Modern Day Doctor | Ancient Wisdom

Natural Treatment for PMDD: How to Relieve Severe PMS Symptoms

Premenstrual dysphoric disorder (PMDD) affects countless females, disrupting their lives and causing severe emotional turmoil.

We often hear of PMS negatively impacting a woman’s life, however, individuals with PMDD suffer even more significantly due to the toll it takes on them physically, mentally, and emotionally.

If you don’t feel like yourself for the weeks leading up to your period, and have a profound shift in mood and systemic symptoms including pain and fatigue, then you may have PMDD and want to keep reading.

What if there were natural treatment options that could alleviate the distressing symptoms and improve quality of life?

In this blog post, we’ll explore natural alternatives from the perspective of a Naturopathic Doctor for PMDD relief, from dietary changes and supplements to mind-body techniques and more.

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  • PMDD is a severe hormone-based mood disorder that affects women for approximately 2-3 weeks of their menstrual cycle.
  • 1 in 3 women experience PMS
  • 1 in 12 women experience PMDD.
  • Natural interventions for PMDD include diet and lifestyle modifications including, supplements and herbal remedies, mind-body techniques, acupuncture, and more.
  • Take precautions when starting new herbal supplements for PMDD as there may be potential interactions with their medication. It is advised to consult with a medical professional before starting a new herbal supplement.

Premenstrual dysphoric disorder (PMDD) is a severe hormone-based mood disorder that affects an estimated 3-9% of women causing significant physical and emotional symptoms during the luteal phase of the menstrual cycle (days 14-28 of the menstrual cycle).

Individuals with PMDD have a reduced quality of life and lose 3 full years of their life.

Because symptoms of PMDD can occur for at least half the month and even longer, this takes a toll on an individual’s life in multiple ways. First, It affects their career and performance at work. Extreme fatigue, unstable moods, and pain can harm their productivity. They may have to call out of work sick, especially during their menstrual cycle and the days leading up to it. Supervisors may or may not understand and have compassion for women who are experiencing this.

What makes it even worse is that you may go to a doctor and be told “It’s in your head.” Getting dismissed by doctors adds to the mental anguish of this disorder. The Physician or OB-GYN often tells the patient that they do not need hormonal labs, or they may test and tell them that “their labs look normal” because they fall into lab ranges.  I talk about that HERE in my past Instagram Post.

As a Naturopathic Doctor, I often see my patients collecting hormonal labs on days of their cycle where the values are not as accurate to decipher hormonal imbalances.  Combine that with the fact that conventional doctors are not using ranges that are for optimal health, this leads the patient without support or answers.


PMDD is an extreme or heightened version of PMS.

To address premenstrual dysphoric disorder, it is essential to understand its differences from premenstrual syndrome (PMS).

PMDD as mentioned is much more severe and can considerably impact daily life. The key to differentiating between PMS and PMDD is the frequency, severity, and duration of the symptoms involved.

Common PMDD symptoms, which can also be considered premenstrual syndrome symptoms, include

Mood changes:

  • Anxiety
  • Depression
  • Suicidal thoughts
  • Apathy
  • Severe mood swings
  • Irritability
  • Hopelessness
  • Decreased interest in school, work, and social life

Systemic symptoms:

  • Extreme fatigue
  • Headaches
  • Difficulty concentrating
  • Insomnia
  • Joint pain
  • Muscle pain
  • Breast pain
  • Swelling
  • Cramps
  • Food cravings and appetite changes
  • Acne


There are underlying contributing factors in those diagnosed with PMDD, but no single cause is known. Below are common causes of PMDD in women:


1. Genetic sensitivity to progesterone and estrogen 

There is an abnormal reaction to the fluctuations in normal hormonal changes that take place during a woman’s monthly cycle. The cyclical nature of women’s hormones which have highs and lows throughout the month can trigger symptoms for these women. 

2. Decreased sensitivity to gamma-aminobutyric acid

(GABA) due to lower concentration of Allopregnanolone (ALLO) receptors during acute stress and their luteal cycle. 

This correlates specifically to these patients because they do feel their worst during the luteal phase. GABA is our inhibitory neurotransmitter that controls anxiety, stress, and fear. This hormone produces a calming effect on the mind. Since SSRIs make GABA receptors more sensitive, this is why so many women end up on Serotonin Reuptake inhibitors (SSRIs), but there are more natural alternatives available.

3. Estradiol-serotonin connection

When estrogen drops naturally in the cycle, there is a reduction in serotonin. PMDD individuals may already have a deficiency due to decreased production of this hormone, so this can compound the problem. Serotonin regulates our mood and is our “feel good” chemical. When produced at normal levels, you are emotionally stable, happier, and calmer.

