Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects around 5-8% of menstruating women1. Among autistic women, the prevalence of PMDD is notably high, making the connection between autism and PMDD an important topic for discussion in women's health.
Studies have found that between 14% and 21% of autistic women2 deal with PMDD—so if you're navigating PMDD and autism, or trying to figure out if you may have both based on your history and symptoms, you're not alone.
In this article, we'll cover the overlap between these two conditions, their underlying causes, and potential solutions that can help you reclaim control over your mood, mental well-being, and reproductive health.
In this arcticle:
- PMDD and Autism: Why the Connection?
- Hormonal Imbalances and Histamine: The PMDD Trigger
- How Do I Know If I Have PMDD? Symptoms & Signs
- What About ADHD, Autism, and PMDD?
- Common Treatments for PMDD in Autistic Women: The Pros and Cons of Birth Control Pills & SSRIs
- Managing PMDD & Supporting Your Health Naturally
- Key Takeaways on Autism and PMDD
PMDD and Autism: Why the Connection?
Research suggests that autistic women are more likely to experience PMDD due to the unique ways their bodies process hormones and neurotransmitters.
Autism often comes with heightened sensory sensitivities and a predisposition to conditions3 like anxiety and mood disorders, which in some cases can amplify PMDD symptoms. One study even found that 92% of autistic women4 with learning disabilities experienced late luteal phase dysphoric disorder5 (an earlier term for PMDD) compared with 11% of non-autistic women with learning disabilities.
Additionally, issues with histamine, a compound involved in immune responses and hormone regulation, are increasingly recognized as a potential contributing factor to autism6, as well as PMDD among autistic women.
Elevated histamine levels in the brain can increase inflammation7 and contribute to neurotransmitter dysregulation8, which may exacerbate symptoms like anxiety, sensory sensitivities, and behavioral challenges in individuals with autism.
Histamine is also involved in the gut-brain axis, and many autistic people experience gastrointestinal issues that may further disrupt histamine processing and worsen autism-related symptoms.
Hormonal Imbalances and Histamine: The PMDD Trigger
The interaction between hormones like estrogen and histamine is believed to play a significant role in PMDD among autistic women.
Estrogen can increase histamine levels, leading to symptoms like headaches, anxiety before your period, and inflammation—which can be especially intense among those with PMDD.
Since autistic women often exhibit heightened sensitivity to hormonal fluctuations, this estrogen-histamine connection can create a perfect storm for PMDD.
How Do I Know If I Have PMDD? Symptoms & Signs
If you experience severe emotional and physical symptoms during the luteal phase of your menstrual cycle—the week or two before your period—that consistently improve after menstruation begins, you may have PMDD.
PMDD symptoms9 can include those that affect your mood, physical comfort, sleep, and mental performance, such as:
- Severe irritability or anger
- Depressed mood or feelings of hopelessness
- Anxiety, tension, or feeling on edge
- Extreme mood swings or crying spells
- Difficulty concentrating or focusing
- Fatigue or low-energy
- Loss of interest in usual activities
- Social withdrawal
- Breast tenderness or swelling
- Bloating or weight gain
- Headaches or migraines
- Muscle or joint pain
- Increased appetite or food cravings
- Insomnia or difficulty sleeping
- Oversleeping or feeling excessively tired
Looking at the list above, you can see that PMDD symptoms often overlap with those of autism, ADHD, and even bipolar disorder.
This is why it's important to track your cycle and consult with a knowledgeable healthcare provider for a proper diagnosis and treatment plan (you have to know which condition you're dealing with in order to properly treat it!).
Is PMDD a Disability?
For many women, PMDD can feel debilitating—so in some ways, yes, it's a disability. And since it has a significant mental health component, in some instances it is classified as a disability.
PMDD symptoms such as severe mood swings, irritability, and physical discomfort can disrupt daily life, work, and relationships. For example, PMDD can cause some women to miss work or school due to intense abdominal pain and other symptoms like anxiety, and generally to not feel like themselves for the week or two leading up to their periods.
Recognizing PMDD as a disability is an ongoing conversation within the medical community, especially when discussing its impact on people with co-occurring conditions, which can include autism or ADHD.
What About ADHD, Autism, and PMDD?
