Premenstrual Syndrome (PMS) refers to a combination of emotional and physical symptoms that women experience in the days or weeks before their periods (menses). Some of these symptoms include abdominal cramps, cravings and bloating, weight gain, low energy, breast tenderness, joint pain and headaches. Emotional and psychological symptoms include mood swings, anxiety and depression, irritability, emotional extremes like anger and sadness and challenges with concentration and memory.
Mild combinations of these symptoms is considered normal. However, when these symptoms are more severe and affect a woman’s quality of life, they should be addressed. These symptoms are outward signs of abnormal processes occurring in her internal environment.
Questions like “what can I do for bad cramping with my period”, or “what do you recommend for feelings of anxiety or depression around my period” are all too common. As with everything in health and wellness, these questions can only be answered by assessing the root causes of why these things are happening in the first place.
A woman’s menstrual cycle is like a beautiful dance when everything is functioning optimally. The menstrual cycle is 21-30 days long – from one period to the next one. The number of days of bleeding varies from 3-7 days for most women and girls with heavier bleed at the beginning. The blood is mostly bright red and does not have large clots. The common symptoms of PMS are mild and don’t significantly impact her quality of life.
The first part of the menstrual cycle is the follicular phase that begins with menstruation (bleeding). Once the uterus sheds its lining, the brain sends signals, using the hypothalamic-pituitary-axis (HPA), that follicles should be formed in the ovaries. Each follicle contains an egg, but generally only one matures and produces estrogen. As estrogen rises, another hormone, luteinizing hormone (LH) is released from the pituitary. This stimulates ovulation. This phase is about 11-14 days long.
The second phase is the luteal phase. Once ovulation has occurred, the corpus luteum is formed from the mature follicle and starts secreting progesterone. Progesterone is important in preparing the uterus for a pregnancy. Estrogen is also produced in smaller quantities. If fertilization does not occur, the corpus luteum degenerates and the menstrual cycle begins again.
This balanced dance is well coordinated, and a shift or imbalance at any point will cause some disruption to the whole cycle.
It is recognized that mild PMS symptoms are thought to be due to shifts and fluctuations in this hormone balance. It’s becoming evident, that many women and girls and not only experiencing mild, natural, hormone shifts, they are experiencing more extreme highs and lows which is indicative of hormone imbalance.
Naturally, hormone imbalance – or, a change in hormonal patterns – happen every day, all the time. Our hormones are chemical messengers who are always on call to respond to every need. Other hormones, like thyroid hormone, insulin and stress hormones have ebbs and flows. These hormones all impact one another. They always work in tandem. Like a row of dominoes, whatever affects change in one of them, affects change in all the others.
Some of the most studied aspects of this as it pertains to PMS is how estrogen and progesterone are behaving. What are some of the reasons these hormone levels are too high or too low as compared to one another? What are some of the signs of this happening? For example, if progesterone isn’t produced by the mature follicle, is that because there was no ovulation or is it because the brain did not signal estrogen production for a follicle to be produced in the first place?
All hormones have a job to do at a specific time. After that time, they need to be metabolized, detoxed and moved out of the body. Inhibition of all or part of the metabolism and detoxification pathways of estrogen is one of the causes of hormonal imbalance.
The liver is responsible for detoxifying estrogens. When estrogens are only partially detoxified, they are more toxic in the interim. Some of the most common issues surrounding poor detoxification of estrogens are: poor nutrition and low fiber intake, oxidative stress, junk foods and non-foods, fatty liver disease, metabolic disorders and high insulin, inflammation and genetic snps. A snp (/snip/) refers to single nucleotide polymorphisms which is like a mutation of a gene from it’s desired expression. Genetic snps like CYP1A1, CYP1B1 and CYP3A4 are part of the CYP450 enzymes that encode for estrogens detoxification. These snps are involved in numerous other genetic processes as well. There can be a host of genetic mutations that make it more challenging for the liver to detoxify hormones and chemicals. These genes are modifiable. This means that the expression of and function of these genes can be changed by targeting what is found in the genetic testing.