4. Gut-hormone connection

Since hormones get metabolized in our digestive tract, it’s important to mention the gut-hormone connection. When someone has a leaky gut, also known as gut permeability, estrogen may re-circulate, instead of being removed via the bowel. We can see if this is the case when doing a functional stool analysis to test for a marker called β-Glucuronidase. When this enzyme is high, it can help us determine if we are recycling our estrogen, which is common when there is dysbiosis and a compromised microbiome. 

5. Vitamin and mineral deficiencies

B vitamins, calcium, and magnesium are common nutrient deficiencies in those with PMDD.

B vitamins are important as they are precursors for neurotransmitters. This is particularly important when it comes to stabilizing one’s mood.

Magnesium deficiency is incredibly common in our patient population. A study demonstrates that 24.1% of women with hormone-related conditions were deficient in magnesium. Maintaining proper magnesium status can help reduce the risk of depressive disorders and have fewer depressive symptoms.

6. Endocrine disruptors

Xenoestrogens can mimic our hormones. These are exogenous estrogens that our body does not make on its own and come from our outside environment. This will affect the delicate balance of our hormones and this is why hormone disruptors like BPA can have a significant impact.

7.  HPA axis dysfunction

Dysfunction between the brain and adrenal axis can cause alterations in mood. The HPA axis is the connection we have between our hypothalamus, pituitary, and adrenals and can have a significant impact on our sex hormones and stress hormones. 


Risk factors include individuals with a history of trauma, sexual abuse, and or high stress.

Because of the stress, trauma, and inflammation thereafter of stress hormones, these patients can have an altered Hypothalamic-pituitary-adrenal (HPA) axis. Inflammation becomes chronic and this further perpetuates mood disorders and hormone imbalances.

It is highly recommended that anyone with a history of trauma and or C-PTSD seek proper trauma counseling which includes somatic work, EMDR, Internal family systems, and DBT. Talking about trauma does not heal trauma and therefore it is pivotal to seek a professional trained in trauma.  


Other risk factors:

  •   Smoking cigarettes: The risk is higher for those who started smoking in adolescence. 
  •   Obesity: The risk for PMS increased when BMI >27 compared to <20. 
  •   Genetics: Variants of the ESR1 gene
  •   Past oral contraceptive pill: Post-pill alterations to the liver, thyroid, gut microbes, etc.


There is a criterion one must meet to be properly diagnosed with PMDD. This includes:

  • At least five physical, affective, and/or behavioral symptoms.


  • Symptoms are present for 5 days before their menstrual cycle and for at least 3 menstrual cycles in a row.


  • Symptom relief 4 days after a period initiates.


  • Decrease in quality of life due to significant distress it causes and interference with daily life.

It is important to note that other psychiatric disorders should be ruled out by a trained professional. 



While no test can help diagnose PMDD, we do recommend a whole-body holistic approach. This can include:


Comprehensive blood lab testing:

  • Full thyroid testing includes Ft3, Ft4, TSH, Rt3, and thyroid antibodies.


  • Vitamins and minerals include B12, folate, zinc, magnesium, calcium, iron, and more.


  • Blood sugar testing via fasting glucose, fasting insulin, and Hemoglobin A1c.


  • Hormones:

    • Estrogen, LH, and FSH should be done on Day 3 of the menstrual cycle if done through blood testing.


    • Progesterone: Day 21 of the menstrual cycle, or generally 1 week after ovulation if done through blood testing.

Specialty hormonal testing via the Dutch test

  • A comprehensive view of your sex hormones via urine testing.

  • A comprehensive view of adrenal hormones to see if the HPA axis is a culprit. Your cortisol (stress hormone) will be plotted on a graph morning, afternoon, evening, and night and you can see if your cortisol is high, low, a combination of both, or the opposite circadian rhythm pattern (low cortisol morning and high at night).

Specialty stool testing:

One place our hormones get metabolized is in our gastrointestinal tract. Therefore, it is important to get a close look at what’s going on in our gut that contributes to our hormonal health. Additionally, most of our neurotransmitters (feel-good chemicals) get produced in our digestive tract and therefore if looking to support mental health and mood, we can not neglect to look at the gut. 

  • This testing can show your commensal bacteria (think of these as your good guys) in your gut, as well as pancreatic enzyme function, secretory IgA levels (mucosal immunity in the gut), inflammation markersβ-Glucuronidase (to see if you are recycling estrogens contributing to hormonal symptoms), as well as candida, parasites, and bacteria.

