present and other criteria must be met. It has to be clear that there is a connection between a woman’s symptoms and her menstrual cycle, rather than another health condition or as the result of drugs or medications.
Finally, five of the following symptoms must be present during the last week before a woman’s period begins and they must improve once her cycle begins. 
One or more of the following symptoms must be present:
One or more of the following symptoms must also be present:
Symptoms must also be severe enough to cause significant disruption in relationships, home, work, social, or school activities.
Typically, many doctors will treat PMDD symptoms by prescribing birth control pills for PMDD and anti-inflammatory medications. Other PMDD medication recommendations may include prescribing antidepressants such as Prozac for PMDD or other selective serotonin reuptake inhibitors (SSRIs). Naturopathic and integrative practitioners tend to seek the cause of the imbalance before prescribing medications that may promote more stress and toxicity in your body. Lifestyle, diet, and holistic evaluations of the entire endocrine system are key to finding the cause of your symptoms and eliminating the source.
Now that you have a better understanding of PMS vs. PMDD, you may be wondering what you can do at home to ease the symptoms. Luckily, there are a variety of options for treating PMS symptoms and helping to relieve PMDD symptoms with natural remedies. (Note: Before trying any of the specific herbs mentioned below, it’s important to identify the specific cause of your PMS and PMDD symptoms.)
Research has shown that breathing in the soothing scents of some essential oils—especially lavender oil—can help to calm the parasympathetic nervous system. This calming effect promotes relaxation in women experiencing PMS. [8, 9]
Used as a remedy for PMS and other female hormonal imbalances for centuries, chasteberry is the fruit of the chaste tree. It helps to relieve breast tenderness and other discomfort caused by PMS. 
Chemical compounds in this herbal remedy help to decrease muscle cramping. It is often used to help relieve menstrual cramps, hence its name. 
Also known as the “female ginseng,” dong quai is a traditional Chinese medicine (TCM) remedy that has been used for thousands of years to help alleviate pain and discomfort caused by PMS and painful periods and to help regulate irregular periods. 
Researchers have found that ginger has prostaglandin inhibitors and anti-inflammatory properties, which help to reduce pain and muscle cramps. Ginger is also known to help relieve nausea. 
St. John’s wort can be an effective treatment for mild to moderate depressive symptoms in women diagnosed with PMS and PMDD. 
Research has shown that supplementing with magnesium may help to reduce mild PMS symptoms such as bloating, mood changes, and even muscle aches. 
Combining magnesium with vitamin B6 has been shown to help reduce PMS symptoms.  While more research is still needed, another study showed that consuming high amounts of the B vitamins thiamine and riboflavin from food sources can help to reduce PMS symptoms.  Make sure you are getting your B vitamins, either from food sources or through supplementation.
It is also important to choose the correct B vitamin for proper absorption. I highly recommend taking a B vitamin complex that is full of activated, methylated vitamins. Why? Many sufferers of PMS and PMDD also have a genetic mutation called MTHFR, which inhibits proper methylation—impacting hormone and toxin metabolism and removal. In addition, if your body is under stress, you will not absorb nutrients as well from your food—and B vitamin deficiency is linked to hormone imbalances.
Studies show that getting enough vitamin D and calcium can help to reduce PMS symptoms. [18, 19] These two micronutrients work together: Calcium helps the body to build bones, and vitamin D helps the body to absorb enough calcium. Calcium supplementation alone is not enough, though. Vitamin D levels should also be evaluated and addressed to keep these key nutrients in balance!
Spending a little time outside in the sun each day is a good way to make sure you get enough vitamin D. If you’re not able to get outside regularly, be sure to take a vitamin D3 supplement if your blood tests show a deficiency.
Applying a heating pad to the abdomen or lower back can help to alleviate cramping and backache associated with PMS and PMDD. [20, 21] You can also try sitting in a warm bath, particularly an Epsom salt bath.
Epsom salt is also known as magnesium sulfate. Although studies have not proven it, it’s thought that the magnesium helps to relax the muscles. If nothing else, a soak in a warm bath is a calming way to unwind and improve your mood. 
Stretching and engaging in low-impact, mindful exercise can help to alleviate muscle cramps and stress, and by extension help to promote relaxation and improved mood. 
A PMDD diet essentially means replacing culprits such as sugar and processed and packaged foods with healthier choices.
Incorporate important vitamins and minerals into your diet to help alleviate PMS and PMDD symptoms. Examples include almonds, avocado, bananas, wild-caught Pacific salmon, and dark, leafy greens.
Reducing alcohol and caffeine intake will also help to relieve PMS symptoms.
In general, eating a plant-based diet can do wonders for your overall health!