What is premenstrual syndrome (PMS) and what causes it? Is it “normal” to experience premenstrual symptoms that affect our mood, energy, and digestion? Let’s delve deeper into the topic to understand what’s normal and what isn’t, and how to support yourself throughout the menstrual cycle to avoid the barrage of symptoms that hit you before your period.
What is PMS?
Premenstrual Syndrome is a group of physical and psychological changes during the luteal phase of the menstrual cycle (usually a few days before menstruation). Typically, it is manifested by changes in appetite, mood swings, irritability, fatigue, pain, anxiety or breast tenderness.1 In fact, different types of PMS have been identified, e.g. PMS-A (Anxiety), PMS-D (Depression), PMS-H (Hydration/Water Retention), PMS- C (Cravings) ), and the most severe type - Premenstrual Dysphoric Disorder (PMDD). Although the exact pathology of PMS still remains inconclusive, the symptoms occur simultaneously with hormonal changes, mainly fluctuating oestrogen and progesterone levels during the luteal phase, affecting each woman differently, but…1
… is PMS “normal”?
The existence of PMS has been debated over the last 100 years. We know that the prevalence of women experiencing PMS is approximately 50%, with 20% experiencing acute symptoms affecting their daily activities, and 2-9% of women are affected by PMDD.1
Naturally, sex hormones fluctuate across the menstrual cycle affecting our behaviour as well as physiology.2 Ain increase in progesterone during the luteal phase can resemble PMS symptoms, such as breast tenderness, changes in skin condition, appetite or mood. Some studies have even reported that the majority of women of reproductive age naturally experience cycle-depended increases in negative emotions, including lower mood.3 Therefore, experiencing some mild symptoms before the period may be normal. However, if you suffer from more severe symptoms prior to menstruation and it’s affecting your everyday life, work, and personal relationships, this could indicate that the hormones are out of balance. Sex hormones drive and support our basic human needs affecting mood, emotions and behaviour. Hormone regulation is a complex process and has its own natural rhythm, and some women can be more predisposed to hormonal issues than others. Those imbalances are predominantly caused by higher levels of oestrogen and often decreased levels of progesterone, the two main sex hormones, although high progesterone and testosterone can also be a factor for some.4
What happens to oestrogen and progesterone at the end of your cycle?
Oestrogen is responsible for several functions, for example, regulating menstrual cycles, regulating fat stores, and supporting mood, whereas progesterone principally facilitates and maintains a viable pregnancy and supports embryonic development. It also performs other broader functions, from being the precursor to other hormones like cortisol or aldosterone, to supporting blood pressure and mood, and counterbalancing the proliferative, inflammatory effect of oestrogen.
During the luteal phase (between ovulation and period), oestrogen and progesterone levels increase to prepare the uterus for a possible pregnancy. If the egg isn’t fertilised, oestrogen and progesterone levels decrease, and menstruation begins. Producing too much or too little of these hormones has been linked with many symptoms. For instance, hormones can have a big influence on the balance of our neurotransmitters, such as serotonin, dopamine or GABA, which regulate our mood, emotions, motivation, stress response, and cognition.3 Sex hormones can also affect our kidney function, increasing water retention, which often gives you a feeling of bloating.4
The right balance between progesterone and oestrogen is a key to overall wellbeing and reproductive health, not just before menstruation, but overall, and it can affect many bodily functions. Unfortunately, many factors related to our diet and environment can disturb that balance.
What causes hormonal imbalances
- Diet & lifestyle: Eating excess sweets, deep-fried and processed food, coffee, lack of exercise and poor sleep are associated with PMS and PMDD.1
- Stress can affect hormonal balance and increase the severity of premenstrual symptoms.6 It can directly affect oestrogen, exacerbating its natural drops and reducing peak levels,7 and it can also lead to a decrease in progesterone,8 disrupting the balance between the two hormones. Chronic stress can also affect neurotransmitters in the brain, such as serotonin, and low serotonin levels have been linked with depression, PMS-like symtoms9 and PMDD.10
- Environmental chemicals such as xenoestrogens (e.g. BPA,11 phthalates,12 or heavy metals13) mimic the action of oestrogen in the body, leading to overall higher oestrogen activity in relation to progesterone, whilst also reducing our detoxification capacity.
