navigating severe PMS symptoms

Raise your hand if you've ever felt personally victimized by severe PMS symptoms [insert Mean Girls GIF].

I think we've all been there once or twice. But if your pre-menstrual symptoms are consistently unbearable, affecting your relationships & ability to function, then you're dealing more than just PMS.

A condition called Pre-menstrual Dysphoric Disorder (PMDD) is essentially "PMS on steroids" & is characterized by:

• Anxiety

• Depression or feelings of hopelessness

• Extreme fatigue

• Bouts of rage

• Extreme mood swings

• Physical symptoms like breast tenderness, bloating, or joint or muscle pains

• Decreased interest in usual activities

• Trouble sleeping or sleeping too much

• Difficulty concentrating/brain fog

• Changes in appetite or food cravings

• Acne

• Headaches

• Cramping

• Hot flashes

• Suicidal thoughts

In PMDD, these symptoms onset 1-2 weeks before your period starts and, unlike PMS, can significantly disrupt functioning & relationships. 

Which means, you feel like absolute dog sh*t for half of the month (this is not normal & is a sign from your body that something is off).

This was exactly how I felt my last 3 cycles. With this last cycle being particularly severe, I finally said “enough is enough” & committed to some root cause investigation.

I finally went and got the routine labs drawn that my PCP ordered for me back in May. This was a starting point, but honestly, those labs led to more questions than they did answers (I did an Instagram live review of those labs here.)

Luckily, being a functional medicine practitioner, I have the ability to order and interpret my own labs (ones that are actually helpful). I ordered a list of things, but a few of the biggies included a whole blood histamine, serum copper, & GI MAP stool test.

PMDD can be driven by a number of things, including:

• Genetic sensitivities to estrogen & progesterone fluctuations

• Estrogen dominance*

• High copper

• High histamine

• Dysbiosis in the gut 

*Estrogen dominance can stem from estrogen being overtly too high or progesterone being too low. 

*Estrogen can become too high when:

• Detox pathways in the liver are impaired

• Estrogen is not being excreted efficiently in the gut

• Exposed to xenoestrogens (chemicals in our environment that mimic estrogens, like parabens & phthalates)

• Being overweight or obese, which affects estrogen production in fat cells

Functional lab testing can bring so much clarity & direction, helping to highlight the primary driver(s) of symptoms. Once we know what the root causes are, we can come up with a specific plan to address them & get relief as soon as possible.

My lab results revealed an EXTREMELY high histamine level of 135 ng/mL (optimal is 40-70). 🤯

I can't say I'm surprised considering I've been dependent on daily Zyrtec year-round for 14 years to control allergy symptoms. But seeing this level on paper made me realize how severe of a histamine issue I'm dealing with and is a wakeup call that I actually need to address the root cause of this high histamine vs relying on Zyrtec.

Symptoms of high histamine extend far beyond itchy eyes & sneezies & can manifest as:

• Gut symptoms:

  • gut pains/cramps

  • diarrhea

  • nausea

  • vomiting

  • many food sensitivities (esp fish, chocolate, fermented foods, dairy, citrus, eggs)

• Neurological symptoms:

  • dizziness

  • insomnia

  • OCD tendencies

  • depression

  • anxiety

  • major cyclical mood swings/PMDD

• Period symptoms:

  • painful periods

• Other symptoms:

  • bloody noses

  • intolerant to alcohol (esp red wine)

  • skin issues (hives, eczema, psoriasis, acne)

  • ear ringing

In conventional medicine, the most obvious solution would be an oral antihistamine. 

The problem with oral antihistamines is that they block the body's response to histamine, but they don't actually lower histamine.

Antihistamines may help with allergy-type symptoms, but when symptoms are squashed without addressing the root cause, often times imbalances find other ways to manifest in your body’s desperate attempt to get your attention. It’s important to listen to your body’s whispers so you don’t have to hear it scream.

In functional medicine, we keep asking “WHY?" until we get to the actual root cause. 

Here are 2 questions I ask when I run into high histamine in practice:

1. What's triggering histamine to be high?

   • Gut dysbiosis - certain histamine-producing bacteria, H Pylori infection, parasites, low gut immune function (this can be assessed via stool test)

   • Mold - history of living or working in water damaged buildings?

   • Alcohol intake

   • Stealth infections like lyme, bartonella, babesia

   • Estrogen dominance (what's causing this?)

   2. Is there something that's impairing histamine breakdown & clearance?

   • Meds like antacids, antibiotics, metformin, MAO inhibitors, estrogen-containing birth control

   • Lack of nutrients involved in histamine breakdown, including copper, calcium, vitamin C (can be assessed via hair tissue mineral analysis)

   • Poor methylation (detox pathway requiring B12, folate, B6, magnesium, choline to function optimally)

   • Iodine deficiency

   • Iron overload

I highly suspect that mold exposure may be a contributor to my wildly elevated histamine & I plan on doing a test to confirm.

My husband & I lived in 2 old city houses before moving into our current home 4 years ago. Both city houses used to get water in the basement when it rained, meaning the likelihood of mold & mycotoxins (a damaging gas - basically the “fart” of the mold spore) in these houses is quite high.

In the meantime, while I wait for test results, here's what I'm doing to help relieve my PMDD symptoms:

• Foundations first:

  • Exercise - 20-30 min strength training 2-3x/week

  • Stress management - somatic exercises & guided visualizations (my faves, but find what works best for you!)

  • Mineral mocktails - Cure [JENNYMAHONEY for 20% off] or coconut water + OJ

  • Bed by 11pm for 7+ hours of sleep

  • Eating protein + fat + carb every 3-4 hours for adequate fuel & blood sugar balance

  • Real, whole food-based diet

  • Limiting alcohol intake

• Enhancers (since I already have solid foundations in place at baseline, I feel comfortable adding in some extras):

  • Saffron supplementation (PMID: 33457343)

  • Vitamin B6 supplementation for progesterone support, controlling histamine, & supporting estrogen detox

  • Nettles tea for reducing histamine & supporting healthy estrogen levels

  • Supplemental progesterone (temporarily) to help oppose estrogen & also combat histamine (I used this 2 cycles ago & def felt my symptoms were softened)

• Further investigation:

  • Mycotoxin test to assess mold toxicity as a histamine trigger + mold detox protocol, if high (stay tuned 👀)

This is MY plan based on MY root causes. What's supportive for me may not work for you. 

This is where conventional medicine falls short – treatments are standardized, not personalized.

In functional medicine, treatments are tailored to each individual patient & their specific root drivers of symptoms.

& that's exactly what I support women with here in my practice! 💃

If you're sick of being handed cookie cutter, band aid approaches for your symptoms that don't actually work & this root cause approach has you feeling inspired & hopeful, you can apply to work together here. If it seems like we'd be a good fit, I'll reach out to schedule a free chemistry call with you to chat through the deets!

Also, know that if you're struggling with PMDD symptoms, you're not alone, you are not broken, & my inbox is always open to chat. 🫶