It is ideal to rule out hormonal imbalances, nutrient deficiencies, thyroid disorders, cortisol excess or deficiency, and gut dysbiosis if looking for a true holistic approach to your hormones.


Now that you have a background on the disorder, its causes, risk factors, and symptoms, you are probably eager to learn what natural intervention can be done to help you feel better and regain the quality of your life. The below have been incredibly helpful for my patients in supporting their physical and mental symptoms from PMS and PMDD.

Dietary Changes and Supplements;
Vitamins and Minerals 

  • Omega-3 Fatty Acids

    Food for the brain as I like to call them!
    Omega-3 fatty acids have a significant effect on the brain and mood disorders. They have helped help increase focus and help with anxiety and depression. They have a positive effect on the gut microbiome and can reduce inflammation which can help with menstrual pain.

    Food sources: Sardines, hemp seeds, chia seeds, wild salmon.


  • Vitamin B6


    Supports a calm mood and proper production of progesterone. Aim for the P-5-P source of B6 in supplement form. Can consider 50-100 mg.

    Food sources: dark leafy greens, bananas, oranges, cantaloupe, beef liver, tuna, chickpeas, chicken.

  • Calcium


    The Mayo Clinic speaks on using calcium in combination with magnesium, vitamin E, vitamin B6, and Tryptophan to help with PMDD, as well as PMS.

    Food sources: Chia, almond, dried figs, sunflower, broccoli rabe, kale, sesame seeds, broccoli, sweet potatoes, butternut squash, arugula, and beans.

    Dairy may aggravate women with hormonal concerns and therefore you mustn’t need to depend on dairy for calcium.

    Aim for 1200 mg of calcium between your supplements and diet.

  • Magnesium

    The relaxation mineral. This can help with anxiety, depression, calm mood, blood sugar, energy, hormones, menstrual cramps and more! The therapeutic dose is 600 mg-800 mg, however, some women may benefit from lower amounts at 3-600mg. My favorite is magnesium glycinate.

  •   Vitamin E

    A fat-soluble antioxidant supportive for hormones that can help reduce prostaglandins which can help reduce menstrual cramps. Nuts and seeds are great sources and the  Beeya seed cycling kits can help to support hormones and provide a source of vitamin E.

Magnesium and omega-3- 3 can be found in my Basic Supplement Starter Kit.


  • Chasteberry (Vitex Agnus castus)
  • Evening primrose oil
  • DIM (do not take DIM unless you know you are estrogen-dominant)
  • Rhodiola
  • Probiotics
  • Gingko (caution with high blood pressure medications)
  • St. John’s wort (contraindicated if on SSRIs)
  • Inositol


Definitely not! Start with working on your diet to incorporate nutrients with these foods and if you want to DIY, can introduce supplements one by one into your routine. If you want to meet your overall foundational nutrient needs, I do recommend starting with the basic supplement starter pack if you are interested in doing it yourself at first.

It’s important to seek advice from a healthcare professional or a certified herbalist before starting any supplement regimen, due to potential interactions with medications or other supplements.

We are here to help and you can make a free 10-minute consultation to see if we are a good fit to help you relieve symptoms of PMS and PMDD. 


Every meal must include protein, fat & fiber

  • Protein: can come from a mix of animal protein (grass-fed beef, chicken, turkey, wild fish/seafood, lamb) and plant protein (nuts, seeds, hemp, and chia). Ideally, we need to get about 100 grams of protein in our diet a day.

  • Healthy fats: include avocados, nuts, seeds, olive, and coconut oil. Fat is satiating and helps keep us fuller for longer.

  • Fiber: This is your veggie; ideally, experts recommend 6-8 cups daily to support hormones. The cruciferous veggies help with estrogen metabolism, and therefore if your digestion allows it, make sure to favor broccoli, Brussels sprouts, and cabbage.


  • Caffeine can increase anxiety and those with PMDD are already experiencing a level of anxiety and agitation. Caffeine can negatively impact sleep, which is crucial for keeping hormones balanced and your mood stable. Caffeine can increase breast tenderness around your cycle. Matcha is a good alternative with less caffeine if you are trying to come off of coffee. Matcha is beneficial for your gut microbiome, can promote a sense of calm due to its L-theanine content, and helps with focused energy. Matcha may still have too much caffeine for some who are very anxious, so as always, listen to your body!

