PMDD Treatment Strategies—8 Effective Approaches For My Own Premenstrual Dysphoric Disorder Journey

There is hope for healing from Premenstrual Dysphoric Disorder (PMDD).

By: Julie Sarton, PT, DPT, WCS

As a pelvic floor physical therapist, I have learned that healing any condition is multi-modal.

In other words, healing involves integrating various avenues of treatment & different professionals. I have always told my patients that the magic happens when all the pieces of the puzzle fall into place. For me, PMDD (Premenstrual Dysphoric Disorder) was no different.

Up to this point, we have addressed the who of PMDD, the what of PMDD, and today we’re going to uncover the how.

While everyone’s journey is unique, my puzzle pieces have looked a little something like this:

1. Flouxetine

After finally getting a diagnosis, I was started on an antidepressant called Flouxetine (Prozac). This antidepressant helps prevent the reuptake of serotonin on the brain level. Studies support the efficacy of this treatment with PMDD; so, despite the stigma surrounding this, I started taking it 7-10 days before my period. This was the first shift for me. While I was so grateful it helped, I knew I had to dig deeper. Serotonin levels are lower in women with PMDD so I wanted to attack this from other angles, preventing dependence on this medication with the goal of eventually getting off of it completely.

2. Stress reduction & mindfulness

Chronic stress changes cortisol, which influences serotonin levels. I knew it was time to go after the mind-body connection more than ever before. After a decade of chronic stress, I started working with 2 practitioners that have helped me enormously - a guided imagery therapist and a DO (Doctor of Osteopathic Medicine), who specializes in helping people achieve transformational change through an eclectic approach. Through these two avenues, I have experienced new neuronal firing patterns on the brain, the development of daily healthy practices, integration of mindfulness based cognitive therapy & various mind/emotion/stress management skills. This has been huge in helping me through my PMDD journey.

3. Diet

To further influence serotonin and inflammatory levels, I had to go after my diet & heal my gut. This is an ongoing process, and a hard one for me as I love food that isn't necessarily good for me. Truth be told, I tend to do great for awhile and then fall off the wagon. When I get this piece consistently dialed in, however, my bloating, GI upset and period pain are so much better! Specific changes I have made include going gluten free, adding good healthy fats into my diet, eliminating inflammatory foods and eating on a different schedule (intermittent fasting). All of this in turn has helped with blood sugar regulation preventing blood sugar crashes that I use to have as a hypoglycemic causing fatigue, brain fog and being “hangry”.

4. Supplements

After lab testing and learning that I was low in several key areas, I have supplemented my personalized treatment plan with the following: high dose fish oil to increase omega 3 levels (has helped my period pain greatly!!), vitamin D with K, L methyl folate, methylcobalamin, adrenal support with adaptogens, magnesium & other liver detox supplements.

5. Detox

One word: methylation. If you haven't been tested to see if you are compromised with methylation, then I highly recommend you do. This requires genetic testing. I am what is known as MTHFR positive, which means I do not detox as well as others. This plays a role in inflammation, toxin load and pain. It’s a complicated topic & I plan to address more of this in a future post. Doing routine liver cleanses have certainly helped me with this, along with specific supplements mentioned above. Please note that estrogen is broken down through the liver. If this organ isn’t healthy (i.e. is sluggish & overloaded), then this process can become impaired and you can be estrogen dominant (like me!) or even estrogen toxic.

6. Pacing

Physically & energetically. I had to learn specific strategies to pace on both of these levels. Stay tuned for an upcoming post on how to do this energetically and refer back to our prior post on how to do this physically.

7. Hormone balancing with a naturopathic doctor

I am now peri-menopausal, which has added another twist to my PMDD. Hormones rule our world and finding a balance with hormones has and continues to be a challenge for me. I am not just looking at levels, but also metabolites of both estrogen and progesterone.

8. Pelvic Floor Physical Therapy

At one point, my period pain was so severe that I would vomit if I didn’t get medication into my system in time. Thanks to pelvic physical therapy, this no longer is the case. I am fortunate to have the knowledge base to be able to treat myself; however, my preference is to get on the table routinely with one of my amazing physical therapists in my clinic. I try to coordinate this each month, occurring between ovulation and menstruation. My treatment involves both external and internal manual therapy which is magical when it comes to the physical symptoms of PMDD and/or period pain. If you haven’t seen a pelvic floor physical therapist, this is a must even if your period pain isn't associated with PMDD.

Click to read more about Julie’s journey with PMDD.

The Good News

If you can dig deeper into the presentations and treatment strategies listed above, know that like me, you can significantly improve your experience in the days leading up to your period. You are not alone. Please contact us to learn more.

We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment for 1 of our 3 Southern California locations, or inquire about a virtual, online treatment session.

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