PMDD Antihistamines: Why They May Help — and Why Histamine Isn’t the Whole Story

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Dr. Brighten: It sure seems like everyone and their mother is talking about antihistamines like Allegra and even Pepcid for PMDD right now. And I asked you what you wanted to know and your questions were very clear. Here are the questions I'm going to be answering in this episode.

Can you explain the whole PMDD? Could be a histamine response thing. What are your thoughts on the Allegra Pepcid thing that's been circulating? Is there any natural relief? And how do I tell if I have PMDD and not PMS? 

So today on the Dr. Brighton Show, and hi, by the way, this is your host, Dr. Jolene Brightner. We're gonna get into all of this. But before we do, I wanna make sure that you don't miss out on this because if you're struggling with PMDD, I don't want you stuck guessing. I am a PMDD girly myself, and it's no coincidence that I also have endometriosis, ADHD, and autism.

Now, for a limited time, when you pre-order my book, ADHD in Women, you're gonna get access to my live PMDD workshop [00:01:00] that's happening June 10th. In that training, I'm going to help you identify your PMDD pattern, understand how ADHD, histamine, and hormones are interacting in your body.

And we're gonna map out what to do in each phase of your cycle, but I'm also gonna walk you through supplement strategies, what to talk to your doctor about, including dosages, and I'll be answering your questions live. Now, if that sounds good to you, go to drbrighten.com/pmd. Grab a copy of ADHD in women, where I have an entire chapter on PMDD just for you, and then you'll also get access to the June 10th workshop. 

okay, so I'm actually gonna start with the question I've been asking, and that is, if PMDD affects millions of women, why in the hell are there only nine active NIH funded studies going on right now? Now, PMDD, premenstrual dysphoric disorder, that's anticipated to affect anywhere from three to 8% of menstruating women.

Some research says it's as [00:02:00] high as 10%. And since medicine is absolutely awful and not gaslighting women and believing them, that 10% may even be an underestimate.

And while someone will definitely comment, 3%, that's not a lot of women. No, that's millions of women. That's actually a lot of women. And so despite that, we've got limited research, limited treatment options, and a lot of women are being dismissed. So what happens when medicine doesn't give clear answers?

Women start experimenting because PMDD, and we're gonna talk about the symptoms in this episode. We're gonna talk about how to tell if it's PMS or PMDD, but I want you to understand that PMDD is so severe, the self-harm rate is so high that women are literally doing anything they can to remain on this planet with us.

And I think anyone out there looking at you, mainstream media, judging women and saying, "Oh, they're using antihistamines, these dumb women just following a TikTok trend." Like, you should slow your role, because what we're not talking about is why the hell don't we have more research studies going on? Why is it so [00:03:00] underfunded?

And why do we act like women's lives are so expendable? Women are literally doing anything they can to stay with us. And I think we need to pause and we need to listen.

Now, the antihistamine conversation is not new. Hi, I have endometriosis, PMDD. We've been talking about this for years now, and I think the first time I saw people on social media was, like, five years ago. Women started trying it, it started working, and that's exactly how something like antihistamine suddenly became a trend.

B- but here's the thing, trends don't come out of nowhere. If it wasn't working, no one would be talking about it. So there's a biological reason this works for some people. And that now brings me to your question, which is,

can you explain the whole PMDD? Could be a histamine response thing. Okay, so here's the truth. Yes. Histamine can be involved in PMDD. I write about histamine all throughout ADHD in women because [00:04:00] it is acting as a neurotransmitter, but histamine alone is not the whole story. If histamine had nothing to do with PMDD, antihistamines wouldn't help anyone. We're gonna talk about, uh, antihistamines and the Pepcid H2 blocker in this episode as well. So stick around for that. Now, histamine is part of your immune system, but it's also playing a role in inflammation in the brain, neuroinflammation, brain signaling, our mood.

It can disrupt our sleep at night, and estrogen increases histamine release. So during certain times of your cycle, especially when your brain is already more sensitive, histamine can be amplifying your anxiety, your irritability. We see the perimenopause rage that can come with that, and even perimenopause, sleep disorders, insomnia, brain fog, that can be part of the PMDD picture.

