Medical Research and causes of PMDD?

The occurrence of PMS is thought to be increasing in Western society, yet not much is known about it's causes still. Some experts think pollution may be to blame, particularly environmental oestrogens (chemicals which mimic the female hormone oestrogen and could also be responsible for the increase in breast cancer). What can we do about environmental oestrogens? Not a lot, they are present in most cosmetics, tap water (via contraceptive pill) and plastics. Eating plants which contain phytoestrogens is recommended to help combat the effects of environmental oestrogens (since these block the effects of oestrogen). Soya beans are a particularly rich source of phytochemicals. I'm not sure how effective this is, but i think the quality of the soya protein is important (soya milk and tofu being better than processed soya protein).

The most recent PMDD research points towards the GABAergic system being modulated by the menstrual cycle, especially by the neurosteroid allopregnanolone which is a derivative of progesterone. Allopregnanolone combats anxiety (anxiolytic) as it is a potent GABA-A receptor agonist. It surprises me therefore that natural progesterone did not cure my symptoms since taking progesterone should increase allopregnanolone levels in the brain. It did have a strong sedative effect but i suppose the mood swings are also related to serotonin/oestrogen levels. Apparently progesterone can be converted to cortisol though, and perhaps other derivatives? PMDD has been likened to drug-withdrawal since allopregnanolone acts like a sedative on the brain. If this is the case though surely taking a high dose of progesterone before your period will only aggravate the withdrawal symptoms when you stop taking it. My moods were a lot worse the second month I took progesterone, especially during my period. Perhaps it would be better to take a smaller amount of progesterone all month round?
 
Oestrogen is a GABA-A receptor antagonist, meaning it prevents the receptor from functioning. I'm not sure how this fits in with PMDD symptoms though as oestrogen also raises serotonin levels and mood.
 
Prozac partly treats PMDD by increasing serotonin levels. Supplementing with the amino acid L-tryptophan may be a safer way of increasing serotonin levels. Prozac's rapid onset of action for PMDD treatment, is thought to be due to the increase in allopregnanolone levels. Curiously alcohol increases allopregnanolone levels, and many women (including myself) crave alcohol and drink more while they are premenstrual. Alcohol also increases dopamine which rewards the pleasure centres of the brain which could explain the cravings as well. Incidentally they don't recommend drinking while menstruating.
 
Clearly more research needs to be done in this area, especially since most women in Western Society now work, as well as raising a family! The question is, who is going to fund the research? Pharmaceutical companies don't seem that interested, perhaps because Prozac makes them a lot of money, or perhaps because they are run by men who are uneducated about woman's issues! They are missing out on a huge marketing opportunity though given 5% of women suffer from PMDD, and even more from PMS. And researching hormones and neurosteroids could help solve other problems which are linked to low serotonin such as IBS, allergies, migraines, depression etc 

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PMDD

My first experience of periods was a mild 'shock', what is happening to me?
As a teenager, i remember having to leave class sometimes because of the cramps & dizziness & migraine. I also remember feeling very tearful, and much more sensitive to rejection around certain times of the month. 

At university i had boyfriends, and they commented that 'i definitely got PMS' ! I can remember staying in my bedroom crying all evening on occasions, while my bemused boyfriend sat in the living room watching TV. After i finished my degree, I was on a progestogen-only pill at the time, i started charting my symptoms and self-diagnosed myself with PMS.

I started my first job and i was ok for another year or so, until i had another relationship and took a progestogen-only pill again. This one made me drowsy and depressed, and i lost my libido. My ex-boyfriend and I, argued a lot when i had PMS. He didn't understand it made me dopey/scatty, and so got annoyed when things went wrong which weren't my fault, just misunderstandings on my part because i wasn't really 'with it'! After I came off that pill, my moods were worse again. I started developing 'monthly' depression and lots of other symptoms, including hot flashes during my period.

So i started seeing GP's and gynecologists, trying to get some help for the moods. A long road, since none of them seemed to understand that PMS could be that much of a problem, or would admit to me that contraceptive pills had side-effects! Because they didn't listen to me, it felt like a constant battle, not what you need when you feel low anyway! Sometimes you do really have to fight to get what you want, especially with poorly recognised conditions like PMDD. It is worth spending time looking for a sympathetic doctor though.

My main symptoms are anger, depression, fatigue, migraines, feeling overwhelmed, or  uncomfortable & restless, and unable to concentrate on anything. On top of all that, i feel quite lonely when i have PMS. It's hard to explain to people that you are feeling 'crap' because periods are a taboo subject, especially with most men. People think you are weird if you talk about your hormones, or call you a hypochondriac. So you feel shit but aren't allowed to talk about it with out risking a negative reaction. People are a stress-trigger, and so I am more wary of social situations when in PMDD phase, and so it's easier to distance yourself. But during my period is also when i feel most needy, I guess i want to be looked after and have the pain 'taken away'. I also crave affection more. So i feel torn between wanting to be around people but also feeling unsociable and ill. 

In the past, PMDD has made relationships more difficult because of the mood swings, but i've been more depressed when i've been alone. A therapist said any illness can put you more in touch with subconscious feelings, and that the psychological defenses come down. So perhaps what I am feeling, isn't completely irrational or pointless. Even my mum said that PMS may make you 'overreact' but the trigger is still real. In the past i've spent too much time feeling guilty and apologising for my moods, when sometimes they may have been caused by other people's behaviour. I've blamed too much on my hormones (and therefore myself).

The reptilian/primitive part of the brain controls our basic emotions (love, hate, fear, lust). In experiments where people have to make a decision on a computer simulator and have had a brain scan at the same time, the unconscious parts of the brain make the decision, and the 'conscious/thinking part' of the brain lights up afterwards, giving us the illusion that it has made the decision. I think it's the same when you feel depressed, the 'thinking part' of your brain is looking for reasons for your bad mood. This may be why you blame people around you, or self-blame (depression). I don't think it's true for me that negative thoughts cause depression, negative thoughts may come from trying to rationalise my mood. Many illness's and drugs can cause 'biological' depression. 

I was lucky to see Dr Panay, and to receive HRT treatment for PMDD, which hasn't cured my moods completely but i don't suffer from the suicidal lows that i used to. Although i took this in conjunction with seeing a psychotherapist and swimming regularly, which may have helped too. I used to think 'why see a shrink for something biological'? But if you can afford it, it does help having someone to talk to. And the mind and body are not separate entities, they are linked.

Bad relationships, work stress and contraceptive pills have always made PMDD worse for me. And i've worked hard recently to rid my life of stressful people and to have more control over my life. The same with men. On the whole i feel positive and happy at the moment but the oestrogen implant will wear out of my system in 6 months time, so we will see. I stopped HRT treatment because I became intolerant to progesterone. I have already noticed my concentration dropping at work.

Given hormones aggravate other illness's and psychiatric disorders, it could be that PMDD just intensifies existing problems. Or it could be biological, or caused by lifestyle (not enough sunlight/diet/the contraceptive pill?). Perhaps it has many causes. Whatever the cause, it's extremely distressing and prevents some women from fully living their life. And it would be great if they did more research into it, especially as hormones play such a big part in our personality and behaviour.