  • A diet rich in sugar and processed and refined carbohydrates: Remember, blood sugar has a large impact on your mood, and those with PMDD are already having ups and downs. What comes up must come down and if your blood sugar elevates with refined carbohydrates and sugar, the blood sugar has to come down and that is when you feel a crash in mood and energy. Favor foods with a low glycemic index that do not raise blood sugar levels and eat meals with fiber and fat to help stabilize your blood glucose levels.

  • Endocrine-disrupting chemicals: These chemicals mimic our endogenous hormones and can create hormonal havoc. Use the Skin Deep website by EWG to help rate your personal care products and switch to safer and less toxic versions.

  • Sedentary lifestyle: If you are exhausted, stretch, walk, or do a low-intensity yoga video or class.

  • Sleep deprivation: Adequate sleep will help with hormonal balance, gut health, energy, and mood.


As discussed above, it is imperative to avoid toxic chemicals not only that we apply to our skin, but also what we use during our menstrual cycle. Swapping conventional products to organic tampons, and pads, or even trying a menstrual cup may help PMDD.


The use of Aromatherapy and essential oils is a hot topic in the holistic world. You can enjoy the benefits of oils by either diffusing them, applying them to your skin (with a carrier oil to avoid skin irritation and safe application), or putting them into a warm bathtub.

Some helpful oils are lavender, chamomile, and ylang-ylang for those with PMDD. Lavender essential oil specifically may help decrease anxiety levels and enhance sleep quality for those with PMDD.


Integrating some mind-body therapies will benefit individuals with PMDD.

Meditations, deep breathing exercises, and yoga can be something enjoyable you can add to your routine. The goal is to lower stress and help ease anxiety levels. At least 10 minutes a day should be done, ideally morning and evening to set yourself up for your day and also wind yourself down for a restorative night’s sleep. Start slow with smaller amounts to set yourself up with an achievable goal and work your way up from there. If you have a lot of mind chatter, you can do guided meditations.

Also, consider cognitive behavioral therapy or Dialectical behavioral therapy if you feel you need more support. Additionally, EMDR and somatic work if there is a trauma history as mentioned earlier in the article. 


Acupuncture is a traditional Chinese medicine technique, that involves inserting thin needles into specific points on the body to stimulate the flow of energy and promote healing. This stress-relieving treatment can support hormone balance and patients often report that after acupuncture they feel much less stressed, more relaxed, and less anxious. All favorable outcomes with someone with PMDD.

Another alternative therapy, acupressure, is also something someone can do to themselves in the comfort of their own home with points that their acupuncturist shares that may be beneficial for their mental and physical symptoms.


Consulting with Naturopathic doctors at our practice will provide you with the following:

  • A complementary and integrative approach to your health
  • Advice on herbal medicine
  • Tailored health plans
  • A comprehensive approach to health via lab and specialty testing
  • Alternative solutions when conventional treatments are not successful
  • Understanding of the mind-body connection

Our practitioners have expertise in natural intervention for hormonal conditions, including PMS and PMDD. You can book your free 10-minute consultation and see if it fits you well.

Precautions and Potential Interactions

As mentioned, always talk to a qualified healthcare professional before starting any herbal remedies or vitamins if you are currently being prescribed pharmaceutical medicines.

Keep in mind, that natural treatments should supplement, not replace, medical advice or prescribed treatments.


In conclusion, there is hope for individuals suffering from PMS and PMDD. There are many different lifestyle modifications, lab testing, supplements, and stress management techniques that can truly increase the quality of their life.


A 25-year-old female patient in my virtual practice reported significant improvement of her PMDD where she did not have significant depression and mood changes as she normally did 2 weeks leading to her cycle. We did a whole-body approach ordered proper lab testing and worked together to support her in every aspect of her health. The patient reported having some PMS symptoms a week leading to the period, but nothing debilitating. Her headaches improved as well! One of the largest contributors she felt was the omega-3 fatty acids. She reported the most change with that addition to her care plan. 


What vitamin deficiency causes PMDD?

A deficiency in vitamin B6 can be a possible cause of PMDD.

What vitamin helps with PMDD?

Magnesium glycinate, Vitamin B6 (preferably the P-5-P form), Vitamin E, and Calcium can support an individual with PMDD.

How do I get rid of PMDD permanently?

Making a concerted effort to change your lifestyle is key. Sleep hygiene, nutrient-dense meals, stress management, proper lab testing, physical activity, mental health support, and eliminating endocrine-disrupting chemicals are pivotal to help improve PMDD.

What is the difference between PMS and PMDD?

PMS and PMDD are similar in that they share similar physical and mental symptoms, however, PMDD is a severe form of PMS that affects women for at least 2 weeks of the month and reduces their quality of life greatly.  


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