Premenstrual Syndrome (PMS)

Premenstrual syndrome or PMS is a syndrome which is comprised of a broad range and complex combination of mental, physiological and environmental issues. It is mostly characterized by a host of recurrent psychological, gastrointestinal, reproductive and general signs and symptoms of discomfort in the 7-14 days leading up to menstruation, ie the luteal phase.

Such symptoms vary from person to person, and include but are not limited to:

• Mood swings 
• Change in personality
• Nervousness 
• Anxiety 
• Irritability 
• Depression
• Lethargy
• Fatigue 
• Altered libido 
• Cravings (especially sugar)
• Change in appetite
• Bloating (especially in the abdominal area)
• Diarrhea and/or constipation
• Uterine cramping
• Tender breasts
• Skin breakouts (acne)
• Headache
• Backache 

Between 30-40% of menstruating people, especially those in their 30s and 40s are estimated to experience PMS, with most reporting mild symptoms; though for some they can be severe. It is important to note here the tendency of most people to underreport their discomfort. 1-2% of the population however will report symptoms so severe that it qualifies them for a diagnosis of Premenstrual Dysphoric Disorder (PMDD). It seems that there is no difference in symptoms across varying ethnicities and cultures, which is interesting to note as well. 

PMS affects the quality of life of most menstruators of reproductive age in some way or another, albeit to varying degrees. If the average person’s luteal phase lasts for 10-14 days, that means that some of us are spending up to half of our monthly cycle feeling not like ourselves. This has an effect on our relationships, work productivity and quality of life in general. 

There is an element to PMS that is somewhat natural, as there is an inevitable ebb and flow to a menstruator’s monthly cycle which will change the way they feel both energetically and psychologically from week to week. That said, it does not have to be a negative experience, and it should not cause the extreme suffering that it does. When beginning to look at PMS and considering how it might be addressed, it is helpful to have an understanding of this rhythm and how we can expect it to affect the way we think and feel throughout the month. 

Phase 1 – Follicular Phase (7-10 days) – Estrogen and progesterone levels begin to rise. This is when most women tend to feel their most positive, energetic and social. 

Phase 2 – Ovulatory Phase (3-4 days) – Estrogen begins to peak while testosterone and progesterone continue to rise. Energy is typically still high at this point. 

Phase 3 – Luteal Phase (10-14 days) – Estrogen and progesterone rise. This is when PMS symptoms arise. Energy is typically lowered in this phase, and one might feel more inclined to spend time alone. 

Phase 4 – Menstrual Phase (3-7 days) – All hormones are at a low, and while the mood might have improved the body will still feel somewhat lethargic. It is a good time to focus inward. 

The cause of PMS was once looked at from the somewhat simplistic perspective of an inappropriate ratio of estrogen to progesterone in the luteal phase and the symptoms that occur as a result. While this can certainly play a role there are several other bodily systems and behaviors that will have an affect on the severity of this imbalance, which is to say that dramatic, quality of life reducing symptoms might be indicative of imbalances elsewhere, and are not necessary to grit one’s teeth through every month. 

In fact, healthcare practitioners will rule out other conditions with PMS-mimicking symptoms before making a diagnosis, due to the broad range and individual-specific nature of PMS symptoms. One such condition is hypothyroidism, which is said to affect a large number of women with PMS. 

Essentially, there is no consistent set of imbalances responsible for PMS but rather a unique set of them for each person. For this reason, the syndrome actually lends itself perfectly to an integrative and lifestyle-based approach. Diet, exercise, stress management and mindset play such an integral role in fact that by addressing these one will likely inadvertently end up improving her overall health, vitality and quality of life in general. By learning to tune in with the natural rhythm of her cycle she may also improve her relationship with her body. 

If narrowed down the most apparent areas of concern and causation seem to be the following: 

Diet – There is a rapidly growing body of evidence to support the link between nutrition and PMS. It seems that women who eat a standard American diet with an excess of processed foods, ie sugar, carbs and damaged/saturated fats, and inadequate amounts of protein and vegetables tend to experience PMS. Caffeine is also indicated, though not necessarily a cause but can certainly exacerbate symptoms, especially those involving anxiety, irritability and gastrointestinal issues. 

Brain Chemistry – Depression is one of the most common features of PMS, and one that is most commonly reported. Those who suffer with depression in general also tend to report it being worsened in their luteal phase, likely due to the natural decrease in serotonin during this time. Endorphins also play a role in PMS, as it seems that estrogen excess has a negative effect on endorphin levels.

Estrogen Metabolism – Estrogen excess seems to be a huge contributor to PMS symptoms, which points to liver detoxification and gut health. A diet low in healthy protein, fats, complex carbohydrates and plants, especially leafy greens and cruciferous vegetables and high in refined sugar and carbohydrates will not be conducive to optimum liver detoxification or a healthy microbiome. This makes it difficult for the body to flush out excess estrogen, eventually causing estrogen dominance and an increase in PMS symptoms as a result. 

Stress – Stress has a negative effect on everything! The endocrine system in particular, as chronic stress leads to adrenal fatigue, cortisol depletion and the waterfall of imbalances that happen as a result and tend to wreak further havoc on our hormones, causing a vicious cycle. 

Environmental Estrogens – Toxic xenoestrogens found in our environment will have a negative effect on the endocrine system by mimicking estrogen in the body and storing themselves in fat cells. It is common for all of us to have daily exposure to these toxic substances without even being aware as they are hiding in personal and beauty products, cleaning products and even plastic tupperware. 