- Poor detoxification - Oestrogen is kept within balance thanks to the complex detoxification processes performed by your body, mainly methylation, glucuronidation, and sulphation. Unfortunately, many women have a reduced ability to effectively metabolise and eliminate oestrogen due to genetics, constipation, imbalance in gut bacteria, nutrient deficiencies, paracetamol use,14 and smoking.15
- Nutrient deficiencies, including vitamins B6, B9, B12,17 A, C, D, as well as zinc and magnesium.18,19 Vitamin B6 and magnesium regulate hormonal and neurotransmitter balance, alleviating PMS symptoms and improving mood.20 Vitamin C supplementation can increase serum progesterone in women.21
- High testosterone is also linked to the angry/irritable type of PMS,22 and during the luteal phase, testosterone production increases.
What Can You Do?
Liquids are our go-to recommendations as they support the optimal absorption of this fat-soluble vitamin and can help you to easily adjust the dose to raise levels when someone is deficient.
- Reduce your exposure to ‘xenoestrogens’ such as synthetic cosmetics and plastic. To find out more information on how to do that, read our Xenoestrogens and Environmental Toxins article.
- Manage your stress levels and improve sleep by using relaxation techniques, mindfulness, deep breathing, and increasing your intake of magnesium, B vitamins or calming nutrients such as lemon balm or l-theanine.
- Regular physical activity can help to reduce stress and reduce oestrogen levels. Saunas and physical exercise can further promote the detoxification of heavy metals in sweat.23 Another study reported that an 8-week exercise intervention significantly reduced symptoms of PMS.5
Dietary and nutrients Recommendations
- Support detoxification of hormones and toxins by increasing your intake of green leafy vegetables (e.g. kale or broccoli), and having good quality sources of protein (e.g. eggs, pulses, oily fish).
- Optimise digestion and regular bowel movements by increasing your fibre intake,24 and support detoxification via the skin, through adequate hydration and skin brushing.
Reduce your intake of stimulants and instead opt for herbal or green teas or water-filtered decaf coffee or herbal teas (green tea). Green tea is a potent antioxidant which can reduce oestrogen levels.25
- Reduce alcohol consumption as it can increase levels of free, unbound oestrogen, making it more potent.
- Increase phytoestrogen intake from flaxseeds, sesame seeds, tofu and tempeh, which weakly bind to oestrogen receptors, blocking more stimulating types of oestrogen. Also, phytoestrogens from red clover can be useful in the luteal phase to balance oestrogen and improve PMS.26
- Increase foods rich in magnesium (leafy greens, squash, pumpkin seeds, spinach, Swiss chard, sesame seeds, quinoa, black beans, cashews, sunflower seeds, daikon radish, cacao) and B vitamins (avocado, whole grains, liver, berries, green leafy veg, nuts, eggs, broccoli, cauliflower, daikon radish, mushrooms, salmon, meat, dairy) to reduce stress.
- Increase your intake of healthy fats, including foods such as avocado, nuts and seeds, extra virgin olive oil, coconut oil and oily fish such as salmon, mackerel, trout, sardines, and anchovies. Healthy fats are needed for our cell membranes and neurotransmitter function. Thanks to their anti-inflammatory properties, they also support hormonal balance and blood sugar regulation.
Most women experience moments of pain or slight mood changes that can be related to hormonal fluctuations during the menstrual cycle. Naturally, we may become more emotionally vulnerable. We need to embrace those imperfections and learn to manage them rather than fighting them. Sometimes the symptoms can be more severe, but it’s key is to remember that “symptoms are not enemies to be destroyed but sacred messengers which encourage us to take better care of ourselves”, and there are many dietary and lifestyle changes we can implement to regulate our menstrual cycles and nourish our bodies for better quality of life, mood, energy and beyond.
