Many of us are likely well-acquainted with pre-menstrual syndrome (PMS): the symptoms that may occur in the days or weeks leading up to your period. These symptoms appear during the luteal phase of the menstrual cycle, which occurs after ovulation and before the start of our period. Once our period begins, symptoms typically go away within a few days.
PMS is a widespread phenomenon, with as many as three in four people with periods reporting PMS in their lifetime. For some, PMS symptoms are mild and rarely bothersome. For others, it can be so severe that it disrupts their ability to function.
The symptoms of PMS are wide-ranging, spanning both the physical and emotional. More than 150 symptoms have been attributed to PMS! Common physical symptoms include:
- bloating
- headaches
- cramping
- acne
- food cravings
- breast tenderness
- fatigue
- backaches
- changes to bowel movements
Many of us recognize the typical emotional symptoms of PMS as well:
- irritability
- weepiness
- increased emotional sensitivity
- depression
- mood swings
- anxiety
- insomnia
After reviewing this (non-exhaustive) list of symptoms, I hope it’s clear just how much of an impact PMS can have on a person’s quality of life and sense of well-being.
While the widespread nature of PMS is well-accepted, it has also resulted in the normalization of these uncomfortable symptoms. Many accept PMS as an inevitable and painful reality that must be faced each month. It’s important, however, that we do not confuse what is common with what is normal. PMS may indeed be common, but moderate to severe iterations of symptoms are not normal. This normalization has also led to the trivialization of the suffering so many people experience before their periods. We must demonstrate compassion for their suffering while helping them to navigate the pre-menstrual phase with more ease.
WHAT CAUSES PMS?
The most notable contributors to the development of PMS are:
- nutrient deficiencies (e.g., calcium, vitamin D, magnesium, and vitamin B6)
- blood sugar dysregulation
- stress and high cortisol levels (our body’s main stress hormone)
- chronic inflammation
- imbalance between estrogen and progesterone
STRATEGIES FOR REDUCING SYMPTOMS
Eat An Anti-Inflammatory Diet
Diets that are rich in sugar, refined carbohydrates, inflammatory fats, processed foods, and caffeine can promote inflammation, hormonal imbalances, and worsen PMS symptoms. These diets also tend to be lacking in nutrients which, when deficient, are associated with a higher incidence of PMS. When the connection between inflammation and PMS was studied, inflammation was found to be higher in people with PMS, and the worse the inflammation, the worse the PMS symptoms. This is why I always test my patient’s inflammation levels, and why an anti-inflammatory diet can be so helpful.
Consume healthy fats from:
- oily fish (wild salmon, mackerel, sardines, anchovies, herring, and trout)
- extra virgin olive oil
- avocados
- hemp seeds
- chia seeds
- walnuts
- flax seeds
- almonds
Colourful vegetables and fruits are also particularly anti-inflammatory. Aim to eat at least one vegetable or fruit from each colour category daily (green, red, orange, yellow, purple/blue).
Lastly, it’s important to note that caffeine is well-known for aggravating PMS, most notably triggering breast tenderness and menstrual cramping. If you need multiple cups of coffee to get through the day, talk to a healthcare practitioner and evaluate why you may be struggling.
Self-Care & Stress Management
Finding healthy ways to manage our stress levels is essential for a comfortable menstrual cycle. High cortisol levels often lead to chronic inflammation and an imbalance between the sex hormones estrogen and progesterone—two important hormones that regulate your cycle. Yoga, meditation, and breathwork have all been shown to work well, but don’t feel limited to these options if you don’t enjoy them. It’s important to choose activities that leave you feeling joyful and fulfilled; it can be as simple as singing along to your favourite song or creating art. There is only one rule: whatever you choose, it cannot involve a screen or electronic device because the light emitted by these devices increases cortisol levels.
Similarly, if your stress management strategy is having a drink or two at the end of the day to unwind, it may be time to find an alternative. Alcohol limits the liver’s ability to process estrogen, contributing to rising estrogen levels and throwing off the delicate balance between this hormone and progesterone. I recommend speaking to a practitioner who can help you find alternative strategies for relaxation. Also, consider making yourself low-sugar, alcohol-free mocktails instead—serve in a beautiful glass with an eye-catching garnish to make it feel special.
Balance Blood Sugar
Erratic blood sugar levels wreak havoc on your endocrine system, leading to hormone imbalances, inflammation, elevated cortisol, and worsening mental/emotional health. This is why I use detailed testing in my practice to determine exactly what a patient’s blood sugar pattern is. There are some steps you can take immediately, however, to help balance your blood sugar. Firstly, ensure you are choosing balanced meals.
A balanced meal includes a source of protein, healthy fat, fibre, and complex carbohydrates. Avoid snacking on sweets, candy, or anything that could be classified as a dessert. Instead, check that all snacks contain a source of protein. If eating dessert, make sure to enjoy it after a balanced meal, and not between meals.
Movement is an essential contributor to healthy blood sugar levels, so it's important to commit to at least 30 minutes of intentional movement daily. Lastly, make sure you’re getting seven to nine hours of quality sleep each night. If you are struggling with your sleep, it’s imperative that you find the root cause by speaking to a trusted healthcare practitioner.
Minimize Exposure to EDCs
Endocrine-disrupting chemicals (EDCs) may mimic, block, or interfere with the function of our body's hormones. Because slight changes in our hormone levels can result in significant biological effects, we must be mindful of even the smallest amounts of EDCs in our environment. Exposure primarily comes through cosmetics, food and beverage packaging, household cleaners, scented products, pesticides, and common household items. I recommend auditing your daily routine and identifying the biggest culprits in your home. Look for common EDCs such as phthalates, dioxins, BPA, PFAS, and anything with parfum or fragrance on the label. Replace these items as they run out, choosing the cleanest options you have access to.
Get Enough Fibre
Having regular bowel movements is critical to maintaining a healthy balance between estrogen and progesterone. This is because extra estrogen is removed from the body through the stool. Since fibre is important for bowel regularity, I ask my PMS patients to aim for 35 g of fibre daily via their diet. Always increase fibre slowly and drink lots of water to prevent constipation. If you are dealing with constipation after increasing your water and fibre intake, speak to your healthcare team for an assessment.
Honour Your Cycle
The very nature of having a menstrual cycle means that we are a different version of ourselves every day. No two days are the same, as our hormones are constantly cycling and changing. In the week before our period arrives, our body detects a lack of pregnancy, and estrogen and progesterone levels decline. This fall in hormones comes with changes in mood, energy, and metabolism.
During the luteal phase, our basal metabolic rate (BMR) increases, which also causes an increase in appetite. The resulting carb cravings you notice are your body’s way of asking for more energy. It may also be your body’s attempt to increase serotonin levels, which tend to drop along with declining estrogen levels. Often, the luteal phase is a time of heightened emotional awareness and increased creativity. We may naturally want to spend more time alone and engage in slower, introspective activities. Taking time for yourself and honouring your body’s natural rhythms can provide substantial relief during this period. This isn’t the time to beat yourself up for not getting to the gym or for needing a little rest—giving yourself some grace can reduce your PMS symptoms more than you expect.
