Updated: Nov 26, 2020
Yes, it’s THAT time again.
Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms that many women get 7–14 days before the menstrual cycle (1). It is troublesome enough to interfere with some aspects of a woman’s life. Some women get their periods without any signs of PMS or only mild symptoms of it. For others, PMS symptoms may be so severe and unbearable that it makes it hard to do everyday activities.
In this article, we will discuss the symptoms of PMS, the probable causes and general practical tips you can implement to help alleviate PMS symptoms and have a healthier, happier and smoother 2 weeks prior to your menstrual period!
What are the symptoms?
There are several different symptoms that have been associated with PMS. Below is a list of some, however it is not comprehensive as the nature and frequency of the symptoms vary between women, and may vary between cycles in the same woman.
Emotional and behavioural symptoms
Mood swings
Irritability
Anger
Tension or anxiety
Depressed mood
Crying spells
Appetite changes and food cravings
Trouble falling asleep
Social withdrawal
Poor concentration
Changes in libido
Physical signs and symptoms
Headache
Breast tenderness
Fatigue
Weight gain related to fluid retention
Abdominal bloating
Skin problem flare-ups e.g. acne
Constipation or diarrhoea
Joint or muscle pain
Why does it happen?
The exact cause is not fully known but thought to be linked to the changes in hormone levels which occur throughout the menstrual cycle. The complex relationships that exist among hormones may offer insight into why some women suffer more than others.
An important note to mention is that there is no ‘one’ hormone involved in PMS but a complex interaction between hormones, diet, lifestyle and environment.
Theory 1: Hormonal imbalances
Research indicates that PMS might occur after ovulation because oestrogen and progesterone levels fluctuate and are not balanced (2,3), specifically low progesterone levels during the second half of the cycle. PMS symptoms usually go away within a few days after the period starts as hormone levels begin rising again.
Theory 2: Chemical changes in the brain
Changes in mood may be attributed to the effects that oestrogen and progesterone have on serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in a persons mood. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems (3).
General strategies to improve PMS symptoms
1. Nutrition
Limit simple refined carbohydrates such as white bread, pastries and sugar. Replace with wholegrain carbohydrates such as oats, sweet potatoes, quinoa and brown rice. Daily consumption of wholegrains in place of refined grains can contribute to improvement in PMS symptoms (4).
Balance your blood sugar by eating protein at every meal. Protein sources can be eggs, chicken, chickpeas, lentils, and nut butters to name a few.
Eat evenly throughout the day and do not skip meals to balance blood sugar levels.
Consider eliminating dairy and other common allergens (such as gluten) for 4 -6 weeks.
Increase fibre in your diet from vegetables, fruit, nuts, seeds, beans, and whole grains. Studies have indicated that high fibre diets help reduce oestrogen levels based on their effect in reducing constipation and balancing gut bacteria.
Increase omega-3 fats by eating more wild fish like sardines, herring, wild salmon and walnuts (5, 6).
Consider eating organic food, especially animal products, to avoid environmental oestrogens that can enter our body and create imbalances with our hormones.
2. Vitamins + Minerals
Vitamin supplements should only supplement your diet as we are able to get all the vitamins we need from a well-balanced diet. With that being said, studies have shown their positive effects on PMS. Below are some vitamins to consider:
Calcium. Some studies indicate that supplementing calcium can help reduce some PMS symptoms, such as fatigue, cravings, and depression (7,8,9)
Vitamin B6 may help with PMS symptoms, including mood swings, irritability, forgetfulness, bloating, and anxiety (7). Vitamin B6 can be found in foods such as fish, poultry, potatoes, bananas, spinach, beans and sweet potatoes. You may want to consider taking a good quality B6 supplement (25-50mg per day).
Magnesium may help relieve some PMS symptoms, including migraines (7). Magnesium is found in green, leafy vegetables such as spinach. They are also found in nuts and whole grains. You may want to consider taking Magnesium Glycinate (250-500mg per day).
*Always remember to speak to your doctor before considering taking supplements if you are on any other medication or have underlying conditions. Circumstances differ based on different cases.
3. Lifestyle
Reduce stress + build resilience. Find healthy ways to cope with stress. Talk to your friends or write in a journal. Some women also find yoga, massages, or meditation helpful. There is evidence that a mindfulness practice actually reduces PMS symptoms (10).
Regular exercise. Exercise can help with symptoms such as depression, difficulty concentrating, and fatigue in PMS (11).
Getting good quality sleep. Lack of sleep is linked to depression and anxiety and can make PMS symptoms such as mood swings worse (12).
Conclusion
For many women, PMS is a frustrating monthly ordeal. However, the recommendations above may help with both your physical and emotional symptoms.
It’s important to note that hormones take at least 3 - 6 months to show real changes, so do not be disheartened or discouraged if you are not symptom free next month. Real change takes time.
References:
1) Dickerson, LM, Mazyck, PJ & Hunter, MH (2003) Premenstrual syndrome. Am Fam Physician 67, 1743–1752.
2) Kumar P, Sharma A. (2014). Gonadotropin-releasing hormone analogs: understanding advantages and limitations. J Hum Reprod Sci. 7(3):170–174.
3) Halbreich U. (2003). The etiology, biology, and evolving pathology of premenstrual syndromes. Psychoneuroendocrinology. 28(3):55–99.
4) Esmaeilpour M, Ghasemian S, Alizadeh M. Diets enriched with whole grains reduce premenstrual syndrome scores in nurses: an open-label parallel randomised controlled trial. Br J Nutr. 2019;121(9):992-1001.
5) Nahid Sohrabia, Maryam Kashaniana, Sima Seyed Ghafooria, Seyed Kazem Malakoutib. (2013). Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: “A pilot trial”. Complementary Therapies in Medicine. 21 (3)141-146.
6) Rocha Filho, E. A., Lima, J. C., Pinho Neto, J. S., & Montarroyos, U. (2011). Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reproductive health, 8, 2.
7) National Institute for Health Research, U.K. (2008). Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy.
8) Ghanbari, Z., Haghollahi, F., Shariat, M., Foroshani, A.R., Ashrafi, M. (2009). Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwanese Journal of Obstetrics and Gynecology; 48(2): 124–129.
9) Shobeiri, F., Araste, F. E., Ebrahimi, R., Jenabi, E., & Nazari, M. (2017). Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. Obstetrics & gynecology science, 60(1), 100–105. doi:10.5468/ogs.2017.60.1.100
10) Lustyk, M.K.B., Gerrish, W.G., Douglas, H. et al. (2011). Relationships Among Premenstrual Symptom Reports, Menstrual Attitudes, and Mindfulness. Mindfulness.2: 37.
11) Aganoff, J. A., Boyle, G. J. (1994). Aerobic exercise, mood states and menstrual cycle symptoms. Journal of Psychosomatic Research; 38: 183–92.
12) American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS).