When I was at my lowest point of health in the last few years, one of the most frustrating symptoms I was experiencing was fairly severe PMS.
While I’ve always had a little moodiness and cramping prior to the first day of my period, I was noticing far more disruptive symptoms such as exhaustion, severe cramping that would even wake me up at night, IBS-like gut symptoms (bloating and loose stools), and nausea.
It was awful to feel so sick and in so much pain once a month.
I was getting used to the idea that the first day of my cycle was basically a day I needed Advil and lots of rest to get through.
However, despite getting “used to” this experience, I was very aware that this wasn’t normal or desirable to be experiencing, and that it was a sign of deeper health issues. I knew I had to get a handle on it in order to be as healthy as possible.
PMS is “normal”… right?
One of the most frustrating aspects of PMS is the pervasive attitude that PMS is normal. PMS is certainly prevalent, but it shouldn’t be considered the norm.
Don’t get me wrong, I think noticing a couple mild shifts before your period is normal. But, it’s a flawed belief that debilitating symptoms before your period is just a consequence of being a woman.
This attitude trivializes premenstrual symptoms which leads many women to grin and bear their symptoms, instead of hacking their PMS symptoms.
While I still struggle with PMS, my symptoms have significantly improved since making changes to my diet and lifestyle.
Lately, I’m finding that the stress of planning a wedding with my long-distance fiancé has caused some of those symptoms to return. For me, stress is a huge culprit of my PMS (and one that I’ll discuss later in this post.) I can easily identify higher stress events with an increase in PMS symptoms 3 months later.
For those of you looking to hack your PMS symptoms, I’ll share 7 different reasons why you might be experiencing PMS and how to take back control of your hormonal health.
What is PMS?
Premenstrual syndrome or “PMS” is a non-specific but common condition that affects 75% of woman in their childbearing years. Symptoms of PMS can vary greatly between different women and usually occur a few days to two weeks before your period starts. Premenstrual dysphoric disorder or PMDD is a more severe form of PMS that affects 3–8% of menstruating women.
The most common symptoms include bloating, breast tenderness, mood swings, irritability, cramps, depression, fatigue and appetite changes. But, there are actually 150 different symptoms that have been attributed to PMS! The severity of these symptoms can range from annoyance in one woman to complete disruption of daily life in another.
It is important to point out that PMS is a syndrome – not a “disease”. A disease is a condition that is well-defined and we understand what causes it, how it causes symptoms in the body and how the disease progresses.
A syndrome is merely collection of signs and symptoms that are often found clustered together, but there isn’t a singular clear cause of the symptoms.
So, there isn’t a single clear cause for PMS, which means it requires a customized individual treatment plan for each PMS sufferer.
Unfortunately, conventional medicine’s one-size fits all approach fails to address the root causes of PMS leaving many women suffering with debilitating symptoms. Conventional treatments for PMS tend to focus on symptom control rather than solving the underlying causes of the symptoms.
These treatments include birth control pills, steroids, antidepressants, NSAIDS (such as ibuprofen or advil) and diuretics. Not only do these drugs not address the root cause, but they have a lot of negative side effects too.
With a little detective work, you can greatly reduce or eliminate PMS by discovering and addressing the root cause of your symptoms. Let’s dive in!
Potential Causes of PMS
(Please note: these causes are not mutually exclusive and some are inter-related. Work with a trusted practitioner to get to the root of your unique health issues!)
Gut bacteria imbalances
Disturbances in gut bacteria can negatively influence many aspects of your health and can even lead to bad premenstrual symptoms. Gut bacteria can effect hormone levels in the two major ways.
First, an overgrowth of certain anaerobic bacteria can produce high levels of an enzyme called beta-glucuronidase, which effects estrogen metabolism. High levels of this enzyme prevents proper excretion of estrogen, which can cause it to build up and recirculate in our bodies.
In the luteal phase of our cycle (the two weeks prior to menstruation), estrogen levels are supposed to decline and remain low, while progesterone rises. Higher estrogen during the luteal phase is associated with more severe PMS symptoms.
With beta glucuronidase blocking estrogen excretion, estrogen levels will be higher through the luteal phase causing bad PMS in individuals with gut disturbances.
Second, overgrowths of bad bacteria can produce high levels of endotoxins called lipopolysaccharides that produce inflammation in the body. This inflammation causes a host of problems in the body one of which is hormone dysfunction. Higher levels of inflammation have been found in women with PMS compared to controls.