Now, in your cyclical gears, this is hitting you like seven, 10, maybe 14 days out of every month. Put it in perspective, y'all. That is six months out of every [00:05:00] year. And we got nine research studies active right now, actively being funded by the NIH. I don't think so. That is lame. If you are in perimenopause and you have PMDD, this can become a lot more unstable and unpredictable, and the rage can be amplified. Now, you add on top of that, having ADHD or autism, which is commonly associated with emotional dysregulation, and ADHD in autistic brains have a propensity towards throwing histamine, having histamine issues.

We see a lot of MCAS being involved in this, um, which is mast cell activation syndrome. We see histamine intolerance, but there's also this underlying neuroinflammation that's already happening when you have a neurodevelopmental condition.

And when you have a neurode- developmental condition, you are also more hormonally sensitive. And so the same shifts that another brain experiences, the normal hormone shifts throughout our cycle, you know, as it turns out in the research, it's actually not that bad if you're [00:06:00] neurotypical, but if you are neurodivergent, in that camp, things swing wildly.

And we see that roughly around 50% of those with ADHD in one survey, they reported having concomitant PMDD, and over 90% of those who are autistic report having concomitant ADHD. So there's something going on here, and it is very much related to the full body experience, which is being a, a neurodevelopmental condition.

And that, I know, is a reframe for a lot of people because ADHD is always like, "That's a brain condition. That's a psychiatric condition. Hate to break it to you. " It's a full body condition, which is why in my book, I was like, "We gotta go through all the systems here."

Now, the other thing I will mention is endometriosis. So endometriosis, those lesions tend to be rich in mast cells, and I like to joke that if you, like, look at them wrong, they just degranulate and they dump histamine. And so we see women with endometriosis reporting more symptoms of PMDD. We do not have research at this time [00:07:00] to say, "Oh, endometriosis, PMDD, they go together like besties," or anything like that.

But we do understand, and if you just listen to women, that women with endometriosis experience more PMDD-like symptoms. And all of this, the ADHD, the PMDD, the endometriosis comes down to inflammation, immune signaling, and definitely those histamine pathways. So when someone takes antihistamine and then they feel better, that is because histamine is involved, but it's not the full picture of PMDD.

And I want you to understand that. We're also gonna go through some warnings here of why that is not a good idea as a long-term treatment.

Now, another question you asked me was, what are my thoughts on the Allegra Pepcid thing that's been circulating? So Allegra, that is an antihistamine. Pepcid is an H2 blocker. The antihistamine's working on the H1 system. I'm gonna break that down a little bit more, but what I wanna share with you is that when I was going through infertility treatments, it [00:08:00] was my fertility doctor who recommended doing a combination of H1 and H2 blockers.

And the reason why they recommended that is because of the history of adenomyosis and endometriosis, there can be higher levels of histamine. Histamine is inflammatory, it can, um, affect how implantation happens. And what I noticed with that is that, yes, my symptoms of endometriosis, they did mildly improve.

It wasn't a complete game changer for me, but it was also something as well that when I went through my miscarriage, which was a second trimester miscarriage about a year ago, and I went through grief, as one does, I was in a really dark place, but then months later, cyclically, what started to move in was that dark cloud that I remember of PMDD, and I realized my old friend was back.

And I was mana- I had managed PMDD very well through my life, and then following [00:09:00] the, the, the pregnancy loss, this is a very inflammatory state to be in, not to mention where my mood, my mental health was. And I was like, "I gotta get relief ASAP," and I used the combination, I used Claritin and H2 blocker, Pepcid, and taking both of those gave me relief, but I didn't stay with that long-term.

I am not on antihistamines now, and we're gonna be talking, this is gonna be a two-part episode, but we're gonna be talking about more layers. And in the workshop, I'm gonna take you through things of ways to approach, uh, PMDD so that you're not beholden to antihistamines. Antihistamines are not a root cause approach.

They can be a lifesaving approach for some people, but I got a lot more to say on this.

So firstly, a lot of people will get relief with just using the antihistamine, the H1 blocker. So histamine is like a signal that your immune system sends, but your body has different receptors for that signal. And H1 receptors are what most people think [00:10:00] of with allergies. So that's what most people think of when they think about histamine.

They think about the itching, the hives, maybe the stuffy nose, the watery eyes, the swelling that can happen. If you're really histamine sensitive, maybe you drink wine, you have flushing and for some people, they have a more wired and reactive filling. So that's the H1 receptor. The H2 receptors are found heavily in your stomach, and they are responsible for your stomach acid production. Already, if you understand that, you understand why this is not going to be a long-term solution, and if you don't, don't worry, we're gonna get there.

