PMDD Still A Perplexing Condition That Has Significant Mental Effects

PMDD is a very perplexing condition as the more we study we find out a lot about the condition, but still lack a treatment or a cure. Most women think that the ultimate cause of these symptoms are due to hormones are in disarray if they have Premenstrual Syndrome (PMS) or the severe kind called PMDD. It has long been argued whether these conditions are fundamentally physical, or mental, or even real as The American Psychological Association even relatively recently brings up the question of whether it is a real disorder. One of the biggest debates in the gyno world in the past few years is whether PMS/PMDD would benefit by being labeled psychological, as there are a variety of brain responses the condition causes.Hormones and the menstrual cycle control both PMS and PMDD.  It's not necessarily that a PMS/PMDD patients' levels are different than others…but they have much the same hormonal swings normal women have but as far as physical and emotional symptoms are these hormones can trigger a very different response. Estrogen peaks during ovulation, and a lesser peak during the third week. Progesterone peaks in that 3rd week and then the levels plummet to very low during the period itself. The worse symptoms of PMS are are 5 days before and 5 days after menses, so these symptoms do not even correlate with hormonal swings most people have.

The psychological /mental symptoms of PMS and PMDD are thought to be primarily due to changes these hormones induce in three main brain transmitter systems: these brain chemicals include opioid, GABA (gama-aminobutyric acid), and the serotonin systems. Think of transmitters as keys that when inserted into their proper locks will turn on certain brain functions. If there are not enough "keys" these functions cannot be turned on very promptly, if there are jammed locks, then the function won't ever occur. It's very complex as sometimes it's not the hormone that triggers the action, but one of its metabolites (as they get metabolized they get into other hormones). So the actual outcome of what the brain effect has to do with your hormone level, how much it's been metabolized, and your natural levels of the brain transmitters.

Fatigue is often an important component of the PMS and PMDD complex and Some menstrual fatigue is due to a mild degree of anemia or deficiency of other vitamins do to the blood loss of menstruation. Some menstrual fatigue and the disordered thinking women get with their cycles (and fog) is due to the disruption that is produced by headaches and poor sleep.In addition some of these side effects can be worsened by those treatments that make other aspects of PMS better. Often gyno docs will treat PMS with progesterone. Progesterone in high doses makes one sleepy, so this might contribute in the second half of the cycle.

Sugar metabolism disorder can also make one think and function poorly. The hormones of the menstrual cycle affect the effectiveness of insulin's ability to direct the processing of sugar, so the highs are higher and lows are lower, we think this may also be related to cortisol, but cortisol has more of a daily variation rather than closely linked with our cycles. This is the main reason to avoid sugar. But too much sugar intake can cause gas, diarrhea, and water retention so to a large extent the effects of sugar on our mental functions is not severe, but the effects of sugar on the physical part of PMS can be important. Gynos think that the mental symptoms that are mood or anxiety related may be related to changes in serotonin, and the thinking may be more related to the GABA system or the opioid system.



Cortisol peaks in awakening and not changed based on menstrual cycles. We first began to realize how cycles and lack of cycles can alter cortisol peaks when we began studying the cortisol light response in women with PMDD. It turns out there is a blunted phase shift response to bright light in women with PMDD. Women with shifted biological clocks have more hormone related problems such as moodiness, PMDD and menopausal mood changes.
 
Simple therapies for fatigue and foggy thinking are useful no matter what the cause: better rest, iron, good nutrition, exercise. Ultimately changing the neurotransmitters may be the best way to fight brain fog. You can preload opiods earlier in the cycle by being a high exerciser in that 2nd and third week before PMS/PMDD hits in the third week..  Long term and the more fit exercisers also have steadier and overall lower estrogen levels so they won't quite have the peaks and valleys of hormones, so that may be why this works. Cardio and strength building both help release endorphins as does yoga. The breathing exercises of yoga also help pace our physiologic rhythms and improve thought processing.

 Treating migraines or headaches very promptly will help the disordered thinking around PMS time. Migraines should be treated promptly as if you let them get out of control they are more disabling and jumbling to your thinking. Eventually we also learn that behavioral strategies will help clear brain fog. Note taking to focus on what someone is telling you. No one sounds smart if you have to "hum and haw" to think, but literally repeating the question back helps you sort as you respond. Extra sleep. Caffeine, it can be a mental boost when used judiciously, it's something that you have to weigh against other side effects. Alcohol is to be avoided if possible. Again, not well worked out exactly why, but every study says it makes symptoms worse. Chasteberry tree extracts have been shown to help irritability and anxiety of PMS time of the month, but I haven't exactly seen studies of "thinking or processing" better. Calcium and Vitamin D also shown to reduce symptoms over time. Just like exercise and yoga can increase the release of substances that help us be calm and elevate the mood, so can massage. Massage would be good as well as healing touch, probably due to endorphin release and stabilizing release of adrenaline and cortisol.but if you still have brain fog, it's time to see your gyno.



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