Are you struggling with symptoms leading up to your cycle, like:
mood changes, restlessness, anxiety and/or depression, irritability
weight gain and water retenion
breast tenderness
bloating, nausea, digestive changes
headaches
insomnia
fatigue
acne
These can be symptoms of Pre-Menstrual Syndrome (1).
PSA: We can’t yet accurately test for PMS through bloodwork… and what I mean by this is if we tested a bunch of women mixed up the tests, and then tried to match those tests up to each individual woman that we thought had PMS, we can’t consistently do that.
PMS is what we call a diagnosis of exclusion, so we'd want to rule out other conditions that could be contributing.
Some root causes of PMS :
High oestrogen relative to progesterone (you could be struggling with high oestrogen or low progesterone)
Low serotonin
Histamine response
Sensitivity to changes in hormones
Poor nutrition
Lack of sleep
Stress and burnout
Lack of movement
Perimenopause
If these symptoms are extremely intense, where they are making it difficult for you to participate in work or activity, they’re impacting your relationships, and you may have suicidal ideation, you may want to be assessed for PMDD (pre-menstrual dysphoric disorder).
Two important notes surrounding PMS:
PMS should be happening during your luteal phase (after ovulation), not all month long
You technically need to ovulate to experience PMS
So what can I do about my PMS?
As you can see from the root cause list above, there can be a big connection between lifestyle and PMS. I like to individualize treatment to the person. Here is my approach to PMS:
Doing a thorough intake (which includes a deep dive into areas like nutrition, digestion, sleep, energy, and stress as well) and exploring if testing for PMS is warranted.
Some basic nutritional changes to start.
Eat lots of leafy greens as they have nutrients that can support the liver's Phase 1 and Phase 2 detoxification processes. A significantly lower risk of PMS was observed in women with a high intake of thiamin and riboflavin from food sources (4)
Reduce refined sugars and ultra-processed foods
Don’t deny yourself the complex carbs during your luteal phase. Glycogen stores are not as readily available during this time, so carb intake can reduce fatigue and support exercise performance. They also make us happier as an increased intake of complex carbohydrates increases the level of tryptophan, a serotonin precursor (4).
Reduce alcohol and caffeine intake - The research is mixed, but a 2018 systematic review found intake of alcohol (especially heavy intake) was associated with a moderate increase in the risk of PMS (2). Caffeine can exacerbate irritability symptoms.
Improve sleep if that’s a challenge - Leading up to your period, the drop in progesterone can impact sleep. If you have trouble falling asleep or staying asleep, reach out to an ND.
Increase movement if you're largely sedentary - regular exercise may have a more pronounced positive effect in milder cases of PMS (6)
Assessing your coping skills and stress management strategies. Stress amplifies the sympathetic activity, and this results in menstrual pain by significantly increasing the intensity of uterine contraction (3).
Asking yourself the hard questions:
Is your PMS rooted in something else? Is there a conflict or conversation you're avoiding? Is there resentment you're harbouring?
Are you living a life that is aligned with your values?
Are you taking time for yourself or are you constantly on the go?
Do I need to seek additional mental health support?
Are there supplements that I can take?
There are supplements that can be taken, but I do find that there can be a deeper reason for the PMS. I don't like people to depend on supplements, but they can be a good starting point while we work on nutrition and lifestyle:
Chaste tree or vitex agnus-castus
Vitex has been shown to be the only herbal medicine that is proven to control PMS-associated mood swings and irritability. It may also reduce breast tenderness (3).
Calcium and Magnesium (4)
Several studies have shown that subjects with PMS have lower serum calcium levels. Especially with so many people going dairy-free, we need to ensure you're getting enough through other sources (4)
Magnesium supplementation is considered effective in preventing dysmenorrhea, PMS, and menstrual migraine (4)
Vitamin B6 (4)
Magnesium + vitamin B6 has been shown to effectively reduce PMS (7)
It has been studied and found to effectively reduce anxiety in older women (7)
Testing Vitamin D levels and dosing according to the results (4)
Multiple studies have shown the importance of vitamin D in female reproduction. It maintains calcium homeostasis, as well as supports neurotransmitter function (4)
It also helps reduce dysmenorrhea, inflammation, and antioxidant markers in women with PMS and vitamin D deficiency (4)
Evening Primrose Oil - the research is mixed on the impact of EPO on PMS (5)
Other estrogen lowering or progesterone supporting strategies (if indicated)
If you experience the symptoms above or are interested in an individualized plan to prevail over your PMS, check out my Balanced Hormones Program! I work with patients virtually across Ontario or at specific locations. Most clinics offer direct billing to insurance and lab testing ordered by Naturopathic Doctors may be covered by plans as well!
You can apply as a patient to be eligible for a free 15 minute Discovery Call to learn more.