EP.282/ Why your PMdd may be worse in january
It’s a New Year and perhaps you’re feeling the pressure to get up and go, but you can’t get yourself out of bed.
Maybe you’re in more pain than usual, perhaps you’re more depressed than usual or maybe you’re experiencing extreme fatigue and energy crashes?
If this is you, please know you’re not alone.
As I return to work, I’ve received many emails from endometriosis clients telling me their symptoms are worse and they’re panicked, but I’ve also had friends and endo clients who struggle with Premenstrual dysphoric disorder (PMDD) experiencing heightened symptoms.
And even for me, my anxiety, bladder pain and adhesion pain are worse.
This is not uncommon. In fact, in my line of work, it’s expected that many people will have worsening periods or hormonal problems in January.
It doesn’t mean that you’re doomed for the rest of the year and that this is a sign of things to come, which is often where our mind can go when we’re in the middle of a flare up. What it does mean is that we need to understand what’s happening and why, and move away from panic mode and instead, focus on calming and nourishing our bodies.
Now, I could deep dive into the science of all this for hours, but this is a short episode design to be digestible rather than overwhelming, so today, I want to focus on PMDD alone, because starting the new year feeling mentally unwell, is particularly challenging, especially when social media is full of people talking about their goals and hopes for the year ahead.
Many people with endometriosis also have PMDD, whilst there isn’t a definitive researched link here, it is something that my colleagues and I see often.
For those of you who aren’t aware, PMDD normally occurs from the luteal phase (that’s after you’ve ovulated) until the first day of your period. I have occasionally had some clients tell me their PMDD symptoms start and end a little outside of that window, but typically, we’re looking at the luteal phase and symptoms ceasing on Day 1 of your period.
During this time, people with PMDD experience a much, much more extreme form of PMS. Now I want to be clear here, when I say a more extreme form of PMS, I want to emphasise that I am not minimising the extreme severity of PMDD, I know many with PMDD are frustrated that it can often be explained as simply ‘really bad PMS’. It’s not.
For people with PMDD, they can feel like their whole personality has been hijacked. They may feel suicidal, may experience extreme anger, depression, anxiety, overwhelm etc. and may behave in ways they would never normally behave. These emotional symptoms are often accompanied by physical symptoms that can be very severe, like chronic insomnia, water retention, etc. In short, PMDD is an extreme disorder that is debilitating and can put the sufferer’s life at risk due to the mental health struggles it triggers.
Now, whilst PMDD is not the same as PMS, the same causes of PMS can still add to and worsen the symptoms of PMDD.
In my practice and within my training, we see stress, lack of sleep, blood sugar imbalances, and oestrogen dominance as some of the key culprits that can heighten PMDD symptoms, though there are many others. Now, this is a short episode and as I said, I won’t be diving into each topic too much, because we could create multiple episodes if we did that, but if you want to learn more about the causes of PMDD and nutrition and lifestyle changes that can support and help manage it, I have linked to three episodes in the show notes. The good news is, with certain strategies, I often find my clients have significant relief from their symptoms. This isn’t to say you won’t need medication or that you’ve failed in any way if you do require it, but these are just some management techniques that can help.
But let’s get back to why your PMDD may be struggling right now. Before I start, I want to assure you that PMDD is not your fault (and nor is endometriosis), but there are things that can help or worsen PMDD, just like any condition, from diabetes to arthritis. So while it is absolutely not your fault you have PMDD, what I want to do with this episode is rather than pointing the blame finger and saying “oh you ate a lot of this so that’s why your PMDD is bad”, what I want to do is just raise you awareness to what may be contributing, so that you’re not stuck in this awful depression, feeling hopeless and helpless.
As someone with a long history of depression and anxiety, I can sometimes get lost in bad phases and become fearful that this is now my new reality or that the feelings are true and that the way I am thinking is real, but when I step back and ask “Hang on, what have I been doing which could be further fuelling this?” and I recognise the triggers, it gives me hope that I can feel better and it allows me to make sense as to why I am feeling that way and gives me some sense of control, because I can make changes to move towards feeling better.
