PMS + PMDD | with Emily Bathgate

Those of us with a menstrual cycle will be very familiar with premenstrual symptoms, the shifts we notice as our hormones and energy levels take that natural dip in the lead up to each period. Something I see in many of my clients, though, is that this natural dip might have become more of a nosedive. And, while PMS can feel frustrating enough as it is, for some women, that premenstrual phase becomes truly debilitating, and that’s when we might be looking at PMDD…

PMS vs. PMDD: what’s the difference?

PMS (Premenstrual Syndrome) refers to a cluster of physical, emotional, and behavioural symptoms that occur in the luteal phase of the menstrual cycle – usually in that final week or so before menstruation. Up to around 85–90% of women experience PMS to some extent, and while symptoms can be uncomfortable, they usually don’t completely derail daily life.

Often referred to as a “more severe version of PMS”, PMDD (Premenstrual Dysphoric Disorder) is a complex disorder, recognised by the DSM-5 and ICD-11, in which premenstrual symptoms in the luteal phase are so severe that they cause significant disruption to daily life. It affects an estimated 2-8% of women, but its impact can be life-altering – and, in some cases, even life-threatening.

A diagnosis of PMS or PMDD is usually determined by the tracking of the pattern of premenstrual symptoms, usually over at least three menstrual cycles. A PMDD diagnosis requires the presence of at least five symptoms, including at least one affective symptom causing significant impact or interference to day-to-day functioning, activities and/or relationships – and these symptoms must appear during the luteal phase before significantly improving or disappearing entirely within the first few days of menstruation starting.

Not only do PMS and PMDD differ in their diagnostic criteria, but also in the intensity and impact of their symptoms.

What do PMS and PMDD look like?

PMS SYMPTOMS

PMS sits as an umbrella of an enormous list of (over 200!) possible symptoms. While these symptoms vary, women usually experience the same, or at least a similar, set each cycle. Common PMS symptoms include:

• Bloating or fluid retention
• Breast swelling and tenderness
• Fatigue
• Headaches
• Skin changes (including acne breakouts, increased sensitivity)
• Sleep disturbances
• Digestive issues (including constipation or diarrhoea, appetite changes)
• Mood swings and irritability
• Anxiety
• Difficulty concentrating
• Food cravings

For many, PMS is uncomfortable but manageable. For others (it’s predicted that 20-30% of women suffer intense PMS symptoms), it can affect their relationships, work, self-esteem and quality of life.

PMDD SYMPTOMS

PMDD, on the other hand, takes things to another level in terms of intensity, severity, and impact…

Emotional and psychological symptoms often tend to dominate, including:

• Severe mood swings
• Intense anger
• Depression, hopelessness, or suicidal thoughts
• Anxiety, panic, or overwhelm
• Loss of interest in usual activities
• Self-critical or intrusive thoughts

Physical symptoms (similar to PMS) can also occur, think:

• Fatigue
• Insomnia
• Headaches
• Bloating
• Breast tenderness
• Joint or muscle pain
• Cravings and appetite changes

The main difference? PMDD symptoms are usually debilitating – impacting work, school, social life, and relationships, and taking a psychological toll that’s comparable to major depressive disorder. And this pattern is distinct: after feeling awful during the luteal phase, once their period begins, it’s like the switch flips back to normal (at least until the following month, that is).

Why Do PMS and PMDD Happen?

When looking at the potential drivers of PMS and PMDD, it usually comes down to:

• Luteal oestrogen and progesterone fluctuations
• Luteal neurotransmitter changes (especially serotonin, but also dopamine and GABA)
• Genetics and your family history
• Mental health or mood disorders

While the exact causes of PMS and PMDD aren’t totally understood, research shows that it’s got a lot to do with how sensitive your brain and body are to normal, expected cyclical hormonal changes.

