About 80 percent of menstruating women experience PMS - the collective term given to a range of symptoms in the luteal, or premenstrual phase, but only about half of them seek support. These symptoms typically begin 5 to 10 days before menstruation and taper off once the bleed begins.
Those with PMS often report feeling tired, grumpy, short-tempered, frustrated, emotional, sensitive, quick to cry, and ‘not themselves’.
Those with PMS often report feeling tired, grumpy, short-tempered, frustrated, emotional, sensitive, quick to cry, and ‘not themselves’. Signs and symptoms of PMS include:
The symptoms of PMDD are more severe than PMS, and more likely to include episodes of irrational rage, fighting with loved ones, being unable to concentrate, feelings of hopelessness, suicidal thoughts, and being too tired or unmotivated to even get out of bed.
It’s estimated that up to 10 percent of menstruating people experience PMDD, and 30 percent of them will attempt suicide in their lifetime. Various factors can contribute to the development and expression of PMS and PMDD, linked to a surge in oestrogen and progesterone levels which increase in the luteal phase to prepare the uterus for potential implantation and pregnancy.
Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.
These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.
Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected.
The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.
Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).
Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.
Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.
Although no single cause of PMS has been established, hormonal fluctuations that occur during the week or two before the period contribute to the symptoms. People with PMS tend to have excessive oestrogen, and low progesterone and serotonin levels.
Research suggests that heightened inflammation in the body also plays a role in premenstrual symptom severity, as some studies have found increased levels of high-sensitivity C-reactive protein in individuals with PMS.
Other factors that can contribute to PMS are:
PMDD appears to be linked to a heightened sensitivity to the hormones oestrogen and progesterone. Researchers at the National Institutes of Health have also found evidence that PMDD is likely genetic. People whose mothers have a history of severe premenstrual symptoms are more likely to have PMDD. Suppression of ovarian hormone secretion reduces symptoms, but further research is required to fully understand this link.
PMS and PMDD are more common in people with the following:
PMS has become so common in western society that it is considered ‘normal’ by many, and is likely to go untreated. If conventional medicine practitioners are approached for treatment of PMS or PMDD, they are likely to offer one of two options - the oral contraceptive pill, or antidepressants taken for two weeks before the menstrual bleed.
Both of these treatment options carry side effects that may outweigh the benefits for some, and fail to address the root causes of the conditions. As a result, when hormonal intervention such as the contraceptive pill is ceased, the symptoms return.
Hormonal contraception can also stunt reproductive development from the onset of commencement, which may cause long-lasting issues, especially when the pill is taken from a young age. This is significant given two-thirds of Australian women of reproductive age use oral contraception, making it the most popular method of birth control.
At Melbourne Functional Medicine, our practitioners use functional testing to assess hormone and inflammation levels, and investigate imbalances during the lead up to the menstrual period.
The signs they are looking for include:
Our practitioners will then provide a tailored treatment plan addressing each of these factors, which may include:
Anti-inflammatory foods, herbs and supplements have been found to provide relief from some PMS symptoms, including magnesium, omega 3, probiotics, and foods rich in healthy fats like fish, extra virgin olive oil, nuts and seeds.
Food-based nutritional supplements such as magnesium and broccoli sprouts can support oestrogen detoxification pathways in the liver, while herbs like chaste tree berry, or vitex, can help the body produce more progesterone.
Tracking symptoms and how they change throughout the cycle can provide valuable information for the treating practitioner in determining the best approach. Keep a record of the symptoms, when they occur, the severity and how long they last.
Supplementing key nutrients has proven to be beneficial in reducing and managing PMS symptoms. Vitamin B6 given daily for three menstrual cycles resulted in full remission from PMS for 60 per cent of women in a January 2020 study, while 72 per cent reached full remission on a micronutrient formula. Vitamin D deficiency has also been linked to PMS, and restoring Vitamin D to healthy levels assisted in the resolution of symptoms.
Supporting hormonal balance and lowering inflammation also depends strongly on lifestyle factors. Ensuring sufficient sleep of at least 8 hours per night, and finding ways to reduce and manage stress levels is critical to keeping those stress hormones and inflammatory markers in check. Regular exercise, meditation, yoga, work-life balance, and social connection with the community and loved ones are all simple tools you can use to improve your health outcomes, naturally.
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It is thought that a drop in oestrogen in the luteal phase of the menstrual cycle leads to a decline in the neurotransmitter serotonin, leading to fatigue as well as a low mood that women with PMS often experience.
Mood swings associated with PMS are often due to the fluctuations in hormones that happen around the menses that have an impact on neurotransmitters like serotonin.
Eating foods rich in magnesium and B6, and possibly supplementing, can help to improve mood, as they are required to produce the happy neurotransmitter serotonin.
Focusing on relaxation, sleep, stress management and exercise during this time can also help to improve and regulate mood. In terms of a long-term solution, working with a practitioner to address underlying causes of PMS will help to resolve mood and other PMS symptoms associated.
PMS can start 14 days before menses, and typically finishes at the onset, or in the first few days of menses.
Some women experience PMS symptoms for many years, or all through their reproductive lifestage, unless they manage to address the underlying factors that result in PMS such as suboptimal nutrition, inflammation and oxidative stress, electrolyte imbalances, or metabolic syndrome.
It is possible to still experience PMS symptoms while on the pill.
While the pill typically masks a person's natural hormonal environment, many oral contraceptives include 7 days of sugar pills towards the end of the monthly cycle to create a 'period', resulting in a drop off in oestrogen and progesterone which can lead to PMS symptoms.
Oral contraceptives can also deplete nutrients like magnesium and B6 that are needed to make serotonin, the neurotransmitter associated with mood, leading to low mood or depressive symptoms.
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