But the H2, it also exists in immune cells and blood vessels. So Allegra, that's going to block the H1 receptors. So remember the itchy, the swelling, the watery eyes. Pepcid blocks the H2, which is involved in digestion, but also some of the immune cells as well. And that means using [00:11:00] both can reduce histamine signaling by affecting multiple pathways, not just one.

And that's why some people try, um, an antihistamine and they're like, "That's not enough. I have to add Pepcid," because they have to hit both pathways.

But here is something so key that I need you to understand, and that is blocking histamine receptors is not the same as fixing why your body is releasing histamine in the first place or not clearing it. So antihistamines, those are symptom control. They're not root cause. It's like putting on noise canceling headphones while a fire alarm is going off.

Um, but maybe that's not even a fair analogy because in a lot of ways, it does help. You do feel better, right? So if I put on noise canceling headphones and there's an alarm, I feel better, but the alarm is still there. So we can always use things to help you get symptom relief while we work on the root cause of things.

But I don't want anyone hearing this and being like, "Antihistamines for life." Now, [00:12:00] before you go and grab whatever histamine you have at home, I wanna talk to you about something really important because not all antihistamines are created equal. And if you are reaching for Benadryl, that's a first generation antihistamine, and I never recommend this, okay?

Because Benadryl crosses into the brain, and it has anticholinergic effects. That means it interferes with acetylcholine. Acetylcholine is a neurotransmitter that's involved in your memory and your cognition. My perimenopausal women, my ADHD women, I need you to listen up. You have acetylcholine problems.

You don't wanna compound that by adding in Benadryl. So long-term frequent use of medications like Benadryl, those have been associated with an increased risk of cognitive decline and even dementia. So Benadryl, we ain't reaching for that, okay? You wanna talk to your doctor about alternatives to that.

Now, I [00:13:00] just wanna be clear that, like, because I just said this, that doesn't mean if you one time took Benadryl, that it's dangerous or that an occasional use, like, you're like, "I got stung by a bee. I needed it. " Like, that doesn't, like, seal the deal that you're gonna get dementia. It is regular, consistent.

And how are women with PMDD using it? Cycle after cycle after cycle, sometimes for two weeks at a time. That's six months out of the year. That is not something that any doctor who understands the research would recommend. Now, second generation antihistamines, Allegra, Zyrtec, Claritin. Those have a different profile, but even those, we still need to zoom out and we need to look at the bigger picture because the reality is, there is no study for PMDD and antihistamines.

We need that research. There's clearly a mechanism here, but we don't know the long-term impact if you are using that three to six months out of the year. Now, the other question I think is really important and goes along with this is, is there [00:14:00] any natural relief? Yes, but it also has to be targeted. So if histamine is part of your PMDD story, then vitamin C that can support histamine breakdown, DAO enzyme, that's the enzyme that exists to break down your histamine, that can also help.

But I also wanna talk about safron here, and specifically Afron. Now, if you know the radiant mind story of this formulation I created, it's because of my struggles with PMDD and what I knew what was coming down the pipeline for me in menopause, because I did Lupron, and I got a little, like, preview, like a movie clip roll of, like, how hellish that was going to be for me, and I was like, "Ah, absolutely not.

So that's why I designed this formulation.

Now, why this particular form of saffron matters is that it has been studied in PMDD. There was a randomized control trial where PMDD women, they were assigned to saffron, fluoxetine, or placebo, and during the luteal phase for two menstrual cycles, that's what they took. [00:15:00] Saffron group used 15 milligrams twice daily, so it's 30 milligrams in a day.

Both saffron and fluoxetine reduced PMDD symptoms compared to placebo. So when I mentioned Radiant Mind, which you all know I take, it's not just take something for your mood. I'm saying there is evidence that saffron may support mood, irritability, emotional symptoms, it helps with libido, it helps with sleep, it helps with hot flashes, but that doesn't mean that saffron is a replacement for medications, okay?

Supplements are designed to support your natural physiology. They're not designed to treat disease. And I think that's just a really important caveat because I would never want someone to be like, "SSRIs are saving my life, but Dr. Brighton talked about saffron, so I'm gonna jump off that and use saffron instead."

