A Functional OBGYN’s Guide to PMDD

Written for you by Dr. Christy Evans, MD, Functional OBGYN

What is PPMD?

PMDD (Premenstrual Dysphoric Disorder) is a severe form of premenstrual syndrome (PMS) that significantly impacts mood, mental health, and daily functioning. It occurs during the luteal phase (the two weeks before menstruation) and resolves shortly after menstruation begins. PMDD is driven by an extreme sensitivity to hormonal fluctuations, especially progesterone and its metabolite, allopregnanolone, which affect the GABA system in the brain.

Common Symptoms of PMDD

Symptoms appear in the luteal phase and are severe enough to interfere with daily life. Some common symptoms include:

• Severe mood swings (intense irritability, anger, or sadness)

• Depression or suicidal thoughts

• Anxiety or panic attacks

• Extreme fatigue or low energy

• Brain fog and difficulty concentrating

• Insomnia or disrupted sleep

• Breast tenderness, bloating, or headaches

• Cravings for sugar or carbohydrates

• Social withdrawal or feeling overwhelmed

How to Support Your Luteal Phase & Reduce PMDD Symptoms

A functional OBGYN approach targets hormone balance, neurotransmitter function, and inflammation reduction.

1. Balance Blood Sugar

• Eat protein + healthy fats with every meal to prevent blood sugar spikes.

• Reduce refined carbs & sugar, which can worsen mood swings.

2. Support Liver Detoxification (Hormone Metabolism)

• Increase cruciferous vegetables (broccoli, kale, Brussels sprouts) to help the liver metabolize excess estrogen.

• Drink lemon water & dandelion tea to support bile flow.

• Avoid alcohol, which disrupts estrogen metabolism and serotonin function.

3. Optimize Gut Health

• Take probiotics and eat fermented foods (sauerkraut, kimchi) to support estrogen elimination.

• Ensure regular bowel movements to prevent estrogen recirculation (magnesium citrate can help).

4. Reduce Inflammation & Support Adrenal Function

• Curcumin (from turmeric) reduces inflammation.

• Ashwagandha or Rhodiola helps regulate stress hormones.

• Prioritize deep sleep (9–10 PM bedtime, no screens before bed).

5. Track Symptoms & Cycle

• Use a period-tracking app to predict symptom patterns.

• Recognizing symptom timing helps implement supportive strategies in advance.
  
  

6. Prioritize Stress Management & Nervous System Regulation

• Daily meditation or deep breathing exercises to lower cortisol.

• Gentle movement like yoga, walking, or tai chi instead of high-intensity workouts (which can spike stress hormones).

• Consider vagus nerve stimulation (cold showers, singing, or deep breathing).
  
  
  

7. Consider Light Therapy & Natural Sunlight

• Morning sunlight exposure supports serotonin production.

• Full-spectrum light therapy (especially in winter months) may improve mood.
  
  

8. Community & Support

• Therapy or PMDD support groups can be extremely helpful.

Medications That Can Help

While functional medicine focuses on root-cause healing, some medications can provide relief, especially during acute phases:

SSRIs (Selective Serotonin Reuptake Inhibitors)

• Examples: Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro)

• Can be taken continuously or only during the luteal phase.
  
  

Hormonal Therapies

• Examples: Oral Contraceptives (Yaz, Beyaz): Contain drospirenone, which may improve PMDD symptoms. GnRH Agonists (Lupron): Induce temporary menopause (used in severe cases).
  
  

Bioidentical Progesterone

• Some women benefit from micronized progesterone (Prometrium) in the luteal phase to stabilize mood.
  
  

Spironolactone (anti-androgen & mild diuretic)

• Can help with bloating, irritability, and mood stabilization.
  
  

Supplements That Support Neurotransmitters & Hormones

• Magnesium Glycinate (calms nervous system)

• Vitamin B6 (supports serotonin production)

• L-Theanine (reduces anxiety)

• 5-HTP or SAM-e (supports serotonin)

• Omega-3 Fatty Acids (reduce inflammation & improve mood)

I like to use Fullscript to get my supplements

Final Thoughts

PMDD is not just "bad PMS"—it’s a severe neuroendocrine disorder. Healing involves a comprehensive approach, including lifestyle, nutrition, hormone balance, neurotransmitter support, and emotional well-being. If symptoms are severe or suicidal thoughts occur, seek medical help immediately.