Premenstrual Dysphoric Disorder (PMDD) is an extreme form of premenstrual syndrome (PMS). So consider what is typically associated with PMS; mood swings, irritability, bloating, pain, cravings, headaches and generally feeling unwell.

With PMDD expand these symptoms into 1,2 and even 3 weeks prior to menstruation and multiply them by 2 to 10x the severity. Then you have an understanding of what constitutes PMDD. Its extreme and its life destroying.

The general population have often not even heard of PMDD and even close people to a sufferer of PMDD struggle with understanding the condition. This is of course assuming it has actually been diagnosed which is often not the case.

So its complicated, its difficult to treat and the causes are misunderstood in the mainstream medical system. Honestly it’s a huge problem and women who have PMDD need a lot of support and guidance to overcome this debilitating condition.


Psychological symptoms
Lack of control
Difficulty in concentrating
Severe fatigue
Poor  self-image
Emotional sensitivity
Crying spells
Trouble sleeping

Fluid retention
Swelling of the ankles, hands, and feet
Periodic weight gain
Diminished urine output
Breast fullness and pain

Respiratory problems
Eye complaints
Vision changes
Eye infection

Gastrointestinal symptoms
Abdominal cramps
Pelvic heaviness or pressure

Skin problems
Skin inflammation with itching
Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms
Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs
Easy bruising
Heart palpitations
Muscle spasms

Decreased coordination
Painful menstruation
Diminished sex drive
Appetite changes
Food cravings
Hot flashes

So PMDD is extreme and it is diagnosed not through a blood or saliva test but simply through presentation of symptoms that are severe and last across the cycle.


There is no proven cause of PMDD and it’s a controversial topic among doctors and suffers as to what really causes the symptoms of PMS to become so severe and spread across the cycle. According to my experience treating PMDD clinically several common threads tend to show.

Firstly and in all cases of PMDD I have observed there is a history of hormonal issues from a young age. This indicates that from the beginning of their reproductive cycle these women have difficulties metabolizing sex hormones.

The surge in hormone levels during teenage years can be very challenging. The most common form of treatment for these girls is the contraceptive pill which in most cases makes things worse because of course you already have difficulty metabolising hormones.
A whole range of other treatments mostly based around hormones are suggested as treatments until eventually surgery is the only option. In between a range of anti depressants will be prescribed and often secondary conditions develop such as endometriosis and polycystic ovarian syndrome.

Now to dig a little deeper into why these women have difficulty metabolizing hormones, its not just genetics, although it’s a common predisposition. The bowels ability to clear oestrogens in particular is of key importance. When the bowels are not regular there is a secondary absorption into the blood stream so especially when additional synthetic hormones are added to the system the emotional symptoms just get exacerbated.

Healthy bowel function is controlled by the diet consumed and the bacterial balance in the GUT. So a diet high in processed foods and a history of antibiotics can be predisposing factors to PMDD.

The other aspect that signals a close relationship with the GUT and PMDD is that 90% of the bodies serotonin levels are produced in the GUT. It is postulated that depression and mood disorders are associated with low serotonin levels and one of the conventional treatments is SSRI antidepressants.

Secondary to this philosophy is the livers ability to conjugate(breakdown) hormones. If the liver is not working well then hormones are excreted into the bowels and again if the bowels are not clearing then this multiplying effect of the hormones occurs.

The final piece to this puzzle lies in the brain in the hypothalamus and pituitary axis HPA which controls hormone levels. This centre in the brain is affected by the poor metabolism of hormones and elevated circulating hormone levels. This causes the body to reduce its own internal production. A confusion is created in the HPA and hormone levels shift too frequently and eventually cause the long range symptoms of PMS that becomes PMDD.

Other factors that contribute to PMDD is a diet high in sugar, wheat and dairy which create minor allergic reactions leading to adrenal exhaustion along with stress levels causing elevated cortisol which further disrupts the HPA axis.


Conventional treatments are largely palliative and manage symptoms. There are no real effective treatment option leaving choices from pain killers and antidepressants.

Our solution to the issue is to deal with the core HPA imbalance in the brain by attempting to balance the centre with proven herbal medicines such as Sage, Black Cohosh and Vitex. Without this intervention rarely do you see improvement in the condition. The key is the combination of these three herbal medicines. Taking them singularly often is not effective.

Then it is important to stimulate the liver function via specific amino acids and herbal medicines such as dandelion, milk thistle, methionine and carnitine. Hormone metabolism is then improved. Improving digestive regularity assists the excretion of hormones and the use of fermented drinks and foods helps to rebalance the natural GUT ecology to assist to improve serotonin levels and natural hormone breakdown in the GUT.

Finally, a healthy lifestyle must be adhered to during the recovery phase which can take up to a year. So a diet high in antioxidant foods, alkaline foods and low in processed foods is critical. Out 8 week program gets women started on the right course to eating well. Exercise is also very important and our plyocentric exercises are excellent to improve blood circulation to the pelvic region and manage the physical symptoms of PMDD.

Premenstrual Dysphoric Disorder is not a life’s sentence. There are very real treatment options but it takes a partnership between natural medicines, diet and lifestyle. Then real changes can occur. For an inspiration story of recovery from PMDD click here.

About Jeff Butterworth:

Jeff Butterworth B.App. Sc, N.D is a Naturopath with over 20 years experience specialising in treating hormonal disorders. Jeff developed the Happy Hormones program after discovering a unique way of treating hormonal disorders - by focusing on endocrine balance rather than hormonal levels - which gives long-lasting and dramatic results.