That's a conversation to have with your prescriber. There's a lot of things that can help with PMDD, and I'm gonna go through them in the workshop with dosages, because I know you can ask clarifying questions, and I feel like [00:16:00] that's a more responsible way to do it so I can help you have a productive conversation with your provider. But the reality is, is throwing the kitchen sync at PMDD and just hoping for the best, that doesn't always work.

And so we have to talk about, like, the exact things. And this is a two-part episode. In part two, I'm gonna also talk a lot more about SSRIs and birth control, but in this episode, I wanted to make it more in the theme of histamine since that is what's circulating, and I've gotten so many questions about it.

Now, to answer the question, like, is it PMDD or is it PMS? Like, how do I tell if I have PMDD and not PMS? So if you don't know which one you're dealing with, you certainly can't treat it correctly, because in PMS, we often need more progesterone. In PMDD, the level of progesterone, that's not necessarily gonna get as positive effect as it does with PMS.

Now, PMDD is defined by a very specific pattern. Those symptoms show up in the luteal phase that is after [00:17:00] ovulation, and then within starting your period, they go away. So they, they improve shortly after starting your period. Premenstrual exacerbation, that is when you have depression that is consistent, but then it gets worse before your period.

That's different from PMDD. PMDD is very luteal face specific as is PMS. But with PMDD, you also need at least five symptoms and at least one must be mood related.

So that's gonna be things like irritability, anxiety, depression. So a lot of mood symptoms are going on with PMDD. You can also have really severe mood swings. Like one minute you're so happy and the next minute you're crying. But the biggest distinction between PMS and PMDD is that PMDD impairs your ability to function.

It's not just feeling off, it's not just feeling like I will ... I'm a little bit sad, a little bit weepy when that one commercial comes on. [00:18:00] PMDD is a, I don't recognize myself, I can't function the way I normally do. A dark cloud has moved in. The way I have always described it, it feels like to me is I can see how great my life is on the other side, but there is a window between me and my life, and I cannot reach through.

I cannot touch it. I cannot feel it. I cannot be grateful for it or get to it. I'm stuck. I'm stuck on this other side, and it sucks. It's the worst.

So in addition to the mood symptoms, we also see lack of concentration. That can be difficult when you have concomitant ADHD going on to differentiate it, but you have these severe, severe impeding your life level of mood symptoms. There can also be physical symptoms, so joint pain, uh, muscle aches, you may have fatigue, you may have increased cravings, you may have symptoms that look a lot like disordered eating.

You [00:19:00] can have severe fatigue despite sleeping and then also wanting to sleep all the time. So track your symptoms because there's a lot of symptoms that fit into PMDD's umbrella. Track your symptoms and then make sure that you're following them throughout your cycle for at least two months to take them to your doctor.

So that brings me to the question of how do I get a doctor to listen?

Now, I will say there is no test to confirm PMDD. There's no blood work. There's no hormone test. There's nothing like that. And most women aren't getting dismissed because their symptoms aren't real. They're getting dismissed because the pattern isn't clear and it hasn't signaled to the doctor that, like, this is a pattern, or your doctor may not believe in PMDD.

That's real, okay? I wrote all about it in my book about how PMDD was pharma initiated, so that pharma could sell us one particular drug for this and get an FDA approved. That's all real, but because of that, that's made some [00:20:00] doctors believe that PMDD is not real. Although as someone who lived it and experienced it before it was even recognized before it was even a diagnosis, before it was an ICD 10 code or DSM criteria condition, like I had it, it's real.

So I want you to know, just because, like, pharma was like, "Hey, we can make some money off of this condition," doesn't mean the condition is not real.

So the biggest advice I would give you is that if you need to get diagnosed with PMDD, you're like, "I have this, I need to get a diagnosis, I need to get help." You gotta track your symptoms, and you do it alongside your cycle, and you have to do it for at least two cycles, and you're tracking everything.

What's your mood doing? How's it impacting work? How's it impacting your relationships? How's it impacting school? How is it impacting your physical capacity? Can you even work out? Are you sleeping 12 hours a day? When you bring that pattern, that should change the conversation. And if it doesn't, then that provider, they weren't really ever gonna help you anyways.

