Premenstural Syndrome (PMS)

PMS – Symptoms, Causes & Natural Treatment 

Premenstrual syndrome (PMS) is characterised by a number of somatic and psychological symptoms that occur during the week before menses begins and end within a few days of the onset of bleeding.

It affects approximately 75% of menstruating women to some degree.  Women can suffer PMS to varying degrees with some experiencing symptoms that greatly affect their normal daily life.

Premenstrual syndrome may be classified according to presenting symptoms:

• PMT-A: characterised by mood changes e.g. anxiety, irritability, nervousness and mood swings
• PMT-C: characterised by symptoms of blood sugar swings e.g. cravings, increased appetite, symptoms of hypoglycemia
• PMT-H: characterised by signs of fluid retention e.g. weight gain, bloating, breast tenderness, puffy eyes, swollen ankles etc
• PMT-D: characterised by signs of depression e.g. crying, confusion, forgetfulness, insomnia
• PMT-P: characterised by aches and pains, reduced pain threshold, dysmenorrhoea
• Premenstrual dysphoric disorder (PMDD): a severe, disabling form of PMS characterised by severe mood changes and physical symptoms.

Causes of PMS

The exact cause of PMS is unknown but it is thought to be related to fluctuations in estrogen, progesterone and neurotransmitters, such as serotonin, following ovulation.  Hormonal imbalances include some or all of the following:

• Relative estrogen excess: increases adrenalin and noradrenaline in the brain, causing irritability, anxiety and nervous tension. Enhances deactivation of dopamine which is needed for serotonin production.
• Relative progesterone deficiency: increases aldosterone resulting in fluid retention
• Decreased synthesis of serotonin: results in mood changes such as depression and anxiety
• Increased prolactin or increased prolactin sensitivity: causes breast soreness and swelling
• Low endorphin production – low mood
• Increased inflammatory prostaglandins
• Fluid and electrolyte imbalance – a high sodium to potassium ratio

Risk factors

• Age between late 20s and early 40s
• Having at least one child
• Personal or family history of mood disorders e.g. depression, anxiety, bipolar disorder etc
• Bacterial of fungal overgrowth of gut
• SIBO – causes deconjugation of estrogen which gets absorbed back into the system
• Methylation imbalances
• Impaired detoxification pathways
• History of postpartum depression or psychotic episodes
• Stress: blocks progesterone receptors in the brain
• Adrenal fatigue
• Excessive consumption of caffeine, salt, chocolate, tobacco and alcohol
• History of other reproductive disorders e.g. endometriosis, PCOS, painful periods
• Blood glucose imbalance or insulin resistance
• Nutritional deficiencies e.g. EFAs, B-vitamins, Magnesium
• Poor liver or lymphatic function
• High glycemic load diet
• Increased toxic load
• Estrogen metabolism dysfunction
• Hypothyroidism
• Constipation
• Psychological and social factors:

Signs & symptoms of PMS

• Abdominal bloating and discomfort
• Breast swelling and tenderness
• Mood changes e.g. anxiety, crying, irritability, anger
• Fluid retention and weight gain
• Fatigue and sleep changes
• Skin disorders e.g. premenstrual acne
• Food cravings especially sugar and carbohydrates
• Increased appetite
• Backaches, joint or muscle pain, cramps
• Inability to concentrate, confusion
• Headaches and migraines
• Digestive disturbances e.g. constipation, diarrhea, nausea etc.

TREATMENT STRATEGY FOR PMS

Depends on particular symptoms of the patient:

• Balance hormones: In most cases, this will involve increasing progesterone and/or reducing estrogen dominance
• Clear bacterial of fungal overgrowth of gut
• Optimise methylation
• Improve digestion and transit time
• Reduce inflammation and inflammatory mediators (esp. Type P)
• Support adrenal function, nervous system and healthy neurotransmitter production (esp. Types A and D)
• Balance blood sugars (esp. Type C)
• Support lymphatic clearance / diuresis (esp. Type H)
• Support proper liver and bowel function to enhance metabolism and clearance of hormones.
• Encourage healthy weight: being both underweight and overweight are risk factors for PMS