As a healthy immune response, inflammation protects the body from harmful assaults by employing the immune system to release very inflammatory chemicals called cytokines and prostaglandins. This process gets more of the immune system involved to kill off or neutralize harmful threats and it also serves to heal and repair tissue. If inflammation stays high for longer than necessary, then chronic disease can develop.
Underlying inflammation is indicated in all PMS symptoms. When the uterus is contracting to initiate menses, inflammatory prostaglandins are produced. When there is already underlying inflammation in the body or in the uterus/ endometrium, then cramping can be very painful simply because the inflammatory load is too high.
Emotional and psychological symptoms of PMS can also be explained by inflammation. Serotonin, one of our neurotransmitters, is produced in the gut and it helps stabilize mood. When the body, brain or gastrointestinal system is inflamed prior to the period, then inflammatory brain issues like lack of concentration or anxiety and depression will increase during menses.
Chronic inflammation overwhelms the immune system since it never really gets to ‘rest and recover’. It is thought that this could be one explanation of how autoimmune disease develops and why it flares up. Autoimmune disease is incurable, but manageable, especially from an inflammatory perspective. Chronic inflammation is found in all our modern disorders and diseases from joint aches to cancer.
Stress and Trauma
The adrenal system that moderates stress is also one of those systems that is designed to respond to a threat for a short time, and then resolve. During the stress response, cortisol is released. When cortisol levels stay high, as in chronic stress, it starts creating inflammation throughout the body. Cortisol also raises insulin and disrupts sleep and circadian rhythms.
Chronic stress resulting in high cortisol is extremely damaging to the brain, nervous system and every other body system.
Past trauma that has occurred within or around the pelvic region can also cause significant PMS symptoms. In those cases, a more targeted approach to healing from trauma needs to be adopted.
The same Hypothalamic-Pituitary-Axis (HPA) pathway in the brain and adrenals that controls how and when hormones are released for ovulation and menstruation also controls when and for how long the body needs stress hormones. The thyroid also uses this pathway to moderate its hormonal cascade. This is the reason all of these hormones directly impact one another.
Toxins and Exogenous Estrogens
We have to discuss toxins, especially endocrine (hormone) disrupting chemicals and xenoestrogens. Xenoestrogens are environmental estrogens that interfere with estrogens balance in the body. They are also endocrine disrupting chemicals. They can mimic, block or interfere with natural hormones in the body. They are found in environmental toxins like pesticides, herbicides, heavy metals and PCBs. They are also found in consumer products like cosmetics, cleaning products, plastics , BPAs and parabens. Other exogenous hormones are found in medications like birth control and hormone replacement therapy. Animal food products and dairy foods can contain additional hormones.
Test and Assess
Hormone Metabolites Testing
These urine tests can help determine which hormones are elevated as compared to other hormones. They can also show how the detoxification pathways are functioning, which epigenetic mutations may be involved and how best to support the person individually.
Blood/Saliva Tests for Hormones
Doctors and practitioners will use blood tests to see where your levels of hormones are at a particular phase of the menstrual cycle.
Testing levels of your average blood sugar and fasting insulin is a way to address an important element of overall health. High insulin and blood sugar causes inflammation. Inflammation contributes to more severe PMS symptoms.
The Complete Blood Count and Comprehensive Metabolic Panel will show how the other systems in the body are functioning. These tests can reveal nutrients deficiencies and immune system issues.
Some other Conditions that impact PMS
In the event that there is another condition or disease process, it’s always valuable to assess what else could be going on. Endometriosis is an autoimmune condition that is extremely inflammatory. Polycystic Ovarian Syndrome (PCOS) refers to a condition that results in high androgen hormones (male hormones) as compared to estrogen and progesterone. Women with PCOS have a particular difficult time keeping their insulin normal and their cortisol and inflammation optimal. Premature Ovarian Insufficiency (POI) is a condition that results in early menopause leading to low estrogen. Hashimoto’s thyroiditis is an autoimmune condition of the thyroid gland.
CALMING THE STORM
What can we do?
So, here is our previous question: “what can I do for PMS?” The answer is: All the things. Premenstrual Syndrome refers to a vast collection of symptoms that point to a short list of causes by comparison. All of the causes are modifiable.
