Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Symptoms can include:

• Extreme irritability or mood swings
• Anxiety
• Depression
• Low energy
• Trouble sleeping
• Changes in appetite
• Headaches
• Bloating

Medical cannabis may help relieve some of these symptoms.

What is premenstrual dysphoric disorder (PMDD)?

Menstruation is the monthly process when the uterus sheds its lining. As the uterus sheds its lining, the muscular organ contracts, sometimes resulting in painful cramps called “premenstrual syndrome” or “PMS.” PMS is a common condition that affects up to 90% of women in their childbearing years. Other than cramps, symptoms include mood swings, fatigue, irritability, anxiety, headaches, bloating, stomach pain, nausea, acne, and breast tenderness.

Approximately 1 in 20 (5%) women experience severe symptoms called PMDD. Women who have PMDD may have higher levels of prostaglandins, a group of lipids made at sites of tissue damage or infection that are involved in processes such as inflammation, blood flow, and the formation of blood clots. Higher levels of prostaglandins can cause more severe menstrual cramps, and intense contractions may constrict the blood vessels around the uterus.

Those with higher levels of estrogen may also suffer from higher levels of menstrual pain, as higher levels of estrogen can create a thicker uterine lining. When this lining breaks down, more prostaglandins are released, resulting in more pain.

However, other evidence shows that those with PMS or PMDD have low or normal levels of estrogen. The problem is a miscommunication between estrogen and the brain or dysfunction in the production of the hormone estradiol. It would seem that there are a variety of paths that cause PMDD, including serotonin fluctuations and withdrawal from some drugs.

Brief Summary of Current Treatments

Usually, the most common treatments include a diet rich in iron and flavonoids, exercise, ibuprofen, and antidepressants. However, regularly using NSAIDs like ibuprofen can wreak havoc on a person’s kidneys and digestive system.

How Might Medical Cannabis Help?

There is a need for a well-tolerated, natural medication that can help treat the various aspects of PMDD, and cannabis could be one of them. Tetrahydrocannabinol (THC) can help beat nausea and cramps, while cannabidiol (CBD) may help regulate mood, and both cannabinoids have anti-inflammatory and analgesic effects when used together.

CBD can relieve pain by inhibiting COX-2 enzymes and activating vanilloid TRPV1 receptors. THC can help ease cramps and distract from the pain. The terpene beta-caryophyllene also has pain-relieving and anti-inflammatory properties.

There is no evidence that THC or CBD affects prostaglandin production, so it is not clear how medical cannabis directly relieves menstrual pain. Medical cannabis may, however, provide therapeutic effects for some of the symptoms associated with PMDD. Many women with more severe forms of PMDD find current treatment methods inadequate, and new medications and treatments are required.

Cannabinoids

Both THC and CBD may be beneficial for their anti-inflammatory and pain-relieving effects.

Cannabinoid Ratios

• THC:CBD 1:18
• THC:CBD 1:9
• THC:CBD 1:3
• THC:CBD 1:1

Terpenes and Terpenoids

Terpenes such as myrcene and linalool may help for relaxation, while eucalyptol, pinene, and limonene may help improve mood. Beta-caryophyllene has painkilling and anti-inflammatory properties.

Flavonoids

Various flavonoids could provide relief from PMDD. Daflon, which is a mixture of 90% diosmin and 10% hesperidin, may be especially helpful. Other flavonoids in cannabis that could be helpful include:

• Quercetin
• Luteolin
• Anthocyanins

Effective Ways of Taking Medical Cannabis for Premenstrual Syndrome

Routes of Administration

• Topical
• Sublingual
• Ingestion
• Suppository

Special Formulations

A mixture of THC, CBD, beta-caryophyllene, linalool, eucalyptol, pinene, and limonene may be helpful.

Dosing Methods

• Topicals, salves, and other cosmetic products
• Oil-based tinctures
• Edibles
• Bathing products such as specially-formulated bath bombs and soaps
• CBD and THC-lined tampons

What are the Pros and Cons of Taking Medical Cannabis for PMDD?

Potential Pros

• May relieve breast pain and tenderness, which is caused by an increase in progesterone production during the menstrual cycle’s luteal phase.
• Some products may be beneficial for PMDD. Cannabinoid-laced tampons reduce and possibly treat cramps and lower back pain.
• May reduce migraine.
• Acne is a common feature of PMDD, and cannabis may help treat it.
• Cannabinoids such as CBD may help act as a mood stabilizer, while terpenes such as linalool and limonene may work as a stress-buster.
• Helps treat insomnia.
• TRPV1 and calcium ion channels are said to be associated with menstrual bleeding, and desensitizing it may help beat any pain associated with PMDD.

Potential Cons

• THC may increase breast tenderness in some.
• Smoking any substance can worsen migraines, and cannabis smoke is no different. Cannabinoids may treat headaches and migraines in some but have a neutral or negative effect on other sufferers.
• Much of the evidence is anecdotal, and most of the science so far for cannabis’ therapeutic potential for PMDD is theoretical.

Useful Anecdotal Information

Dobrogosz, Hannah. “I Tried CBD Products To Help With My Period Symptoms, And WOW.” BuzzFeed, Jun. 2, 2021

Russell, Marley. “I Tried 7 Cannabis Products For Menstrual Cramps.” Bustle, Dec. 21, 2016

Scientific Data Overview and Studies

• Total Studies = 5
• Positive Studies = 4
• Inconclusive Studies = 1
• Negative Studies = 0
• 4 Meta-Analyses (all positive); 1 Double-Blind Human Trial (positive)
• The double-blind trial included a formula that included a blend of linalyl acetate, linalool, eucalyptol, and β-caryophyllene.
• Possible Overall Efficacy: Moderate

Quotes from Studies

“One can use it, and it is being used off label now at various places, but there is no clear evidence in medical studies thus far that it helps. Theoretically, CBD oil should help as a co-analgesic, meaning it can be used in addition to regular pain medication to help. However, studies have shown that CBD and THC used in low doses improve the pain scale only by 0.5 ( on a scale of 1-10). So … there are theoretical benefits but no clear data to support the benefits yet.”

Source: Carlos, Drew, “Can You Use CBD for PMS?” Sunday Riley, March 29. 2019

Conclusion

Although most reports are anecdotal, there is good evidence that medical cannabis can provide some measure of relief for women going through PMDD. More research is merited.

Related Articles

THC Tampons: Gimmick, or Legitimate Way to Treat Menstrual Pain?

Can Cannabis Help Relieve Menstrual Cramps? 

Medical Marijuana Card Qualifying Conditions That Primarily Affect Women

How Many Women Use Marijuana? More and More Everyday

Endometriosis and Medical Cannabis

Cannabis and Endometriosis: How CBD and THC Can Help

Acne and Medical Cannabis

Post-Partum (Postnatal) Depression and Medical Cannabis

Please note: the information in this article does not constitute medical advice

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