Diet plan guidelines for PMS

• Fresh, whole food, unrefined diet, focusing on fruit and vegetables, grass fed meats, whole grains, oily fish, eggs, legumes, and nuts and seeds.
• Balance blood sugars: low glycemic diet which avoids sugars and refined carbohydrates; avoid missing meals and eating small meals regularly; include protein and healthy fats in meals to balance blood sugars
• Carbohydrates, however, are important for serotonin production and women with PMS may not benefit from low-carbohydrate diets. Therefore, whole grains, fruit and vegetables, and legumes should be included.
• High-fibre diets slow glucose absorption and encourage estrogen clearance: oat bran, psyllium, linseeds, fruits, vegetables, whole grains, legumes
• Cruciferous vegetables and sulphur-containing foods enhance liver clearance of estrogen: broccoli, cauliflower, cabbage, kale, eggs, garlic
• Phyto-estrogenic foods such as organic fermented soy products, linseeds and alfalfa sprouts should be included to block uptake of the more potent xeno-estrogens.
• Pro-inflammatory foods, such as caffeine, refined sugars, commercially produced red meat, saturated fats, trans fats and alcohol, should be avoided, especially in the luteal phase
• Chamomile tea: beneficial in premenstrual breast pain
• Excessive intake of dairy products should be avoided, especially in the luteal phase, as increased dairy intake has been associated with PMS
• Exposure to xeno-estrogens such as excessive animal fats, pesticides, foods wrapped in plastic may increase estrogenic load
• Excessive salt should be avoided as it can contribute to fluid retention.
• Methylxanthines found in coffee, tea, chocolate and caffeine-containing soft-drinks reduce the liver‘s ability to clear estrogen and should be avoided in the luteal phase
• Food allergies and sensitivities should also be identified as they may contribute to the inflammatory response
• A bowel and/or liver detoxification may be indicated to support proper metabolism and clearance of estrogen. Bowel flora should be balanced to reduce inflammatory response
• Weight loss or weight gain diet as indicated.

Supplements to consider for PMS

• Magnesium – supports stress response, reduces nervous and muscle tension, cramping and fluid retention.
• Active B-complex – for nervous system support.
• B6 / P5P – needed for dopamine and serotonin production. It also helps support diuresis in fluid retention
• Vitamin E – may be useful for breast symptoms, tension, irritability and lack of coordination
• Zinc – zinc is often low in women with PMS
• L-tryptophan 300-500 mg/day: low tryptophan is associated with increased levels of aggression in women in the premenstrual phase
• Tyrosine – dopamine precursor
• Omega-3 EFA‘s – reduce inflammatory response
• Evening primrose oil – reduce inflammatory response
• Chromium – blood glucose control
• Probiotics: to improve bowel flora and support clearance of estrogen

Herbal Medicine Treatment that supports PMS

• Increase progesterone / decrease prolactin – chaste tree
• Improve estrogen clearance – turmeric, St Mary‘s thistle, rosemary
• Estrogen modulators – black cohosh, false unicorn root, wild yam
• Nervines – St John‘s wort, passionflower, zizyphus, oats, valerian, scullcap, chamomile
• Blood sugar balance – gymnema, goat‘s rue, fenugreek, cinnamon
• Digestive & Liver Support – barberry, celandine, bupleurum, dandelion root, yellow dock
• Anti-inflammatory – black cohosh, turmeric, ginger, boswellia, feverfew
• Adaptogens – withania, ginseng

Lifestyle / Physical measures

• Regular exercise: associated with lower incidence of PMS symptoms
• Stress management: very important to regulate Hypothalamus/Pituitary/Ovary Axis (HPO axis). Stress has a direct effect on sex hormone regulation.
• Relaxation techniques such as meditation, qi gong, breathing, etc. can alleviate PMS symptoms

FUNCTIONAL MEDICINE TREATMENT OF PMS

Premenstrual Syndrome, better known as PMS, is a set of symptoms that affects menstruating women for the week prior to menstruation.  The severity of the symptoms are linked to hormonal imbalances and the overall health of the woman.

At our Perth clinic of Advanced Functional Medicine we are experienced in identifying underlying causes of hormonal imbalances to allow the body to efficiently create and clear hormones. 

We commonly find in patients that present to us with PMS and other hormonal imbalances that there are a number of underlying imbalances.  These often include methylation issues, gut dysbiosis, SIBO, nutrient deficiencies and blocked detoxification pathways.

If you or a family member are suffering from PMS we would love to hear from you.  What strategies to you use to minimize your PMS symptoms?  Have you investigated your gut health and/or methylation and resolved your long standing PMS?  Please leave a comment below.

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