If you have a uterus, or live with someone who has a uterus, then you know what PMS is! In fact, it has been estimated that up to 80% of all woman have experienced some form of PMS, or premenstrual symptom, at some point in their lives. Menstrual cramps, known medically as dysmenorrhea, affect approximately 50% of menstruating woman, 10% of whom experience incapacitating pain, usually lasting between one and five days each month.* It has been estimated that in the USA over 600 million work hours each year are lost due to any number of premenstrual symptoms.* There are many symptoms associated with each of the different categories of symptoms, not only cramps. PMS is often broken down into groups:
PMS – A → Anxiety (most common)
Anxiety, anger, irritability, emotional instability, cramps
PMS – C → Cravings
Increased appetite, carb cravings, headache, fatigue, fainting, heart palpitations
PMS – D → Depression
Crying, confusion, insomnia
PMS – H → Hyperhydration
Weight gain (1-1.5kg), abdominal bloating, breast tenderness, congestion, edema (swelling), changes in bowel habits
It is common for women to experience any combination of these symptoms. Below I've included important information about PMS including tips that I generally find helpful when assisting patients with symptoms associated with PMS.
Why women may experience PMS
There are many potential causes as to why PMS is so commonly experienced, not one answer will fit every woman. Four main areas to look at include:
Hormonal imbalance. This mainly involves the ratio between the sex hormones estrogen and progesterone with higher amounts of estrogen compared to progesterone presenting as the major PMS symptoms. Blood or saliva tests collected at specific times in a cycle can provide information about these hormones. High estrogen compared to progesterone levels have been linked to headaches, weight gain, poor sleep, panic attacks, swollen or fibrocystic breasts, and many more symptoms.
High prostaglandin levels. Prostaglandins are hormone-like molecules involved in multiple reactions in most tissues. They control processes of inflammation, blood flow, clot formation, and deal with illness and injury. When these levels are high it can lead to pain and discomfort. Prostaglandins are derived from arachidonic acid and certain foods are high in these molecules, such as red meat and peanuts. NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen work by inhibiting enzymes that are responsible for production of prostaglandins and decreasing the pain and inflammation associated with dysmenorrhea and other symptoms.
Lifestyle. There are many common daily activities that can lead to an increased risk of experiencing PMS. Smoking, lack of exercise, obesity and increased stress levels all have potential to cause or exacerbate symptoms. Exercise is important on so many levels. For reducing PMS, exercise increases blood flow around the body increasing oxygen levels to the reproductive tissues stabilizing hormones. Studies have shown that women who exercise regularly have less PMS then those who do not.** Large amounts of caffeine intake have also been linked to PMS, especially severe PMS and can worsen fibrocycstic breasts – swollen, painful, lumpy breasts. Keep your caffeine intake to less than two cups per day.
Diet. Certain foods have also been linked to PMS; like red meat which is high in arachidonic acid. We know that foods high in fat, sugar, salt, and alcohol can all influence metabolism, water retention and mood. Dairy is another food group to pick on as the pesticide use and in some countries, the direct use of hormones can lead to excess estrogens or hormone disrupting chemicals in the body. I'm not suggesting that you cut dairy out of your diet completely, but when possible choose organic dairy products – many times I have seen premenstrual symptoms lessen or disappear when women make the switch. (Note that this may be especially important to consider for children, boys and girls, entering puberty).
How to help alleviate PMS symptoms!
Even though so many women experience some symptom prior to their menses, they really do not have to! There are many ways to help prevent or treat PMS, including:
Eat a wide variety of fruits and vegetables each day. Make a point of eating 1-2 servings of the Brassica family vegetables everyday which are high in molecules specific for liver detoxification of excess estrogens. These include: kale, broccoli, cauliflower, cabbage and Brussels sprouts. Consuming 1-2 tbsp of ground flax seeds each day is also helpful for many women as flax is a phyto-estrogen as well as a great source of fibre.
Other important diet considerations. Avoid highly processed and fatty foods especially the week prior to your menses. Keeping your blood sugars stabilized by having small, frequent, low glycemic meals may also be beneficial. As discussed above, limit your caffeine intake to less than two cups of per day, and try to eat organic dairy when possible.
Vitamins and herbs. Certain B vitamins are beneficial especially if you are on an oral contraceptive as these medications deplete these very important nutrients. Evening primrose oil can also be helpful as it has strong anti-inflammatory effects and can influence hormone production. Magnesium can be extremely helpful for calming muscles and reducing symptoms; there are many different forms of magnesium all of which have specific uses. As there are multiple products on the market that may be helpful for one person and not another, it is best to have a conversation with your naturopath, nutritionist, or other healthcare professional trained in natural therapies about your unique needs. Herbs are a great example of this as there are many powerful hormone balancing herbs but which one will depend.
Hormone support. In clinical practice, it is common to look at correcting nutritional deficiencies and balancing hormones. Depending on specific symptoms, it is sometimes necessary to run labs, either serum or salivary, to see what type of intervention is necessary. Bio-identical hormone replacement is another therapy quite commonly used by naturopaths to rebalance stubborn cases when other therapies haven’t provided relief.
Exercise. As discussed above, exercise can help reduce PMS by increasing blood flow around the body, increasing oxygen levels to the reproductive tissues and stabilizing hormones. Getting some form of exercise each day can be beneficial for a number of reasons, even if you only have time for a quick workout. Here are some helpful tips for starting (or getting back to) an exercise regime.
Acupuncture and other health tips:
Acupuncture is a great therapy that can help alleviate symptoms. If receiving acupuncture while on your menses you may be more sensitive to the treatment.
Castor oil packs can provide much needed relief from cramps, constipation and muscle spasms. Find out how to make a Castor Oil Pack here.
Avoid plastics and beauty-aid products with endocrine disrupting chemicals whenever possible to avoid exposure to environmental estrogens or xenoestrogens. This includes no microwaving plastic containers or re-using thin plastic water bottles. This resource provides more information on which chemicals to avoid.
When to see your doctor
There are some underlying medical conditions that can present or make PMS worse. These include, iron deficiency, anemia, thyroid issues, endometriosis, depression, auto-immune conditions, PCOS (polycystic ovary syndrome), pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, fibroids, and uterine polyps. In any case, it is advisable to talk to your healthcare provider about the symptoms you are experiencing to rule out a more serious condition but also to see what therapy is right for you to prevent and treat your symptoms for good.
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* Hudson, 1999. Woman’s Encyclopedia of Natural Medicine.
** Agonoff, et al, 1994. Aerobic exercise, mood states, and menstrual cycle symptoms.