As with our other systems and pathways, they all rely on nutrients to function well. Changing the type of foods we eat to address severe premenstrual syndrome symptoms is the first line of defence. The optimal diet for healthy menstruation has to be anti-inflammatory, with enough fibre and nutrients. Healthy fats from foods and non-processed oils can be especially helpful since they are both anti-inflammatory and building blocks of additional hormones.
Some of my favourite options for pain relief and anti-inflammation are magnesium glycinate, EPA/DHA, vitamin D3-K2, ginger, cramp bark and curcumin. Some herbal hormone modulators are chaste tree, white peony, motherwort and fennel. Milk thistle tincture is helpful for detoxification and liver support.
Numerous studies actually found that exercise was exceptionally important in reducing PMS symptoms as well as balancing hormones. Exercise still remains the primary immune modulator and brain support which would explain how inflammation, gut health, mood and mental health all improve with daily exercise.
Every cell in the body has a rhythm of when and how it performs its tasks. We also have a rhythm that is dictated by light/dark and when we sleep or wake. This is the circadian rhythm. One night of lost sleep can impact all other body systems and throw off that rhythm. It stands to reason that if we need the brain, the glands, the cells, the hormones, liver, gut, immune system working together, a good place to start would be to get optimal sleep.
Lunar Phase Methodology
This is an ancient approach in which women were encouraged to coincide their menstrual cycles with the moon cycle. At the time of new moon, they were to take estrogen supporting foods like ground flax seeds for two weeks. At full moon, the woman was to switch to more progesterone promoting foods like evening primrose oil. That would continue until new moon.
This method is controversial since there doesn’t seem to be much scientific basis published about this. On a positive note, it can’t harm to support the menstrual cycle during these phases. Fibre, especially, is important in completing detoxification phase of estrogens. Fatty acids are anti-inflammatory. The moon cycle and circadian rhythm cycles are naturally occurring. We encourage cycle-syncing in other aspects of natural health.
Acupuncture for PMS and infertility doesn’t get nearly enough credit in my opinion. Studies prove that acupuncture can improve and re-balance to at least 50% improvement in all symptoms of PMS.
Castor Oil Packs
Castor Oil packs or with/without a warm pad is one of my favourite hacks. These are anti-inflammatory, they address pain, liver supportive, gut/bowel support and mood improvement. What’s not to love?
A warm bath with epsom salts and a drop or two of eucalyptus or lavender oil is helpful in reducing muscle spasm and provides pain relief. The bath is a good place to relax, breathe and calm the nervous system.
Adopting a Healthy Environment including our Thoughts
We can’t completely eliminate toxic influence in our world, but we can minimize exposure from toxic air, water, food and thoughts. This is the time to cleanse and heal through air, water, food, rest and thoughts. Devote the menses (bleeding) phase of your cycle to self nourishment and care.
Walking, running and biking in nature infuses the cells with oxygen. Having oxygen perfuse throughout the body is actually detoxifying. Make an effort to breathe well.
Always drink clear, filtered water. Have your water tested. Choose organic food and only grow chemical free foods. Use chemical free cosmetics, tampons, pads, lotions, deodorants. Minimize the use of plastic for heating, carrying and storage of foods. Try to pay attention to your personal exposure, your kids and family’s exposure and your baby’s exposure when you are pregnant.
Negative thoughts promote more negativity, more stress hormones, more insulin and more inflammation Gratitude, however, serves up joy. Although, interchangeable, gratitude is not quite the same as thankfulness. A statement of thanks is an acknowledgement for something done by someone else, while gratitude implies an internal transformation that has to be adopted. As long as we are open to receiving, we can maintain a grateful state in perpetuity. Alternative to thankfulness, there is no implied action born from gratefulness- it can simply exist as a state of being.
I found a nicely written article that expounds on the scientific findings when gratefulness is practiced. Gratitude actually changes the brain at a cellular level. https://positivepsychology.com/neuroscience-of-gratitude/
Biblical gratitude is a sustenance that strengthens us and explains the intention behind our actions. It is is a positive response to experiencing God’s goodness and grace. Once we realize that God is working in our lives, we will show gratefulness by how we live.