Autism, ADHD, and PMDD are interconnected in several ways, with overlapping symptoms, shared neurological and hormonal influences, and heightened challenges for people living with these conditions.
ADHD and autism frequently co-occur, with studies estimating that around 30-50% of women with autism also meet the criteria for ADHD. This overlap means many autistic women experiencing PMDD are also struggling with ADHD-related challenges, such as impulsivity, inattention, and executive dysfunction.
Shared Neurological Pathways:
Both ADHD and autism involve differences in brain function, particularly in areas that control emotional regulation, impulse control, and sensory processing.
These same areas are often affected by hormonal fluctuations during the menstrual cycle, leaving women with ADHD and autism more vulnerable to severe premenstrual symptoms, including PMDD.
Additionally, women with ADHD and PMDD both experience disruptions in neurotransmitters like dopamine and serotonin, which play key roles in mood regulation. For example, shifts in estrogen levels during the menstrual cycle can influence dopamine and serotonin activity, intensifying emotional dysregulation and sensory sensitivities.
Overlapping Symptoms:
- Emotional Dysregulation: Both ADHD and PMDD can lead to intense mood swings, irritability, and feelings of overwhelm, making it harder to distinguish between conditions.
- Cognitive Impairments: Difficulty focusing and concentrating is common in ADHD and can worsen during the luteal phase of the menstrual cycle in those with PMDD, creating compounded challenges for women with both conditions.
- Fatigue and Sleep Issues: Poor sleep quality, a hallmark of ADHD, may exacerbate PMDD symptoms, and vice versa.
Common Treatments for PMDD in Autistic Women: The Pros and Cons of Birth Control Pills & SSRIs
The most common treatment for PMDD is hormonal birth control, particularly pills containing progestin10. SSRIs are also used to manage PMDD. Here's a closer look at both options:
Birth Control Pills:
Birth control can help manage PMDD11 by regulating hormonal fluctuations that trigger severe premenstrual symptoms. Specifically, combination birth control pills provide a consistent dose of estrogen and progestin, which can stabilize mood and reduce the physical and emotional symptoms associated with PMDD.
By suppressing ovulation, birth control prevents the cyclical surge of hormones like estrogen and progesterone that contribute to PMDD. Some formulations, such as extended-cycle pills, allow for fewer menstrual cycles, further minimizing the hormonal shifts that exacerbate symptoms.
However, not all women tolerate birth control well. While the pill can help regulate hormone levels, many women with autism and PMDD find progestin intolerable due to side effects like mood changes and fatigue.
It is important to evaluate if this therapy works for you and while much of medicine will tell you this is the best option, know this idea is based on neurotypical research. At this time, we lack extensive research on interventions for autistic women, which means you should always honor what’s true for you when it comes to treatment options.
Selective Serotonin Reuptake Inhibitors (SSRIs):
Antidepressants for PMDD, such as SSRIs, are another option. Selective serotonin reuptake inhibitors (SSRIs) can help alleviate mood-related symptoms12, but they're not always a long-term solution for everyone.
Like other drugs, SSRIs can cause side effects that vary from person to person. For example, some people experience SSRI side effects like:
- Nausea or upset stomach
- Headaches
- Insomnia or drowsiness
- Decreased libido or sexual dysfunction
- Weight changes
- Increased feelings of agitation or anxiety
While medications including the pill and SSRIs can help control PMDD in some cases, another important approach is to work on addressing the root causes of hormonal imbalances and histamine sensitivity that contribute to PMDD in order to help provide lasting relief.
Managing PMDD & Supporting Your Health Naturally
For those who prefer a natural approach to managing PMDD and its overlap with autism—or one that includes both medication and lifestyle changes certain diet changes, habits, and tweaks can often make a significant difference:
1. Focus on Hormone-Balancing Nutrition
Nutrition plays a foundational role in hormonal balance and mental health. Consuming the right foods can help stabilize hormones, reduce inflammation, and alleviate PMDD symptoms.
- Prioritize anti-inflammatory foods like leafy greens and other veggies, berries, nuts, seeds, legumes, and fatty fish.
- Incorporate seeds, such as flaxseeds and pumpkin seeds, which support hormone production.
- Avoid processed foods, added sugars, and trans fats, which can exacerbate inflammation and hormone imbalances.
