There’s a lot more to treating premenstrual mood symptoms than just the pill or 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 people because there are different drivers of premenstrual mood symptoms: mast cell activation, nutrient deficiency, high prolactin, and gut health. Consider your situation and then try one or more of the following treatments.
💡 Tip: Mood symptoms on the pill are not “premenstrual” symptoms because 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 could be premenstrual symptoms (because it’s possible to cycle naturally on the hormonal IUD), or they could be side effects of the contraceptive drug (levonorgestrel).
Consider an antihistamine approach
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. I recommend first trying an over-the-counter antihistamine such as diphenhydramine (drowsy) or loratadine (non-drowsy) to see if it helps. If it does, 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 studied at Deakin University.
Take iodine (but only if it’s safe)
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. That dose of 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)
Magnesium, taurine, and vitamin B6 can improve premenstrual mood symptoms 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.
Test prolactin
High-normal prolactin is common and can cause premenstrual symptoms, 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 have been clinically trialled for premenstrual mood symptoms.
Understand progesterone
Progesterone is usually soothing but can sometimes cause anxiety. That’s true for endogenous progesterone (the progesterone we make) and body-identical progesterone medication like Prometrium.
Many women have a negative mood reaction to losing both progesterone and estrogen at the end of a natural menstrual cycle. Hormone-withdrawal symptoms (especially migraine headaches) can be relieved by taking natural progesterone as a cream or capsule.
A few women (about 1 in 20) have a negative mood reaction to rising progesterone at the beginning of the luteal phase. Progesterone sensitivity symptoms can be relieved by stabilizing GABA receptors, supporting gut health, and supplementing progesterone at a slightly higher dose of 100 to 200 mg (above normal endogenous levels).
💡 Tip: The progestins of hormonal birth control often cause mood side effects but are drug side effects (not progesterone sensitivity) because progestins are not progesterone.
Other strategies
Because the nervous system is complex, there are 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 about age 40).
Also see:
- Top 6 natural treatments for premenstrual mood symptoms
- The role of histamine and mast cells in PMS and PMDD