If that’s not the way you think you’ll receive this information and instead, you’ll find it distressing, I suggest you skip this episode for now, and focus on whatever makes you feel good or better – whether that’s walks, prescription medication, exercise, cuddles with your pet or feel-good movies.
Okay, now let’s get to it.
Sleep
So, number one is lack of sleep.
For many of us, even if we move into December with intentions of cosy winter nights, we can often find ourselves in a routine of staying up late watching Netflix, or travelling around seeing people or heading to social events which mean we’re getting to bed late.
Lack of sleep has been shown to raise symptoms of anxiety and feelings of depression and can also trigger the onset of these disorders too. Of course, if you are moving into January feeling sleep deprived and struggling to get back onto a sleep schedule, this can worsen mental health symptoms that can arise with PMDD and even if you’re now back on a better sleep schedule, you may still be dealing with the depression and anxiety triggered from sleep deprivation in December and it may take you some time to work through that, especially if you have other factors influencing these mental health issues and your PMDD.
Sugar
Naturally, many of us enjoy more sweet treats around Christmas and New Year’s, which can result in blood sugar swings. Blood sugar instability can mimic feelings and symptoms of low moods and anxiety, and mental health conditions are being increasingly linked to blood sugar problems. Additionally, blood sugar instability can cause or worsen hormonal imbalances, which can further exaggerate or add to the symptoms of PMDD, which is influenced by the changing hormones in our cycle.
Alcohol
Like sugar, many of us tend to increase our intake of alcohol around Christmas and New Year’s. Alcohol, whilst in the short term may make your feel more upbeat and relaxed, is actually a depressant which can negatively affect the neurotransmitter levels in your brain and cause low moods, even depression, when consumed regularly, which many people do throughout December. In fact, reducing alcohol intake is a recommended dietary and lifestyle change to help manage PMDD, as PMDD in itself is a condition which is linked to our neurotransmitter levels and how they are affected by our hormones.
Caffeine
Finally, for some, though not all, we may have increased caffeine consumption in December. Caffeine is found in green tea, black tea, white tea, coffee, cacao and chocolate and drinks like Coke. I know for me, Christmas is a time when I may increase caffeine because I find I am yearning for drinks that bring me comfort, which is often hot chocolates, cups of tea and coffee.
Caffeine is a stimulant, and it triggers the flight or fight response by raising levels of adrenaline and cortisol. Adrenaline increases heart rate and breathing, feelings of alertness and can mimic the symptoms of anxiety by triggering palpitations, nervousness, etc. In people with anxiety, it has been shown to worsen symptoms – and let me tell you, this year, I had quite a stressful December (a story for another time perhaps) and I defaulted to my old habits of relying on caffeine to get me through, and unfortunately, it just made the stress much worse because it increased my anxiety and therefore my feelings of overwhelm and feeling out of control.
Final Word
There are many other things that can heighten symptoms of PMDD, and just like any mental health issue, stress can worsen symptoms and arguably, Christmas can be quite a stressful time for many, so it could also be that.
However, those are some of the dietary and lifestyle changes that can occur in December, which can impact your cycle, hormones and neurotransmitters and can as a result, exaggerate PMDD symptoms come January.
So, what can we do about it?
I am not a big fan of a huge January detox, as that can stress the body (not to mention your mind) and can just end up making things worse. Instead, if you do want to make changes, I suggest gradual, easy changes that can help you to feel good rather than deprived, is where to start.
Again, we could do an entire episode on each of these topics, but instead, I am going to give you a couple of actional tips to prevent overwhelm and to help you get started.
Sleep
If sleep was an issue for you in December, I suggest slowly working towards a better sleep schedule. You’re unlikely going to be able to move from 1am bedtimes to 10pm bedtimes overnight, so gradually start going to bed 15 minutes or 30 minutes earlier throughout January, aiming for a nine-hour sleep window, to give yourself a chance of a full 7-8 hours sleep.
Try to avoid anything that is going to stimulate brain activity in the hour before bed, such as TV or screens, bright lights, and try to avoid caffeine at least 8 hours before bed as it lasts in the system for at least 8 hours.
If you’ve gotten into the habit of drinking caffeine throughout the day, you may need to begin that process gradually as like I said, we don’t want to further stress the body or mind, and I’ll give you some ideas for reducing caffeine intake shortly.
