PMS

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Your PMS Guide

You know the feeling, the body aches, mood changes, and cravings are all you need to know your period is on the way. But what if there was another experience available? What if the days and weeks leading up to your period were smooth and steady, with little to no symptoms?

Premenstrual syndrome (PMS) affects 47.8% of women worldwide, with 3 to 8% experiencing severe symptoms. However, just because something is common doesn’t mean it’s normal. If PMS is affecting your life, it’s time to use integrative medicine and move toward living symptom-free.

An integrative approach to PMS involves addressing the underlying causes of PMS, reducing symptoms, and improving quality of life, comfort, and well-being. Keep reading to learn more about this approach. We’ll cover:

• What is PMS?
• PMS symptoms
• PMS causes
• The menstrual cycle and PMS
• PMS in perimenopause
• Integrative PMS support

What is PMS?

Premenstrual syndrome (PMS) is one of the most common disorders during a woman’s reproductive lifespan. While 98% of women report at least one symptom before the onset of their period, a single mild symptom isn’t PMS.

PMS is a cluster of life-disrupting symptoms, predictably occurring during the luteal phase (second half) of the menstrual cycle.

The American College of Obstetricians and Gynecologists offers criteria for an official PMS diagnosis. To qualify:

• Symptoms must appear within 5 days before menstruation;
• Symptoms must resolve by day 4 of the period (the next menstrual cycle); and
• Symptoms must present for at least 3 consecutive menstrual cycles.

PMS Symptoms

Over 200 signs and symptoms are associated with PMS. Symptoms include both physical and psychological ones, with some of the more common ones including:

• Increased appetite
• Weight gain
• Abdominal pain
• Back pain
• Menstrual cramps
• Headaches and migraines
• Breast tenderness
• Nausea
• Constipation
• Bloating
• Fatigue
• Anxiety
• Irritability
• Depression
• Mood swings
• Tearfulness

Women with PMS have varying symptoms and severity. The most severe form of PMS is premenstrual dysphoric disorder (PMDD), a depressive disorder.

What Causes PMS?

While there isn’t an official consensus on the cause of PMS and the syndrome is not fully understood, there is some agreement that changes in hormones and neurotransmitters throughout the menstrual cycle play a role. Likely, several factors contribute and may include:

• Luteal phase hormone fluctuations
• Nutrient deficiencies, such as vitamin B6, magnesium, and calcium
• Genetics, family history, or personal history of anxiety or depression
• Inflammation and oxidative stress
• Excess body fat
• Lifestyle factors

The Hormones Behind PMS

Estrogen (estradiol) and progesterone are the primary hormones of the menstrual cycle, where estrogen dominates the follicular phase (the first half), and then after ovulation, progesterone becomes the primary hormone. An imbalance in these hormones, such as too much estrogen or not enough progesterone, may account for some PMS symptoms.

As hormones fluctuate, so do neurotransmitters, which may contribute to some of the mood changes associated with PMS. For example, allopregnanolone is a progesterone metabolite that interacts with GABA receptors in the nervous system to calm the system down. Without enough progesterone, there isn’t enough allopregnanolone, and there could be an increase in anxiety, irritability, and associated symptoms.

As another connection, estrogen influences gut hormones, such as GLP-1, and plays other metabolic roles, including promoting insulin sensitivity. Imbalances in this system lead to increased cravings, higher carbohydrate intake, and binge eating during the luteal phase.

PMS in Perimenopause

As hormones change in perimenopause, you may experience lower progesterone levels, estrogen dominance, and fewer ovulatory cycles. Unfortunately, perimenopause can make PMS (or PMDD) symptoms worse.

If you’re in your 30s or 40s and you start experiencing PMS when you didn’t have it before, or PMS becomes much worse, it may signify that perimenopause is here. While there is a lot of overlap between PMS and perimenopause symptoms, some symptoms including vasomotor symptoms (hot flashes, night sweats) and urogenital symptoms (frequent urination, vaginal dryness) are perimenopause-specific.

Additionally, some research suggests that if you have PMS during the peak reproductive years, you’ll likely also have perimenopausal symptoms.

The good news is that PMS resolves in post-menopause, along with some other perimenopausal symptoms.

PMS Support Tools

An integrative approach to PMS involves combining Western medicine with holistic tools; we utilize all the tools in our toolkit, including nutrition and lifestyle changes, along with medication and other conventional approaches.

Nutrition is a powerful tool that can be quite helpful in shifting PMS symptoms. Western diets and the standard American diet are positively associated with PMS symptoms, whereas traditional diets and the Mediterranean diet are inversely associated.

Overall, it’s helpful to eat more fresh, unprocessed foods, including high-fiber plant foods, and ensure you’re meeting your needs for B vitamins, vitamin D, zinc, calcium, magnesium, and omega-3 fats. At the same time, minimize your consumption of processed foods and alcohol.

Our TārāMD nutritionists can help you personalize and implement a dietary approach for your body and symptoms.

Beyond nutrition, other PMS support tools include:

• Stress management – Stress increases PMS symptoms, so finding sustainable ways to reduce and manage stress is helpful.

• Exercise and movement – Regular movement and dedicated exercise may help ease PMS symptoms, both physical and psychological.

• Sleep habits – The same hormonal fluctuations or imbalances responsible for PMS can also cause sleep disturbance, yet poor sleep contributes to symptoms. Establish pro-sleep habits and support into your daily routine.

• Gut health and microbiome balance – Used hormones leave the body via the colon, but imbalances in the gut microbiome can cause hormones (specifically estrogen) to recirculate, contributing to symptoms. Supporting gut health is often a significant piece of the hormone balance puzzle.

• Detoxification support – Like the gut, liver health is also important. TārāMD offers comprehensive hormone testing and strategies to address the root causes, including detoxification support.

• Targeted supplements – Depending on the root causes of your symptoms and hormonal landscape, supplements may be helpful. These can include nutrient support, such as vitamin B6 and magnesium, as well as herbal support, including Vitex or phytoestrogens.

• Bioidentical hormone replacement therapy – When intense PMS occurs because of perimenopausal changes, speak with your TārāMD about options, including bioidentical hormones. A little progesterone can often make a big difference!

If you’re experiencing PMS or other hormone-related symptoms, you don’t just have to live with it. Our integrated approach combines many tools to address your unique symptoms and their root causes. Why wait another cycle? Start feeling better and putting the pieces in place after your first appointment at TārāMD.

References

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6. Gollenberg, A. L., Hediger, M. L., Mumford, S. L., Whitcomb, B. W., Hovey, K. M., Wactawski-Wende, J., & Schisterman, E. F. (2010). Perceived stress and severity of perimenstrual symptoms: the BioCycle Study.Journal of women's health (2002), 19(5), 959–967.
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