There’s a lot more to treating premenstrual mood symptoms than just calcium, the pill, and SSRI antidepressants. Alternative strategies for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) include iodine, magnesium, vitamin B6, vitex (chaste tree), progesterone, and a natural antihistamine approach.
Different strategies work for different women because there are several variables including mast cell activation, nutrient deficiency, high prolactin, and gut health. Consider your situation and then try one or more of the following treatments.
Just a little clarification before we survey the treatments: this is an article about mood symptoms that occur during the ovulatory and/or premenstrual phase of a natural ovulatory menstrual cycle. Possible symptoms include irritability, anxiety, sadness, anger, and a feeling of loss of control, sometimes with physical symptoms such as headaches and breast pain.
👉🏽 Tip: Post-menstrual mood symptoms are likely to be iron deficiency or a sign of an anovulatory cycle.
Mood symptoms on the pill are not “premenstrual” symptoms because as I explain in my book Period Repair Manual, pill bleeds are not periods and contraceptive drugs are not hormones. Instead, mood symptoms on the pill are the side effects of contraceptive drugs.
Mood symptoms on the hormonal IUD are sometimes true premenstrual symptoms (because natural menstrual cycles can occur with the IUD) but are sometimes the side effects of the contraceptive drug (levonorgestrel) released by the IUD.
Consider an antihistamine approach
As I discuss in my histamine blog post, mast cell activation and histamine can play a major role in premenstrual mood symptoms. Other symptoms of high histamine include urticaria (hives), headaches, and brain fog. In the histamine article, I recommend first trying an over-the-counter antihistamine medication such as diphenhydramine (drowsy) or loratadine (non-drowsy) to see if it helps. If it does help, the next step is to try histamine-reducing natural supplements such as quercetin and S-adenosyl-L-methionine (SAMe) as well as the histamine-reducing dietary strategy of avoiding normal A1 cow dairy. (The potential mood-enhancing effect of avoiding A1 casein is currently being trialled at Deakin University.)
Take iodine (but only if it’s safe)
As I discuss in my iodine blog post, milligram dose iodine (1-3 mg) is one of my favorite treatments for premenstrual mood symptoms and breast pain. It works by promoting healthy estrogen metabolism and stabilizing estrogen receptors in the brain. Milligram dose iodine is safe only if you do NOT have Hashimoto’s thyroid disease or thyroid antibodies on a blood test (also called anti-thyroid antibodies, or anti-TPO antibodies). Read more about iodine safety.
Try magnesium, taurine, and vitamin B6 (but be careful with B6)
As I discuss in my blog posts about magnesium, taurine, and vitamin B6, all three nutrients can improve premenstrual mood symptoms and work by reducing inflammation and boosting levels of the calming neurotransmitter GABA. Vitamin B6 can also reduce histamine. Take care with vitamin B6 because too much can cause nerve damage.
👉🏽 Tip: Magnesium supports GABA, regulates the stress response, and normalizes the action of progesterone on the central nervous system. It works so well that some scientists have proposed magnesium deficiency to be the main cause of premenstrual mood symptoms. It’s fine to use a combined calcium-magnesium supplement in line with the calcium research.
As I discuss in my prolactin blog post, high-normal prolactin is common and can cause premenstrual symptoms together with irregular periods, loss of libido, headaches, breast pain, vaginal dryness, acne, and facial hair. The best natural treatments are vitamin B6 and Vitex agnus-castus (chaste tree or chasteberry), which has been clinically trialled for premenstrual mood symptoms. Vitex is less likely to work for premenstrual mood symptoms when prolactin is low.
As I discuss in my progesterone-mood blog post, progesterone is usually soothing to mood but can sometimes cause anxiety. That’s true for endogenous progesterone (the progesterone we make) as well as for progesterone supplements in the form of cream or capsules (Prometrium and Utrogestan).
Many women have a negative mood reaction to the normal drop in progesterone (and estrogen) at the end of a natural menstrual cycle. Symptoms from “progesterone withdrawal” can be relieved by taking natural progesterone as a cream or capsule. This is especially true for migraine headaches.
A few women (about 1 in 20) have a negative mood reaction to the rise in progesterone at the beginning of the luteal phase. Symptoms of “progesterone sensitivity” or “neurosteroid change sensitivity” can be relieved by stabilizing GABA receptors, supporting gut health, and supplementing progesterone at the “sweet spot” dose of 100 to 200 mg (neither too low nor too high).
👉🏽 Tip: The progestins of hormonal birth control often cause mood side effects but they are drug side effects (not progesterone sensitivity) because progestins are not progesterone.
Because the nervous system is a complex system, there are many, many additional considerations for improving premenstrual mood symptoms. For example, a recent study found that women benefit from access to green space. Another study linked premenstrual mood symptoms to intestinal permeability and gram-negative bacteria, and yet another explored the possible role of posttraumatic stress disorder (PTSD). Iron and zinc are also important.
As a general takeaway: the way to relieve premenstrual mood symptoms is to improve general underlying health, including nutritional status and gut health. That is particularly true during the turbulent time of perimenopause or second puberty (from age 35).
Ask me in the comments.