- Treat any gut infections or imbalances with antimicrobials (work with a trusted practitioner on this!)
- Foster the growth of good bacteria with prebiotic foods
- Eat more fermented foods to create an environment that encourages good bacteria to grow and thrive.
- Use calcium-d-glucarate to inhibit beta-glucuronidase and promote estrogen clearance (or eat foods naturally high in glucarate like cruciferous vegetables, apples and grapefruit)
As I mentioned above, research has shown that PMS sufferers have higher levels of inflammatory markers than controls who did not have PMS. Also, the severity of the symptoms correlated with the severity of the inflammation in that study.
Reducing inflammation is essential to reducing PMS symptoms. Inflammation can be driven by an inflammatory diet, gut imbalances/infections, autoimmune diseases and emotional and physical stressors.
- Avoid inflammatory foods like indusrial seed oils, excessive refined grains and sugars, and processed foods.
- Aim for a nutrient dense whole foods diet making sure to consume a wide variety of anti-inflammatory foods like fruits, vegetables, wild fish, grass fed meats, spices, herbs and fermented foods.
- Build stress tolerance by incorporating stress management techniques into your daily life such as yoga, meditation, walks in the woods, listening to music, deep breathing or any other stress reducer that works for you!
Studies seem to indicate that abnormalities in thyroid function may play a role in PMS for a subset of PMS sufferers. In fact, one study found that administration of thyroid hormones alleviated PMS symptoms in women with sluggish thyroids.
To complicate matters, thyroid dysfunction is often missed by conventional practitioners. But, it is important to rule out because even mild or subclinical hypothyroidism appears to be correlated with PMS symptoms. If you suspect thyroid dysfunction, it would be wise to request a full thyroid panel from your doctor.
Thyroid dysfunction is also related to the other PMS causes we have discussed. Autoimmune thyroid diseases like Hashimoto’s thyroiditis can not only result in low thyroid hormone production, but will also create inflammation that can further exacerbate PMS symptoms.
Gut bacteria are also pivotal players in activating the inactive thyroid hormone T4 into the active T3 form that is readily used by the body. About 20% of total T4 to T3 conversion happens in the gut. If dysbiosis and gut infections are present, lower than optimal T3 may result, which can compound PMS symptoms that precipitate from gut bacteria imbalances.
- Get tested!! Ask your doctor for a full panel that includes free T3, free T4, reverse T3 and thyroid antibodies (to rule out autoimmunity).
- If thyroid levels are abnormal, explore possible causes like nutrient deficiencies, gut infections and inflammation.
- Consider your carbohydrate and calorie intake. Insulin is required for the conversion of T4 to T3 and many of my clients on too low calorie and/or low carb diets end up developing low thyroid function
- Work with a practitioner to determine if hormone replacement is necessary.
One of the most ironic potential causes of PMS is birth control pills since many women take birth control to help relieve PMS symptoms. 1 in 3 women take the pill to regulate their cycles, but birth control only offers a false sense of regulation because the pill actually disrupts hormonal balance. It actually shuts down your hormones by stopping ovulation.
The hormones estradiol and progesterone rely on ovulation for their production. These hormones are essential in regulating our moods, strengthening our libidos and boosting our metabolism. The problem is that synthetic hormones in birth control, while similar in molecular structure, fail to mimic the effects of progesterone and estradiol that are produced naturally when a woman ovulates.
It is not super surprising that many women don’t feel vital on birth control and continue to experience PMS like symptoms. The pill has been linked to depression, anxiety, insulin resistance, and low libido. Learn more about this issue in our interview with Dr. Lara Briden.
- Consider a non-hormonal IUD, condoms and/or fertility awareness method as an alternative to birth control. The Daysy Fertility Monitor is a convenient and easy tool if you choose to go the fertility awareness route. (I personally use a Daysy monitor and find it very user-friendly.)
- If you are on the pill for PMS or to regulate your cycles, dig deeper into the other possible reasons for your symptoms.
Stress and HPA Axis Dysfunction
We have already discussed how stress can cause inflammation which can create worsening PMS, but high levels of the stress hormone cortisol can also increase PMS severity by competing with progesterone and preventing it from binding to receptors.
