PMS

PMS: Just because it’s common doesn’t make it normal

Premenstrual syndrome, or PMS, is a syndrome with cyclical recurrence just before the period, and typically resolves on the first day of our flow, or a few days afterwards. It is estimated that 75% of women experience some symptoms of PMS. There have been about 150 symptoms associated with the condition, but the most common ones include:

  • Mood changes like anxiety, irritability and sadness
  • Mood swings
  • Bloating
  • Breast tenderness
  • Acne
  • Cramping
  • Food cravings
  • Headaches
  • Difficulty sleeping
  • And upset stomach

As a change in our hormones takes place at the end of our cycle, it is normal to experience mild emotional or physical indicators that our period will soon arrive. However, if your PMS is getting in the way of your daily activities or interrupting your relationships, this is not okay. Women have been taught that this is the ‘norm’ and that these symptoms are inevitable each month, but just because something is common, does not make it normal. PMS does not have to be your ‘norm’.

What your PMS could be telling you

If you’ve been living with severe PMS, we have to get to the bottom of it. A decline in progesterone and estrogen, which happens at the end of a normal menstrual cycle just before our period, should not cause intense symptoms. Although a definitive cause of PMS has not been established, here are some common associations.

Hormonal Imbalances

PMS has been linked to estrogen dominance. You may have heard this term by now, as it has been used within the wellness community frequently in the recent years. Estrogen dominance can be an absolute increase in estrogen or relative to a low progesterone, the latter being most likely. Estrogen dominance can be caused by multiple factors including, environmental toxins, birth control pill use, constipation, lack of exercise, consumption of conventional meat products, plastics, and obesity to name a few. Our hormones influence our mood and behaviours as they have a direct impact on our brain chemistry. In one study, when hormones were artificially blocked, PMS symptoms were reduced by 75%. This indicates that our hormones and our response to these hormones play a huge role in PMS.

Chemical Changes in the Brain

Changes in the levels of serotonin, a brain chemical that plays a critical role in mood states, may trigger PMS symptoms. Lower levels of serotonin may contribute to premenstrual depression, fatigue, food cravings and sleep problems. In one study, women with no PMS symptoms had higher levels of serotonin during the second half of their cycle, compared to women with PMS who had serotonin levels that decreased after ovulation. Lower serotonin levels have been linked to depression for a long time, and are also associated with birth control pill users.

Inflammation & Stress

Highly inflammatory diets are common in women who experience PMS. It has been found that women with PMS consume 62% more refined carbohydrates than women without PMS. These women also consume more refined sugars, dairy, and trans fats. Along the lines of diet, we also know that obesity is an independent risk factor for PMS and is a highly inflammatory state for the body. It has been found that women with higher levels of inflammatory mediators in the blood have more PMS symptoms. We also know that chronic levels of stress can lead to inflammation. Stress may precipitate or exacerbate any mood, behavioral, or physical disturbance experienced premenstrually.

It is important if you have PMS that significantly impairs your quality of life, to see a practitioner who can help get you some answers. Underlying conditions that may aggravate PMS, like depression, early menopause, thyroid disorders, and blood sugar dysregulation, need to be addressed. This may warrant some testing with your healthcare provider. Treating underlying conditions is always more effective than treating only the symptoms, especially in the case of PMS, as these symptoms will continue to appear each month.

Treating PMS, Naturally

Like most conditions, treatment for PMS must be highly individualized and may involve some trial and error. Since the mechanism of PMS is still unclear, the treatment for PMS may be different for everyone. One significant benefit of treating PMS naturally is that it promotes positive lifestyle changes that will have a cascade effect on general health and well-being.

Exercise

Exercise may be the last thing you want to do while you are PMS-ing, but I promise it will be pay off. Moderate to intense exercise, 4 times weekly, has shown to significantly reduce PMS symptoms. Aerobic exercise acutely raises progesterone levels, which is too small to affect the menstrual cycle but may be enough to alter mood and decrease the stress response through promoting GABA and serotonin, neurotransmitters that make us feel calm and happy!

