There are several different hormones at play within our bodies all throughout the month. They all have key roles to carry out and have different effects on our bodies and therefore different impacts on our lives. If you suffer from Premenstrual Dysphoric Disorder (PMDD), the effects and impacts hormones can have on you can be drastically different from that of your non-PMDD suffering friends. Let’s look at progesterone and PMDD as an example. Because of the neurosteroid allopregnanolone (Allo) and something called GABA receptors within our bodies, progesterone can either be calming or it can completely flip your state of mind. Let’s look into this further and see how we can help you!
What is progesterone and what is it not?
Progesterone is a steroid hormone that belongs to a class of hormones called progestogens. It is secreted by the ‘corpus luteum’, a temporary endocrine gland that is produced after ovulation during the second half of the menstrual cycle (1). When an ovulated egg is left unfertilised, progesterone falls and the period begins. This rise and fall of progesterone levels post ovulation is called the luteal phase and this is typically when PMDD symptoms occur so it is worth paying attention to.
Before we go any further, it is important to distinguish between the often conflated progesterone and progestins. Progesterone is naturally occurring in our bodies while progestins are synthetic and were created to bind to progesterone receptors in the body and create similar effects as progesterone. Contraceptive progestins such as levonorgestrel, drospirenone, and norethisterone have all been linked with anxiety and depression so changes in mood from birth control are drug side effects, not a sign PMS or PMDD and so it is important to know if you are having a reaction to progesterone or progestins in order to both diagnose and treat the problem at hand (2).
When is progesterone good?
You may have heard progesterone often referred to as ‘the happy hormone.’ For most women, progesterone is good for mood because it converts to the neurosteroid we mentioned earlier known as allopregnanolone or Allo which calms GABA receptors in the brain. GABA is the brain’s off switch and primary regulator of mood. Allo, therefore, has sedative and anxiety-reducing properties similar to the action of alcohol and tranquilliser medications (3). Progesterone’s neurosteroid effect is why progesterone capsules are sedating and why times of high progesterone (luteal phase and pregnancy) cause sleepiness or calmness. (The progestin drugs of hormonal birth control we mentioned earlier do not convert to Allo and, therefore, are not soothing to mood.)
When is it bad and why is it bad for those with PMDD?
Recent studies show that those with PMDD may have an increased sensitivity to this particular hormone and experience increased activity in the emotional centre of the brain (4). For these women, Allo does not calm GABA receptors but instead can produce anxiety and other intense mood symptoms. It’s fascinating because women with PMDD have the same level of Allo but just have a different response to it because of a disturbance with the GABA receptors’ function. We like this analogy: much like some people drink alcohol and become happy, others become angry and depressed (5). Our bodies are dealing with the same hormones and the same levels of those hormones but reacting to them completely differently. The result, according to researcher Tory Eisenlohr-Moul, is ‘neurosteroid change sensitivity’ and the mood symptoms of PMDD such as anxiety or depression.
What does this mean and how can you make this information work for you?
As PMDD is extremely complex, a comprehensive evaluation of you and your symptoms is essential and should be carried out by an experienced doctor with an understanding of both mental health and hormonal imbalance. Typical treatments for PMDD include SSRI antidepressants to regulate GABA receptors, and/or hormonal birth control to shut down ovulation and, therefore, progesterone as a consequence. However, this is where the difference in naturally occurring progesterone and synthetic progestins come into play (aside from a whole host of other factors); if you decide to take birth control to combat PMDD, you may end up suffering from the side effects of that instead. The better approach is to stabilise GABA receptors such that you only experience the normal ups and downs of progesterone and not the rollercoaster ride that is PMDD during this phase in the cycle. Some natural treatments of PMDD include reducing histamine and mast cell activation which you can read about here. (link to histamine article) Others are taking magnesium and vitamin B6 to calm the nervous system and so help stabilise mood. No matter what you decide to do, knowing how progesterone affects your body and how to approach it is key.
As we see, naturally occurring progesterone can be great for a lot of women and, at the same time, the key trigger for mood related issues for those suffering with PMDD. In a similar vein, progestin may be detrimental to those without PMDD and may prove useful for those with it. As always, it never hurts to learn more about our bodies and how we react to certain hormones, chemicals, vitamins, minerals etc. We are not all the same and a one-size-fits-all approach to women without PMDD and even women with it will not do. While, collectively, these issues need to be recognised, individually we need to be treated. The next time you are speaking with your doctor, why not try asking about progesterone and seeing where it leads you?
- Hormone Health Network, “Progesterone and Progestins,” October 2019. Available at: Progesterone and Progestins
- Dr Lara Briden, “Why Progesterone Is Both Good and Bad for Mood (and How to Treat PMDD),” August 2020. Available at: Why Progesterone Is Both Good and Bad for Mood (and How to Treat PMDD)
- The Marion Gluck Clinic, “ Changing the Face of Premenstrual Dysphoric Disorder (PMDD) Treatment.” Available at: Premenstrual Dysphoric Disorder – Changing The Face Of PMDD
- Brauser, D., “Progesterone, Anxiety Affect Premenstrual Dysphoric Disorder,” October 2013. Available at: Progesterone, Anxiety Affect Premenstrual Dysphoric Disorder
- The International Association For Premenstrual Disorders (IAPMD), “Hormones & PMDD,” April 2019. Available at: Hormones & PMDD