Nutrition to support PMDD
Premenstrual dysphoric disorder (PMDD) can have a real impact on daily life, relationships and wellbeing. Medical care is central to managing PMDD, and nutrition may be a helpful part of the bigger picture. Here is what the research shows so far, and some simple places to start.
PMDD is a recognised medical condition, not something you should simply push through. Nutrition may support condition management alongside care from your doctor.
PMDD is a more severe form of premenstrual syndrome (PMS). It affects an estimated 2 to 6% of women and people who menstruate.1 Symptoms appear in the week or two before a period and ease within a few days of the period starting. They can include low mood, irritability, anxiety, feeling overwhelmed, fatigue, food cravings and bloating.1
Research suggests PMDD is not caused by abnormal hormone levels. Instead, the brain appears to be more sensitive to the normal rise and fall of hormones across the cycle.2
PMDD is diagnosed by a doctor, usually after tracking symptoms over at least two cycles. If you think you may have PMDD, your GP is a great first step.
Research on nutrition and PMDD specifically is limited, and much of it comes from studies on PMS. These strategies may support symptom management.
Eat regularly
Eating regular meals and snacks, rather than going long periods without food, may help support stable energy and make cravings feel more manageable.
Support steady blood sugar levels
Including carbohydrate, protein and fibre in meals and snacks may help support steady energy and manage appetite across the day, which may help with cravings. Choosing higher fibre carbohydrates most often, such as oats, whole grains, legumes and fruit, is a simple place to start.
Carbohydrates are worth keeping in. In one small study of women with PMS, a carbohydrate rich drink improved mood and reduced cravings in the premenstrual phase compared with a placebo drink.3
Include calcium rich foods
Calcium has some of the more consistent evidence for premenstrual symptoms, although most studies are in PMS rather than PMDD. In a large clinical trial, women with PMS who took 1200 mg of calcium a day had a greater reduction in symptoms, including mood symptoms, than those taking a placebo.4 A large observational study also found that women with higher intakes of calcium and vitamin D from food had a lower risk of developing PMS.5
Most women aged 19 to 50 need 1000 mg of calcium a day.6 Food sources include:
- Milk, yoghurt and cheese
- Calcium fortified soy or plant milks
- Firm tofu made with calcium
- Canned salmon or sardines with the bones
- Almonds, tahini and leafy greens such as bok choy and kale
If you are considering a calcium supplement, it is best to speak with your doctor or dietitian first, as needs and suitability vary between people.
Support gut health
Your gut and brain are in constant communication, and the gut microbiome is thought to play a role in mood and stress responses.7 Research looking at gut health and PMDD specifically is still very early, so we cannot say yet whether it directly affects PMDD symptoms.
That said, nutrient rich, anti-inflammatory eating is worthwhile for gut health and overall wellbeing. A Mediterranean style pattern is one example. It includes a variety of fibre rich plant foods such as vegetables, fruit, whole grains, legumes, nuts and seeds, along with olive oil and oily fish. Fermented foods such as yoghurt or kefir can be included if you enjoy them, along with enough fluid.
A note on supplements
You may see vitamin B6 and magnesium mentioned online for premenstrual symptoms. The evidence for both is limited, and most people can meet their needs through a varied diet.8,9 B6 supplements are not routinely recommended, as high doses taken over time can cause nerve damage. Please speak with your doctor or dietitian before trying any supplements.
Nutrition is not a cure for PMDD or a replacement for medical care, but it may be a helpful tool in supporting symptom management. Your GP can talk you through treatment options, including medication, and help you find an approach that suits you. Sleep, movement and care for your mental health can all play a role too.
PMDD can sometimes bring very low mood or thoughts of harming yourself. If this is happening for you, please reach out for support. In Canada, you can call or text 988 at any time to reach the Suicide Crisis Helpline. In an emergency, call 911.
Want support with PMDD or premenstrual symptoms?
Nula Nutrition can support your nutrition across your cycle, working alongside your doctor and wider healthcare team. The approach is always evidence based and tailored to you. Registered dietitian consultations are available for women's health in Calgary and online across Alberta, including Canmore, Banff, Edmonton, and Cochrane.
Ready to get personalised nutrition support?
Book a Free Discovery CallWritten by Madison Hows RD APD
References
1. Epperson CN, Steiner M, Hartlage SA, et al. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry. 2012;169(5):465-475.
2. Schmidt PJ, Martinez PE, Nieman LK, et al. Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels. Am J Psychiatry. 2017;174(10):980-989.
3. Sayegh R, Schiff I, Wurtman J, Spiers P, McDermott J, Wurtman R. The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstet Gynecol. 1995;86(4 Pt 1):520-528.
4. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol. 1998;179(2):444-452.
5. Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165(11):1246-1252.
6. Health Canada. Dietary Reference Intakes Tables. Government of Canada.
7. Cryan JF, O'Riordan KJ, Cowan CSM, et al. The microbiota-gut-brain axis. Physiol Rev. 2019;99(4):1877-2013.
8. Wyatt KM, Dimmock PW, Jones PW, O'Brien PMS. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999;318(7195):1375-1381.
9. Walker AF, De Souza MC, Vickers MF, Abeyasekera S, Collins ML, Trinca LA. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998;7(9):1157-1165.