What is a way of eating which is known to positively affect all of the previously mentioned factors – brain chemistry, liver detoxification, gut health, hormonal health, toxic overload and stress? The eating for health model, which is what I use with my clients! A PMS-supportive diet is one that is plant based and consisting mostly of organic leafy greens, cruciferous vegetables, complex carbohydrates coming from root vegetables and whole grains, fruits, nuts, seeds, legumes, superfoods and of course adequate amounts of protein coming from high quality grass-fed and pasture raised animal sources, while minimizing animal based fats and focusing on plant based polyunsaturated and monounsaturated sources instead. It is balanced and diverse and not depriving in any way. 

Three nutrients to support Premenstrual Syndrome: 

Vitamin B6 

Vitamin B6 or pyridoxine is said to be low in people who struggle with PMS and depression, especially those taking oral contraceptives. Since it is thought to have a positive effect on the mood, namely the neurotransmitters serotonin, norepinephrine and dopamine, many people have found supplementing with it helpful in improving their mood related symptoms of PMS, as well as breast tenderness. B6 also works synergistically with magnesium, another nutrient that is low in PMS sufferers, and can increase absorption of magnesium into the cells. 

Foods that are rich in vitamin B6 include meat, poultry, fish, organ meats, nuts, legumes (especially lentils) and some fruits and vegetables. Supplementation can be helpful as well, with the help of a professional.

Magnesium

Not only does magnesium deficiency seem to share symptoms with PMS, but it is also said to be a causative factor. Magnesium deficiency can result in a wide range of hormonal, psychological and physical symptoms associated with PMS such as irritability, anxiety, bloating and muscle cramping. Magnesium rich foods include lentils, cacao, hemp seeds, raw spinach, brown rice, avocado and sweet potato. Though a diet rich in whole foods will supply more magnesium than the standard American one, some supplementation can be useful to reach optimum intake or a therapeutic dosage for PMS.

Calcium

Calcium is another nutrient which has been shown to be low in those with PMS, which is interesting as excessive dairy consumption has been linked with PMS as well. It could be  helpful  to focus on obtaining calcium from whole foods like pumpkin, broccoli, chia seeds, sweet potatoes, lentils, eggs and leafy greens like spinach and kale. Cottage cheese can also be a great option for those who tolerate dairy for its calcium and also l-tryptophan content which can have a positive effect on serotonin levels. 

Additional synergistic nutrients, herbs and botanicals: 

Dietary fiber is an incredibly important nutrient to consider when it comes to PMS, due to its integral role in digestive health and flushing of excess estrogen out of the body. The processed food diet that is common among PMS will not contain optimum amounts of fiber, especially those coming from vegetables and complex carbohydrates. In order for a client to increase their fiber intake I would have them focus on a well balanced, whole food based diet, slowly working up to 6-9 servings of fruits and vegetables per day. 

Essential Fatty Acids – people with PMS are shown to have a decrease in linoleic acid-derived gamma-linolenic acid (GLA). This is what brought about the popularity of evening primrose oil in treating PMS, though research has shown little actual value in that. Alternatively, the best approach is to obtain the proper balance of omega 3 and 6’s through food, ie flaxseeds, walnuts, chia seeds, grass-fed and pasture raised meats, alaskan salmon, etc. 

Multivitamin & mineral nutritional deficiency is common among those with PMS, therefore it could be useful to include a whole food based multivitamin and mineral as they work on incorporating more nutritious foods.

ZInc – Zinc is supportive of many bodily functions including inflammation, which is relevant to managing the painful body symptoms of PMS. Most people who struggle with PMS are deficient in zinc, and it is said to be useful for women with elevated prolactin levels. 

Chasteberry, also known as Vitex, is one of the most popular and well-researched herbs when it comes to the physical symptoms of PMS such as headache and breast tenderness as well as mood issues, anger and irritability. It is said to decrease estrogen and prolactin secretion while raising progesterone levels.

Black cohosh is known to have mild SSRI qualities and an ability to modulate luteinizing and follicle stimulating hormones making it a worthwhile supplement for the negative mood symptoms associated with PMS. 

Lifestyle Support: 

Stress Management and coping techniques – Because of the negative effect that stress has on all systems of the body, and especially because of the psychological nature to PMS symptoms it is a good idea to address one’s stress and find healthy coping techniques. Cognitive behavioral therapy and/or meditation are beneficial to brain health and working with/changing our thoughts, while behavior change strategies can be useful in employing healthy coping techniques and self care rituals that do not involve self destructive activities such as drinking, smoking or eating junk food. 

Exercise is beneficial to the body in a number of ways including improved posture and movement, blood sugar regulation, increased metabolism and bone density. Not only that, but exercise is great for the mood. Menstruators who exercise regularly reported less symptoms of PMS. One such reason for this could be that exercise releases endorphins, which are typically low in the luteal phase. 

Eating Habits – Behavior modification around food is important to address, especially when one’s mental health and well being is so reliant on them making quick but long lasting changes to their diet. I help my clients look at their behaviors around food and make small but diligent changes in their diet so that they can sustain their new way of eating without feeling too deprived. 

Mind/Body Techniques – mind/body techniques such as meditation, breathing exercises, acupuncture, yoga and massage are wonderful for promoting stress reduction, a clear mind and a positive relationship with one’s body, among many other benefits!