- Stay hydrated and ensure regular meals to keep blood sugar stable.
- Limit caffeine and alcohol to help balance blood sugar and get restful sleep.
2. Support Histamine Metabolism
Histamine sensitivity is a common issue in PMDD and autism. By managing histamine levels, you can reduce symptoms like headaches, irritability, and bloating.
- Choose low-histamine foods such as fresh fruits and vegetables (except for citrus and spinach).
- Avoid aged, fermented, or processed foods like cheese, cured meats, and alcohol.
- Include natural antihistamines like quercetin (found in apples, onions, and capers) in your diet.
- Support gut health with probiotics, prebiotics, and fiber to improve histamine degradation.
3. Track Your Cycle
Understanding your menstrual cycle is key to identifying patterns and predicting symptoms. Awareness also allows you to prepare and implement timely interventions.
- Use a cycle-tracking app or journal to log physical and emotional symptoms daily. Keeping detailed records of symptoms can help identify patterns and phases when PMDD symptoms are most pronounced.
- Adjust your diet, supplements, and self-care practices to align with your cycle.
- Share your cycle data with your healthcare provider to guide treatment decisions.
4. Manage Stress and Prioritize Sleep
Stress directly impacts hormone regulation and PMDD symptoms. Reducing stress levels can help balance hormones and improve cognitive health.
- Practice mindfulness techniques like meditation or yoga daily. Techniques like mindfulness, yoga, or cognitive behavioral therapy (CBT) can aid in emotional regulation and stress reduction.
- Engage in light physical activity, such as walking or stretching, to release tension.
- Set aside time for activities that bring joy and relaxation, like hanging out with friends or doing something creative.
- Establish a bedtime routine to promote restful sleep, as poor sleep increases stress. Aim to get 7 to 9 hours of sleep each night.
- Find support networks, such as working with specialists familiar with neurodivergence and hormonal health and/or speaking with others online who have the same conditions to share tips and support.
5. Consider Supplements
Targeted supplementation can help fill nutritional gaps in your diet and alleviate PMDD symptoms. Always consult your doctor before starting new supplements.
- Take magnesium to reduce cramps, mood swings, and headaches.
- Incorporate vitamin B6 to support neurotransmitter balance and relieve irritability.
- Use calcium supplements for supporting mood stabilization and physical symptoms.
- Consider herbal remedies like chaste berry or evening primrose oil for hormonal support.
- Saffron in supplement form can help with improving mood, in some cases.
For more PMDD solutions, please read this article.
A Comprehensive Solution: The Period Problems Solution
If you're ready to take control of your menstrual health, the Period Problems Solution program offers a natural, holistic approach to managing conditions like PMDD. This program helps you:
- Identify the root causes of your symptoms
- Balance your hormones through tailored nutrition and lifestyle changes
- Alleviate discomfort with evidence-based natural remedies
With tools like customized meal plans, cycle tracking resources, and expert guidance, this program is designed to empower you to achieve predictable, pain-free periods.
Key Takeaways on Autism and PMDD
- Hormonal fluctuations during the menstrual cycle may exacerbate sensory sensitivities and mood changes in autistic women, making them more susceptible to PMDD.
- The compounded effects of autism and PMDD (and sometimes ADHD, too) can lead to heightened emotional distress, functional impairments, and difficulty managing daily responsibilities.
- ADHD and autism symptoms, such as mood swings and sensory sensitivities, can also mask or mimic PMDD, delaying proper diagnosis and treatment.
- PMDD and autism can feel overwhelming, but they don't have to define your life. By understanding the unique interplay between hormones, histamine, and autism, you can start implementing strategies (like diet changes and taking supplements) to support your well-being.
References
- https://www.health.harvard.edu/blog/premenstrual-dysphoria-disorder-its-biology-not-a-behavior-choice-2017053011768 ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9344571/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4860203/ ↩︎
- https://journals.sagepub.com/doi/10.1177/147323000803600208 ↩︎
- https://pubmed.ncbi.nlm.nih.gov/18380936/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC5534955/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7309953/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8317266/ ↩︎
- https://www.ncbi.nlm.nih.gov/books/NBK532307/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9066446/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9066446/ ↩︎
- https://www.ncbi.nlm.nih.gov/books/NBK532307/ ↩︎