While awareness of PMS (Premenstrual Syndrome) is widespread, most do not fully understand the condition. The undesirable physical and psychological symptoms that women of reproductive age may experience during their luteal phase, around ten to fourteen days before their period, are attributed to PMS. Irritability, anxiety, depression, emotional lability, anger, difficulty concentrating are common psychological symptoms associated with the condition. However, PMS can also present physically as food cravings, bloating, nausea/vomiting, cramping, back pain, breast tenderness, abdominal discomfort, constipation, insomnia, migraines, and fatigue. Some women may also notice an aggravation of existing muscular/skeletal/joint pain, low immunity, and/or low-grade fevers. PMS symptoms can vary in intensity and severity, from woman to woman, and from month to month, and occur in seventy-five percent of women. [i] Premenstrual Dysphoric Disorder (PMDD) is a more extreme presentation of PMS characterized by severe and disabling symptoms, affecting five percent of women. [ii]
What causes PMS?
The menstrual cycle involves a careful orchestration of hormones, particularly estrogen and progesterone, which are released from the ovary over the course of the cycle to thicken and prepare the uterine lining to receive an embryo. One likely contributor to PMS is “estrogen dominance”, which refers to excessive amounts of estrogen in relation to progesterone in the luteal phase. This can occur when estrogen is normal, but progesterone is too low in the luteal phase or when estrogen levels are too high. Elevated estrogen levels can be caused by a number of factors including impaired liver function and digestive issues (it is the liver’s job among other digestive system organs to break down and rid the body of extra estrogen), chronic stress, environmental exposure to hormone disruptors, and gynecological conditions like PCOS, endometriosis or perimenopause. When estrogen is too high in the presence progesterone, it affects hormone-sensitive tissue like the breasts, gut, and brain. In the brain, estrogen and progesterone affect serotonin and GABA levels. [iii] When progesterone is low, GABAergic pathways may be negatively affected resulting in symptoms of anxiety, depression and insomnia. [iii] Progesterone levels also affect dopamine
While the balance of estrogen and progesterone levels are important, the gross fluctuation of these hormones is also significant. The sudden drop of estrogen and progesterone levels responsible for the shedding of the uterine lining (one to two days before the period begins) often causes physical symptoms such as cramping and migraines from the withdrawal. Additionally, prostaglandins released in the uterus in women who experience severe cramping can cause diarrhea due to the close proximity of the bowel. [iv]
How to Manage PMS
The menstrual cycle should not be correlated with intense suffering. Because so many women experience PMS symptoms, most assume it is normal and don’t seek help. Diet and lifestyle choices can heavily influence hormone balance, and therefore PMS symptoms. Supplements, herbs, and acupuncture can help too.
Dietary Recommendations
1. Avoid or reduce alcohol, caffeine, and refined sugar.
2. Eat more cruciferous vegetables.
Broccoli, kale, Brussels sprouts, cauliflower, and cabbage, contain phytochemicals such as Indol-3-carbinol which increase the metabolism of estrogen by the liver. [v]
3. Emphasize foods high in magnesium, zinc, and iron or incorporate these as supplements.
4. Follow a low animal fat, high fiber diet, which has been shown in studies to lower estrogen levels in the blood without affecting ovulation. [vi]
5. Supplement with Vitex (Chaste Tree berry), which contains dopaminergic substances as well as compounds that influence the pituitary gland and may help progesterone production, which can reduce PMS symptoms. [vii]
Lifestyle Recommendations
Reduce Stress
Incorporate mindfulness practices into your daily routine, such as meditation, yoga, and breathing exercises. Under stress, the adrenal glands produce excess cortisol. Chronic stress disrupts the Hypothalamic-Pituitary-Adrenal Axis (HPA) and prioritizes cortisol production over sex hormones (estrogen and progesterone). Stress also reduces the liver’s function to eliminate excess estrogen. Because of this disruption, stressful or intense emotional events during the course of the cycle have the ability to throw off ovarian function, in turn affecting the cycle and hormone balance.
Sleep
Sleep is necessary for the body to repair, recover, and renew and depriving the body of sleep is thought to affect hormone balance. Unplug and get at least seven to eight hours of sleep. If you struggle with insomnia, acupuncture and targeted herbal therapy may help.
