Premenstrual syndrome, or PMS, is REALLY common. So common in fact that most women assume that it is just something that is just a ‘normal’ part of being female.
And it is something that has only quite recently been accepted by conventional medicine as a real disorder – for many years the very existence of PMS was dismissed, due to the fact that no obvious (or treatable) cause could be identified. The varying symptoms that countless women suffered were put down to imagination or hypochondria.
We now know that PMS is a very real condition (hallelujah!) - and one that can greatly impact a women’s quality of life.
As a naturopath, I see plenty of women with PMS, and I used to suffer horrendously from it myself, back in my pre-naturopathic days. And the key message I want to impart here is that, far from being normal, suffering from significant PMS is always a clear sign to me that all is not well in hormone-town.
What Exactly IS PMS?
PMS, is a collection of physical and/or emotional symptoms that occur during the 2nd half of your menstrual cycle (usually within a week to ten days prior to your period), and then disappear with the onset of your period (or soon afterwards).
There are many symptoms that are associated with PMS - in fact, there are around 150 of them! These may be physical in nature, or predominantly emotional, or a combination of the two. The particular symptoms each woman experiences will depend on her individual set of circumstances and may change from time to time, and from cycle to cycle, depending on what is going on in her life - including her stress levels, sleep, food choices, alcohol intake and activity.
Physical symptoms can include:
- Bloating/abdominal distension
- Breast swelling and tenderness
- Increase in appetite
- Fatigue and weakness
- Weight gain or fluid retention
- Acne breakouts
- Headaches, joint pains and/or backache
- Pelvic discomfort or pain
- Change in bowel habits – an increase in constipation and/or diarrhoea
- Palpitations, dizziness or fainting
- Reduced sex drive
…and then let’s not forget the emotional symptoms, which can include:
- Nervous tension
- Irritability
- Anxiety
- Depression
- Tearfulness
- Aggression or angry outbursts (…ever feel like biting your partner’s head off at this time?)
- Confusion, forgetfulness, or lack of concentration
- Difficulty sleeping
In an ideal world, any PMS symptoms you experience should be very mild and they should not be something that interferes to a great degree with your day, your work or your relationships. But, if you are finding that your PMS is making you feel like you want to run away and hide in a cave for a few days before your period arrives, then it is time to get your hormones to start behaving themselves!
What Causes PMS?
Your two main female hormones, oestrogen and progesterone, could be described as a pair of delicate butterflies, flowing together in an intricate dance….who am I kidding, when you are suffering from PMS they are more like a couple of elephants stepping on each other’s toes!
These two hormones each have a crucial job to perform within your cycle. Oestrogen has the job of preparing the egg that you release each month (if you aren’t taking contraceptive medication). Therefore, oestrogen is a hormone that is all about encouraging growth and proliferation. Oestrogen’s time to shine is in the first half of your cycle, where it slowly builds in anticipation of the egg being released, then it hangs its hat up and says ‘Phew! My job here is done’. Until the next cycle.
Oestrogen’s friend is progesterone, who is quite happy to let oestrogen steal the limelight during the first half of the cycle. But after the egg is released, progesterone takes the stage. Progesterone is a very nurturing hormone – all it wants is to see you reproduce successfully and for it to be able to take care of what it hopes will be a fertilized egg. Therefore, progesterone is all about helping you keep calm and serene.
If you take a look at the chart below, you can see oestrogen (we spell it with an ‘o’ here in Australia), the blue ‘mountain’ is oestrogen which peaks just before the egg is released (ovulation) and the pink mountain is progesterone, which peaks in between when the egg is released and when your period arrives, as this is the most likely time that you would be falling pregnant.
How Is PMS Diagnosed?
When it comes to PMS, the diagnosis is all about timing. True PMS must involve a symptom-free period in the follicular phase of your cycle (from the first week of your period to ovulation), and your symptoms must begin to subside after your period begins. It can be handy (and very insightful) to keep a symptom diary and track your cycle as this not only helps determine your appropriate treatment, but also to track your progress over time.
There are 4 sub-types of PMS, each with their own underlying drivers:
PMS-A
‘A’ stands for ‘Anxiety’, and is associated with emotional symptoms such as anxiety, irritability, insomnia, erratic mood swings, tearfulness, and physical symptoms such as water retention, stress-induced sweating, palpitations, a slightly shorter cycle, and heavier, more painful periods. It is thought to be related to high levels of oestrogen and a deficiency of progesterone.
PMS-C
‘C’ stands for ‘Cravings’, and is associated with cravings for sugar and other carbohydrates, increased appetite, headaches, palpitations, increased sweating, and blood sugar dysregulation. This type of PMS is thought to be caused by improper secretion and/or production of the hormone, insulin.
PMS-D
‘D’ stands for ‘Depression’, and is associated with depression, feelings of despair or hopelessness, tearfulness, apathy, fatigue, insomnia, and low libido. It is thought to be due to low levels of oestrogen, causing a disturbance in neurotransmitter levels, and enhanced testosterone or progesterone production.
PMS-H
‘H’ stands for ‘Hyper-hydration’, or in other words, swelling. It is associated with swelling of the hands and/or feet, weight gain, bloating, breast tenderness or fullness, and nipple sensitivity. It is thought to be caused by excess oestrogen and aldosterone (a hormone that affects water and salt balance, hence the swelling), a high salt diet, stress, and/or magnesium deficiency.
What To Do About It
The conventional treatment for PMS is usually to prescribe the oral contraceptive pill or other hormonal treatments. However, it is important to be aware that this doesn’t fix your hormones – it simply shuts them off for a time. And we know that the contraceptive pill also comes with it’s own list of potential side-effects such as nutrient deficiencies, weight gain and most recently we have become aware that it interferes with your gut health. So whilst it certainly can be a convenient way to temporarily feel better, make sure you keep in mind that it’s more than likely the problem will return as soon as you stop taking the medication.
Thankfully, there are plenty of natural support options available for improving PMS, and addressing that pesky ‘root cause’ that I am always talking about.
- Magnesium is the rescue mineral for anything to do with women’s hormones (not just PMS, it is fantastic for menopause and other hormonal imbalances as well). It is also great for helping address the mood swings that come with PMS. It does this by reducing over-activity of your nervous system so that your body can relax that bit easier (which is important!)
- Supporting healthy detoxification of hormones through the gut. Your liver and your gut are tasked with the job of getting rid of some of your hormones once they have done their job in the body, or if you have too much of any one of them. The trouble is that if this system is held up at any point, your body can actually recycle your hormones and put them back into your circulation rather than getting rid of them. While recycling is usually something to be celebrated, in this case it is a bad thing that can contribute to hormonal imbalances such as PMS.
- Eating good-quality, nutritious food with plenty of protein, healthy fats and fresh vegetables and fruits. A diet that is high in processed foods, sugar, alcohol and fried foods is highly inflammatory to the body, disrupts your gut health, depletes your nutrients and generally leads to a worse period experience all-round. If you do one thing for your cycle – eat well.
- In the clinic I love using specific herbs for reducing PMS – and my favourite part is when I hear from one of my patients that their husband/partner has noticed how much symptoms have improved (errr…you’re welcome!). Popular herbs in my clinic include the likes of Chaste Tree, Withania, Dong Quai, Paeonia, Chamomile and Shatavari. Always keep in mind that it is best to see a qualified herbalist if you want to use herbs to help PMS, as that way you know you are getting the right herb for your particular needs, as well as making sure any herbs are not going to interfere with medications you may be taking.