It’s also important to take into account the influence of the following factors, which can all exacerbate both PMS and PMDD symptoms and severity:

• Nutrient deficiencies, including magnesium, vitamin B6, vitamin D, omega-3s, iron, calcium, and zinc
• High stress & trauma
• Poor sleep quality and/or not getting enough sleep
• A diet too-high in triggers, such as excessive amounts of sugar, alcohol, caffeine, processed foods, dairy, or salt
• Neurodivergence, where brain and reproductive hormone interactions can make luteal symptoms worse. In fact, the neurodvivergent population is the primarily impacted group when it comes to PMDD – a 2021 study showed that almost half of ADHD women had PMDD, compared to 2-8% of the neurotypical population
• High histamine levels or histamine intolerance, as excess histamine can combine with the effects of natural hormone fluctuations to dramatically worsen luteal symptoms

How Naturopathy Can Help

The conventional medicine approaches to treating PMS and PMDD often involve SSRIs (antidepressants) or hormonal contraceptives to manage symptoms. These can work very effectively in terms of symptom management… but they don’t suit everyone, can come with some unwanted side effects, and don’t always address the root cause or the individual’s driver/s.

Naturopathic support takes a more holistic, comprehensive, and root-cause approach – helping to rebalance hormones and neurotransmitters, reduce inflammation, and support your nervous system for overall wellbeing throughout the entire menstrual cycle.

Here are some of the ways I support my clients as a Naturopath:

HERBAL MEDICINE

• Vitex (Chaste Tree) – one of the most researched herbs for PMS, shown to reduce symptoms by balancing progesterone and dopamine levels.
• Nervous system-soothing herbs – including adaptogens (like Withania and Rhodiola), anxiolytics (like Saffron and Passionflower), and nervine tonics (like Lemon Balm and Chamomile) – all work to calm the nervous system and alleviate symptoms such as stress, anxiety or insomnia
• Neuromodulators, such as: Kava, Lavender, Magnolia and Zizyphus for serotonin & GABA modulation, and Saffron, Turmeric, Chaste Tree and Rhodiola for dopamine balance

NUTRITION + FOOD AS MEDICINE

• Opting for fewer inflammatory foods (i.e. refined sugars, processed foods, excess dairy/alcohol), and more anti-inflammatory ones (including omega-3-rich fatty acids, antioxidants, and colourful plants
• Balancing blood sugar levels by consuming regular meals packed with protein, healthy fats, and complex (over simple) carbohydrates to help support hormonal balance
• Liver-loving foods (like broccoli, kale, rocket, and bitter foods) for healthy hormone metabolism, or processing
• Plenty of fibre and hydration to support healthy bowel function (and therefore healthy hormone clearance!)
• Pre-preparing meals during your follicular phase, so that you can grab-and-go when you hit your luteal phase

TARGETED SUPPLEMENTS

• Magnesium, B vitamins (especially B6), Vitamin D, Iron, Calcium, Zinc and Omega-3s to help combat any deficiencies
• Nervous system supporting nutrients, such as Magnesium, Glycine and L-Theanine
• NAC – shown in trials to be as effective as fluoxetine (SSRI) for PMDD, with fewer side effects
• Myo-Inositol – shown to significantly improve PMDD severity scores
• Quercetin and Vitamin C for any histamine-driven issues

These supplements can play a valuable role in supporting women with PMDD and PMS, helping to ease mood changes, reduce inflammation, and restore hormonal balance. However, every body is wonderfully unique, and what works beautifully for one person may not suit another. It’s important to seek guidance from a qualified practitioner who understands the nuances of hormonal health and the art of prescribing high-quality, therapeutic supplements tailored to your individual needs.

LIFESTYLE + MIND-BODY SUPPORT

• Stress management (think breathwork, meditation, yoga, or journaling)
• Gentle, regular movement and exercise (walks, swimming, strength training, tai chi) to improve circulation, release endorphins, and help regulate hormones
• Prioritising consistent, quality sleep as well as healthy morning & evening routines for circadian rhythm health
• Sunlight exposure, and time in nature
• Acupuncture – shown in studies to significantly reduce PMDD symptoms, especially anxiety and depression, by improving circulation and supporting nervous system regulation

If you need some individualised guidance and support, you can book an initial consultation with Emily here

Naturopath Emily Bathgate offers compassionate, evidence-based care for skin, gut, hormone, mood, and neurodivergent health. With a holistic and nurturing approach, she supports women in understanding their bodies, calming the nervous system, and restoring balance — empowering each patient toward clearer skin, steadier moods, and lasting wellbeing.