With progesterone blunted in the luteal phase by high cortisol, the estrogen to progesterone ratio becomes abnormally high leading to PMS symptoms in the two weeks prior to your period. Not surprisingly, women who have higher perceived stress levels report an increase in PMS symptoms and having symptoms further increases perceived stress creating a vicious cycle.
One of the biggest avoidable stressors I see in my practice causing stress induced PMS and all around hormone dysfunction is undereating and/or over exercising. I often see this in woman who have recently switched to a paleo or more whole foods diet.
The large volume of food needed to meet caloric needs on a whole foods diet can make it easy to under eat when your stomach hasn’t adjusted to the increase in volume. In addition, the low carb paleo craze has led many women to under eat carbohydrates, which causes cortisol to rise.
- Incorporate stress management techniques into your daily life to build your stress tolerance.
- Eliminate any unnecessary stressors like an ending a unhealthy relationship or leaving a job you hate.
- Work on identifying negative self talk and changing how you view yourself and your worth as a woman
- Eat a nutrient dense diet with the appropriate amount of calories and carbohydrates. Try to eat at least 150 grams of whole food carbs a day to suppress the stress response to reduce PMS symptoms. You may need even more than this if you’re an active woman!
Blood Sugar Dysregulation
Changes in insulin sensitivity throughout the ovarian cycle can also present as PMS problems. During the luteal phase of your cycle before your period starts, insulin sensitivity is usually lower than the follicular phase of your cycle.
Symptoms of blood sugar instability are strikingly similar to PMS symptoms like brain fog, irritability, fatigue, insomnia and increased appetite.
The other potential causes of PMS we have discussed (thyroid dysfunction, the pill, HPA axis dysregulation, gut imbalances and inflammation) can compound the natural dip in insulin sensitivity before your period. A multi-facetted treatment strategy to address these compounding factors is the best way to reduce symptoms.
- Don’t skip meals or go more than 4-5 hours without eating during the day. Consider adding a snack between meals that have a longer interval between them.
- Make sure you’re eating enough food at each meal. Inadequate food intake is an incredibly common cause of low blood sugar between meals.
- Carbohydrate spacing and food pairings can help mediate some of the blood sugar effects. Space your carbs out throughout the day and avoid having a lot of carbs in one sitting. Pairing carbs with protein, healthy fats and fiber can also blunt blood sugar swings.
- Exercise can also help maintain insulin sensitivity during PMS. It doesn’t have to be intense, even going on a walk after meals can help stabilize blood sugar levels.
There are a number of key nutrients that appear to prevent PMS. Red blood cell concentration of magnesium is lower in women with PMS. Oral magnesium has been shown to relieve moodiness and water retention associated with PMS. This need for magnesium may be in part why so many women crave magnesium rich foods like chocolate before and during their menstrual cycles.
Magnesium relieves PMS symptoms because it boosts progesterone synthesis and assists in the detoxification of estrogen in the luteal phase. Vitamin B-6 also prevents PMS by working closely with magnesium to produce progesterone. While vitamin B-6 has been shown to reduce many PMS symptoms, it may be particularly powerful in reducing PMS associated depression.
Zinc is another nutrient that is essential for hormone synthesis and regulation. Zinc promotes ovulation and prevents build up of androgens like testosterone. Getting adequate zinc can help prevent hormone imbalances and PMS symptoms.
Finally, calcium and vitamin D intake is lower in populations with PMS. Calcium supplementation has also been shown to reduce PMS symptoms.
- Make sure you are consuming enough of these key nutrients by eating a diverse diet.
- Magnesium can be found in foods like dark chocolate, spinach, avocados, bananas and pumpkin seeds.
- B-6 is high in bananas, fish, red meat and poultry.
- Zinc is can be found in red meat, oysters, beans and seeds.
- Calcium can often be a nutrient of concern in paleo populations, so it may be a good idea to supplement if you are not eating dairy or paleo sources of calcium like bone in fish.
- Work with a nutritionist to determine appropriate supplementation if your diet is lacking in these key nutrients
Need some help? I’m here for you!
If you’ve addressed these 7 causes of PMS and you’re still experiencing significant symptoms, I’d love to help you figure out the root cause of your PMS and start improving your hormonal help.
Apply to work with me today and in just a few months you could be experiencing calmer, more symptom-free menstrual cycles!
If you’ve been able to overcome PMS symptoms, what was the most important change(s) for you? Share your story in the comments below!