Nutrition

Premenstrual food cravings can be real. Food cravings that are typical of women with PMS are mainly for the foods that contribute to PMS symptoms, like carbs and junk food. Thus, this creates a vicious cycle that leads to poor food choices and increasing symptoms. If you suffer from PMS:

  • Limit refined carbs and sugars
  • Try an elimination of dairy for 3 cycles and see how you respond
  • If you are still consuming trans fats, ditch them
  • Focus on including high fiber foods to ensure healthy bowel movements
  • Avoid caffeine if you get breast tenderness or highly irritable
  • Include foods that reduce inflammation: fruits and vegetables (surprise, surprise), fatty fish, grass-fed beef, extra virgin olive oil, nuts and seeds, garlic and onions
  • If you experience food sensitivities, remove the culprits! If you are unsure if you have food sensitivities, work with your naturopathic doctor to determine which foods may be increasing your PMS symptoms.

Our Favourite Supplements for PMS:

Chaste Tree (Vitex): Chaste Tree is a botanical medicine commonly used for female complaints. When Chaste Tree was compared to Prozac, a common antidepressant, in women with PMS symptoms, it was as effective for premenstrual mood changes and more effective for the physical symptoms associated with PMS.  Chaste tree has also been used to reduce the intensity and frequency of migraine headaches associated with PMS.

Vitamin B6: Vitamin B6 is required to produce serotonin and dopamine, both of which have positive impacts on our mood. If you’re a lady who has been on the pill for quite some time, you are likely deficient in B6 and this may be causing your premenstrual mood swings. Check out my article: Ready to Ditch the Birth Control Pill? Here’s What You Should Know to read more about the effects of the pill.

Vitamin D: What does Vitamin D not do? This vitamin is indicated for many female concerns, and not limited to PMS. It helps with hormonal regulation, mood stability, and overall general wellbeing.

Fish Oil: Fish oil is a powerful supplement that has been shown to reduce depression, nervousness, anxiety and lack of concentration associated with the premenstrual time period. It also has been shown to reduce bloating, headaches, breast tenderness and the need for over-the-counter painkillers, like Advil and Tylenol.

Magnesium: This is one of the most common nutrient deficiencies in North America. Magnesium inhibits prostaglandins, the chemical messengers in the body that make cramps so painful! It also can work wonders on premenstrual migraines. It has the best effects when taken alongside vitamin B6. Magnesium can also help regulate the bowels, to ensure elimination of excess estrogens.

Probiotics: One of the ways our body detoxifies estrogen is by attaching a glucuronic acid to the hormone and excreting it from the liver. There is an enzyme in the gut that breaks this bond and allows the estrogen to be reabsorbed in the body. One thing we do not need is higher circulating levels of estrogen! By promoting healthy gut flora, through probiotic use, we can reduce the activity of this enzyme and enhance the elimination of estrogen through the bowels.

Stress Reduction

We can all use it! Find ways to incorporate stress management into your daily activities. It can be as simple as taking a few slow, deep breaths at various times throughout your day. You can try journaling, using guided meditations or yin style yoga. Find what works best for you – something that won’t cause any more stress in your life!

PMS can get in the way of you living at your highest potential. This is not cool and it does not have to be your ‘norm’! Once you make these changes to your routine, you should benefit within 3 cycles. If your PMS is still severe, it may be time to look for some help. It is best to work with a naturopathic doctor or functional medicine provider to determine the cause of your symptoms and the right treatment plan for you. You are unique, and your healthcare should be too! If you are in the Toronto area, I’d love to chat! Book in here.

Photo By: Daria Shevtsova
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WRITTEN BY:

Dr. Bronwyn is a naturopathic doctor in Toronto, Ontario with a clinical focus in Women's Health. She works with women transitioning off the oral contraceptive pill and those with specific fertility concerns, to reach a state of hormonal balance or in preparation for a healthy pregnancy. Dr. Bronwyn is passionate about empowering women to reclaim their hormonal health, to enable a full and vibrant life.

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