And that sucks. And I hate to say that. And sometimes it's like, oh, I can say, like, go see another [00:21:00] provider, but is it really that easy? Is it really that easy in women's medicine? It's not. So how do you find a provider? Start getting into forums. Start getting into chat groups, like they have them on Reddit.

Ask in the comments, certainly on my Instagram posts, um, on this YouTube video, if you have a provider who's great, drop their name and their location. You never know whose life you're gonna save, but just by sharing, like, this doctor will listen to you.

Now, when it comes to antihistamines and Pepcid, women are typically using these for half of the month or five days before they expect their symptoms to hit. So they are tracking their symptoms and then they're like, "Okay, five days before, I'm gonna start the antihistamines and p- possibly the Pepcid." Now, I talked about some of the problems with the antihistamines, but what I wanna note about Pepcid is that it is very real that if we are lowering your stomach acid, that can affect your digestion, that can affect gut motilities, so that could set you up possibly for [00:22:00] infections.

Your stomach acid is a barrier for things that are coming in, and it can also lead to nutrient deficiencies. You're not able to liberate minerals, you're not able to liberate B12 as easily, and so being on Pepsi long-term isn't an answer for PMDD.

And that may be frustrating to you because you're like, "But this is actually working." You gotta talk to your doctor. So I'm a doctor, I'm not your doctor. You can't listen to this episode or women on social media and then be like, "Okay, I'm just gonna take antihistamines and Pepcid for the rest of my life."

That, that is playing with fire. We just don't have the data to say that is safe. And like I said, histamine is only one part of the picture. In episode two, we're gonna go even deeper on this. But what I want you to understand is that these medications, while they can be helpful, they're not without side effects.

So while women are following just the standard dose on the package because these are over the counter and they're using those [00:23:00] and they're reporting success. And I believe these women, I have also experienced it with these antihistamines. We've gotta ask the question, "Well, why? Why are you struggling with olisistamine?

Did we miss endometriosis or adenomyosis? Could that be going on? " Do you have gut dysbiosis? So the gut we're gonna talk about in episode two can be playing a role here. Is it a situation where your mast cells are really unstable? We need to stabilize them. Is it a situation where you're not clearing estrogen effectively and estrogen is stimulating those mast cells to release histamine, and then histamine is stimulating your ovaries to make more estrogen?

We have to go deeper and ask why because while the compensa- compensation with an antihistamine may work in the short term, I have had people come to me who are like, "I started the antihistamine thing and I was on it for years and then it stopped working and things got worse." Well, we were using a bandaid approach rather than getting to [00:24:00] the root cause, and I am not against a bandaid approach, okay?

I am a big fan, like, right? If we, if we are thinking about self-harm, if we may injure ourselves, like, I don't think it's a bad idea, whether that is, uh, antihistamine, the go- to, which is SSRI, maybe birth control actually works for you. We're gonna talk about the details on that in episode two, but I'm not against that because I think short-term acute care has a place, but we wanna long-term be thinking about how do we effectively address the root of what is going on for you.

Now, if you want help in doing that, that's exactly what we're gonna do in the live PMDD workshop that's happening on June 10th. When you pre-order ADHD in women, you're gonna get access to that workshop complimentary to you.

You go to drbrighten.com/pmd. And I'm gonna walk you through PMDD, ADHD connection, and we're gonna go through your phases of your [00:25:00] cycle and what to be doing because we wanna be addressing PMDD issues before we arrive to the luteal phase, because once we're there, it's very hard to do the self-care that is necessary when you're experiencing PMDD.

Well, also talk about exact supplement strategies, how to talk to your doctor about different prescriptions that might help you.make sure you're subscribed to the Dr. Brighton Show. There is a second episode coming on PMDD. We're gonna talk about why treatments fail. So if you're someone who's like, "SSRI didn't work for me, birth control didn't work for me, like, what is going on?

I'm gonna go into that deeper. I'm gonna go over the research with you and definitely come prepared to take notes because this is gonna help you advocate a little bit more with your doctor. Now, as always, share, like, comment, subscribe, show this podcast and love so that we can get this information out to more women, help empower them to take charge of their health, and also hopefully change medicine for the better.

And thank you so much for spending your time with me. I, as always, love your questions. You guys guide the [00:26:00] conversation, so please drop me a comment, let me know what you'd like to hear more of, or what was helpful in this episode. I will see you next time.