- Premenstrual Syndrome - PubMed. Accessed July 5, 2023. https://pubmed.ncbi.nlm.nih.gov/32809533/
- Poromaa IS, Gingnell M. Menstrual cycle influence on cognitive function and emotion processing from a reproductive perspective. Front Neurosci. 2014;8(Nov). doi:10.3389/fnins.2014.00380
- Barth C, Villringer A, Sacher J. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Front Neurosci. 2015;9(FEB). doi:10.3389/FNINS.2015.00037/ABSTRACT
- Stachenfeld NS. Hormonal Changes During Menopause and the Impact on Fluid Regulation. Reproductive Sciences. 2014;21(5):555. doi:10.1177/1933719113518992
- Samadi Z, Taghian F, Valiani M. The effects of 8 weeks of regular aerobic exercise on the symptoms of premenstrual syndrome in non-athlete girls. Iran J Nurs Midwifery Res. 2013;18(1):14. Accessed July 5, 2023. /pmc/articles/PMC3748549/
- Gollenberg AL, Hediger ML, Mumford SL, et al. Perceived Stress and Severity of Perimenstrual Symptoms: The BioCycle Study. J Womens Health. 2010;19(5):959. doi:10.1089/JWH.2009.1717
- Assad S, Khan HH, Ghazanfar H, et al. Role of Sex Hormone Levels and Psychological Stress in the Pathogenesis of Autoimmune Diseases. Cureus. 2017;9(6). doi:10.7759/CUREUS.1315
- Herrera AY, Nielsen SE, Mather M. Stress-induced increases in progesterone and cortisol in naturally cycling women. Neurobiol Stress. 2016;3:96. doi:10.1016/J.YNSTR.2016.02.006
- Rapkin AJ, Akopians AL. Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder. Menopause Int. 2012;18(2):52-59. doi:10.1258/MI.2012.012014
- Pearlstein T, Steiner M. Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatry Neurosci. 2008;33(4):291. doi:10.1176/appi.focus.10.1.90
- Krishnan A V., Stathis P, Permuth SF, Tokes L, Feldman D. Bisphenol-A: an estrogenic substance is released from polycarbonate flasks during autoclaving. Endocrinology. 1993;132(6):2279-2286. doi:10.1210/ENDO.132.6.8504731
- Sheikh IA, Turki RF, Abuzenadah AM, Damanhouri GA, Beg MA. Endocrine Disruption: Computational Perspectives on Human Sex Hormone-Binding Globulin and Phthalate Plasticizers. PLoS One. 2016;11(3). doi:10.1371/JOURNAL.PONE.0151444
- Wang J, Pan L, Wu S, et al. Recent Advances on Endocrine Disrupting Effects of UV Filters. Int J Environ Res Public Health. 2016;13(8). doi:10.3390/IJERPH13080782
- Gill P, Bhattacharyya S, McCullough S, et al. MicroRNA regulation of CYP 1A2, CYP3A4 and CYP2E1 expression in acetaminophen toxicity. Scientific Reports 2017 7:1. 2017;7(1):1-11. doi:10.1038/s41598-017-11811-y
- Shimada T, Fujii-Kuriyama Y. Metabolic activation of polycyclic aromatic hydrocarbons to carcinogens by cytochromes P450 1A1 and 1B1. Cancer Sci. 2004;95(1):1-6. doi:10.1111/J.1349-7006.2004.TB03162.X
- Michnovicz JJ, Adlercreutz H, Bradlow HL. Changes in levels of urinary estrogen metabolites after oral indole-3-carbinol treatment in humans. J Natl Cancer Inst. 1997;89(10):718-723. doi:10.1093/JNCI/89.10.718
- Herrmann W, Schorr H, Obeid R, Geisel J. Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am J Clin Nutr. 2003;78(1):131-136. doi:10.1093/AJCN/78.1.131
- Tsao D, Diatchenko L, Dokholyan N V. Structural Mechanism of S-Adenosyl Methionine Binding to Catechol O-Methyltransferase. PLoS One. 2011;6(8):24287. doi:10.1371/JOURNAL.PONE.0024287
- Catechol-O-methyltransferase (COMT)-mediated metabolism of catechol estrogens: comparison of wild-type and variant COMT isoforms - PubMed. Accessed August 22, 2022. https://pubmed.ncbi.nlm.nih.gov/11559542/
- Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010;15(Suppl 1):401-405. http://www.ncbi.nlm.nih.gov/pubmed/22069417
- Henmi H, Endo T, Kitajima Y, Manase K, Hata H, Kudo R. Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect . Fertil Steril. 2003;80(2):459-461. doi:10.1016/S0015-0282(03)00657-5
- Eriksson E, Sundblad C, Lisjö P, Modigh K, Andersch B. Serum levels of androgens are higher in women with premenstrual irritability and dysphoria than in controls. Psychoneuroendocrinology. 1992;17(2-3):195-204.
- Sears ME, Kerr KJ, Bray RI. Arsenic, cadmium, lead, and mercury in sweat: a systematic review. J Environ Public Health. 2012;2012. doi:10.1155/2012/184745
- Clinical trial of a combination of rice bran fiber and cholestyramine for promotion of fecal excretion of retained polychlorinated dibenzofuran and polychlorinated biphenyl in Yu-Cheng patients - PubMed. Accessed July 5, 2023. https://pubmed.ncbi.nlm.nih.gov/7628813/
- YH K, RA H, S L. Modulation of endocrine systems and food intake by green tea epigallocatechin gallate. Endocrinology. 2000;141(3):980-987. doi:10.1210/ENDO.141.3.7368
- Kim HW, Kwon MK, Kim NS, Reame NE. Intake of dietary soy isoflavones in relation to perimenstrual symptoms of Korean women living in the USA. Nurs Health Sci. 2006;8(2):108-113. doi:10.1111/J.1442-2018.2006.00270.X