Exercise
Exercise has been shown to improve mood, stabilize blood sugar, and reduce PMS in women. In Chinese Medicine, PMS symptoms are often attributed to stagnation in the body, so it makes sense to move your body to improve overall circulation, mood, and wellbeing.
Reduce Hormone Disruptors
Modern day environmental factors are also a leading cause of estrogen dominance. Environmental factors that interact with the endocrine system are called hormone or endocrine disruptors. Our skin is the largest organ of our bodies. Take a moment to think about everything you put on your skin on a daily basis and what you come in contact with regularly. Often unavoidable, these chemicals can be found in our everyday products such as detergents, beverages and food packaging, toys, plastics, cosmetics, and pesticides. Look out for and avoid products with phthalates (may be listed as DEP, BPA, DHEP,DBP, DEP), PFCs (perfluorinated chemicals), pesticides containing DDT, and flame retardants. Although complete avoidance of these substances is unrealistic, limiting exposure as much as possible is helpful. It may take an extra moment to check labels, but your body will thank you!
Acupuncture and Chinese Medicine
Acupuncture and Chinese Medicine balance internal regulatory systems such as the nervous system, the endocrine system, and the neuroendocrine system. Studies show that acupuncture effectively treats and manages PMS symptoms. In a study comparing pharmaceutical treatment with acupuncture, women who received acupuncture were 1.5 times more likely to have PMS symptoms improve compared to those on hormonal medications. [i] Acupressure, was also studied to relieve PMS. In a clinical trial, applied pressure to specific acupuncture points was found to decrease the severity of PMS symptoms, decrease anxiety and depression, and improve quality of life measures. [viii]
In addition to acupuncture, Chinese herbal medicine can relieve symptoms related to PMS. A recent study showed that several months of Chinese Herbal therapy successfully reduced the severity and occurrence of physical and psychological PMS symptoms. [ix]
Think of these signs and symptoms as a signal. Pain and discomfort can be the body communicating that there is an imbalance within. Take this time to listen to the body without judgement and treat it with the respect and care it deserves.
i. Kim, S., Park, H., Lee, H., & Lee, H. (2011). Acupuncture for premenstrual syndrome: A systematic review and meta-analysis of randomised controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology, 118(8), 899-915. doi:10.1111/j.1471-0528.2011.02994.
ii. Pinkerton, J. V., MD. (2017, September). Premenstrual Syndrome (PMS) - Gynecology and Obstetrics. Retrieved from https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/premenstrual-syndrome-pms
iii. Barth C, Villringer A, Sacher J. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Front Neurosci. 2015;9:37. Published 2015 Feb 20. doi:10.3389/fnins.2015.00037
iv. Csapo Al: A rationale for the treatment of dysmenorrhea. J Reprod Med 1980; 25:213-221.
v. https://www.sciencedirect.com/topics/medicine-and-dentistry/indole-3-carbinol
vi. Bagga D, Ashley JM, Geffrey SP, et al. Effects of a very low fat, high fiber diet on serum hormones and menstrual function. Implications for breast cancer prevention. Cancer. 1995;76:2491-2496.
vii. Rafieian-Kopaei, M., & Movahedi, M. (2017). Systematic Review of Premenstrual, Postmenstrual and Infertility Disorders of Vitex Agnus Castus. Electronic physician, 9(1), 3685-3689. doi:10.19082/368
viii. Bazarganipour, F., Taghavi, S., Allan, H., Beheshti, F., Khalili, A., Miri, F., . . . Salari, S. (2017). The effect of applying pressure to the LIV3 and LI4 on the symptoms of premenstrual syndrome: A randomized clinical trial. Complementary Therapies in Medicine, 31, 65-70. doi:10.1016/j.ctim.2017.02.003
ix. Chou, P., Morse, C., Xu, H., & Wiebrecht, A. (2009). A Controlled Trial of Chinese Herbal Medicine for Premenstrual Syndrome. Deutsche Zeitschrift Für Akupunktur, 52(1), 53-54. doi:10.1016/j.dza.2009.02.011