For many of us, getting to sleep on time can feel like a boring activity, and an act of painful discipline. Remember, I want us to focus on things that make you feel good, so that your PMDD symptoms improve, rather than causing you further stress. So, try to see your night routine as form of nourishment, an evening spa routine. Perhaps you watch a feel-good show after dinner, or you take a relaxing walk, or unwind with a quick yoga routine. Maybe you have a hot shower or bath, or you light candles and read a comforting book. It doesn’t have to be a long, drawn-out process, but you just want to ensure that the lighting is low, and that the mood is calm rather than stimulating an hour or two before bed.
Sugar
Sugar is a hard one to come off cold turkey, so again, make this gradual and enjoyable to prevent physical or emotional stress.
If you’ve gotten into the habit of say, snacking on biscuits or chocolate, try replacing those snacks with fruit, nuts and some dark chocolate with a lower sugar content.
If you’re very addicted to that sugar hit, you might personally find you do better first with keeping in some of those sweet snacks but reducing the quantity, whilst slowing introducing the healthier ones. So, for example, say over December you got into the habit of eating three biscuits with a cup of tea in the afternoon, you could reduce that to two biscuits and eat some nuts and fruit first, and as you reduce your biscuit quantity, you could also increase your nuts, fruit and dark chocolate portion, until the biscuits are entirely replaced. You could also swap to some healthier biscuit alternatives, I’ve put one or two examples of what I mean in the show notes (these are not sponsored, just examples).
Of course, this is just a single suggestion. If the idea of nuts and fruit doesn’t appeal to you, explore your options and recipe ideas – you could make an avocado chocolate mousse, a healthy hot chocolate, chia pudding or even get super creative; in the Autumn, I was having cubes of cooked pumpkin, with yoghurt and a pecan on top, to make mini cheesecake bites. Have a scroll through Instagram for ideas, but just watch out for anything with added honey, maple syrup, date syrup, coconut sugar, etc. as sadly, they are all just a form of sugar.
Additionally, you could consider focusing on eating for blood sugar balance, which you’ll be pleased to know is more about eating more than it is about eating less! When you balance your meals to support your blood sugar, you’ll crave sweet foods less, so you could try starting here. We could really get into the weeds with this one, but I want to keep the suggestions straight forward rather than a huge diet overhaul in January (but I’ve linked to some other resources in the show notes). So, with blood sugar balance the two key things to focus on are:
· Reducing refined carbohydrates like bread, pasta and cereal
· Ensuring each plate contains health fat, fibre from veggies, protein and a complex carb.
Alcohol
If you’ve gotten into the habit of having a glass of wine or two in the evening or drinking more at the weekends and are struggling to go without it, try diluting your drinks to start weaning yourself off.
We’re currently in Italy and have seen on the menu a number of times, wine mixed with mineral water or sparkling water, essentially making a spritzer. There are plenty of wine spritzer recipes online, which add fruit, herbs, etc. just try to avoid adding any extra sugar.
By making a wine spritzer with just one serving of wine, you can essentially have two glasses, even though you’re only having one glass of wine. Of course, if you’ve only been having one glass anyway, that’s not actually going to help you reduce your intake, so you’d halve your normal serving and dilute it with sparkling water.
Then, try a few evenings with just a healthy mocktail or comforting hot drink, and increase those until you’ve reduced your alcohol intake to a level you’re comfortable with and is good for your body and your PMDD.
If you’ve only been drinking at the weekends and want to lower your intake there, again, try diluting your drinks. Ask your waiter for a neat serving of your usual spirit or wine, and a pitcher or glass of sparkling water, or a low sugar mixer, and mix your own cocktail so you can make your alcohol last over two or three drinks. Ask for some fruit slices like orange and a sprig of rosemary in your mixer, so you still feel like you’re getting something special.
You can also alternate your alcoholic drinks with a mocktail or alcohol-free spirit, of which there are many now served in bars, and I’ve linked to a couple in the show notes just as an example, but again, they are not sponsored.
Of course, if you feel like you need help reducing your alcohol intake, reach out to a professional, your doctor or an AA support group.
Caffeine
You’ve probably guessed the trend by now, that these tips are about reducing slowly to prevent putting yourself under more mental and physical stress.
With caffeine, it’s one of the easier things to reduce practically. So, for example, if you’re having three cups of strong coffee a day, and you want to say, get back to one, you’re likely going to feel some withdrawal from that. So, a steady approach could be, if you’re making your coffee at home, you could make that third cup with half caffeinated coffee and half decaf coffee, or you could switch that third cup to a drink which has less caffeine in it, which is typically green tea or white tea, providing they are from a teabag, if they’re loose leaf, they can sometimes have even more caffeine than a coffee.
After a few days, you could then move to that third cup being entirely caffeine free and then repeat the process with your second cup.
Here’s how I’m doing it. I was drinking about two cups of tea a day and a cup of coffee a day, which is more than I’ve ever drunk in my life.
My first strategy was to remove black tea entirely and swap it to white tea, which honestly takes like black tea, but just a bit fresher, especially if you add some milk.
I then removed my afternoon tea and instead, when I would have my second caffeine drink of the day, which is a coffee, I’d halve the serving and have the second half in the afternoon.
I then entirely removed that half serving of coffee in the afternoon, so I am now down to one white tea in the morning and half a coffee mid-morning. Once I’ve adjusted, I’m going to swich my second drink to decaf coffee with some lion’s mane and cordyceps, which are mushrooms which have a coffee like taste but also boost cognitive function and energy, without caffeine, and that is what I have used in the past instead of caffeine.
Eventually, I will also replace my morning drink with a mushroom latte and keep my white tea for the weekends, as it is very beneficial for skin and gut health, and overall antioxidant levels (plus I love it) but daily caffeine intake is not good for my mental health! And when I have a coffee, I’ll just stick to decaf, which is what I’ve done for years anyway, so this isn’t a difficult adjustment for me.
You can see that I am doing this very gradually. My anxiety would probably benefit from me going cold turkey on the stuff, however, my adrenals have become used to the caffeine kicking up my cortisol and adrenaline for them, so I need to give my body the chance to adapt so I can make enough energy of my own and get through the day without feeling really tired unless I have caffeine.
Of course, you can reduce your intake of these things however you want! These are just ideas to do it gradually, as the temptation is to swing from one extreme in December of indulgence, to another extreme of restriction in January and so this episode is to reassure you, that you don’t have to do it like that, and actually, if you’re in a bad place physically and or mentally, it might not be the best idea.
Having said that, there are some circumstances, like reducing alcohol intake, which you could do quicker. If you wouldn’t find it hard to stop drinking daily or so much at the weekends, you could certainly cut down quicker and this would be advisable and helpful, especially for your mental health and hormonal health.
And lastly, remember – everything we talk about on this show is just about me providing you with information and options. You certainly don’t have to do any of this, and if you feel like for now, you just need some prescription medication to help you with your PMDD to get you out of this period, I totally appreciate that.
If you do want to learn more about a functional medicine approach to PMDD however, I do really recommend you listen to those podcast episodes I mentioned earlier, which I have linked in the show notes.
Show Notes
Other episodes on PMDD
https://www.theendobellycoach.com/podcast/what-is-pmdd?rq=PMDD
https://www.theendobellycoach.com/podcast/natural-treatment-options-pmdd-endometriosis-rebecca-sairs?rq=PMDD
https://www.theendobellycoach.com/podcast/endo-pmdd-healing?rq=PMDD
Blood sugar resources
https://endometriosis.net/living/diet-sugar
https://endometriosis.net/living/how-to-balance-your-blood-sugar-levels-to-reduce-endo-symptoms
Alcohol alternatives
Biscuit alternatives
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This episode is sponsored by Semaine. Semaine is a plant-based supplement for reducing period pain and inflammation, that you take for 7 days of your cycle, during your period. Semaine is made up of 9 super-powered plant extracts and minerals that are all vegan and sourced for maximum quality and bioavailability and selected based on the latest clinical research. If you want to try Semaine, they are currently offering 20% off your first order with code: THEENDOBELLYCOACH and they deliver worldwide! Head to: www.semainehealth.com
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Produced by Chris Robson