PMS: alleviating symptoms through root cause resolution

PMS symptoms

Signs and symptoms of PMS

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:

• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability
• Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Social withdrawal
• Change in libido
• Joint or muscle pain
• Headache
• Fatigue
• Weight gain related to fluid retention
• Abdominal bloating
• Breast tenderness
• Acne flare-ups
• Constipation or diarrhoea
• Alcohol intolerance

PMDD

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.

Signs and symptoms of PMDD

• Sudden rage, often unexplained or irrational
• Depressive, suicidal thoughts, self-harm
• Highly sensitive
• Hyper-reactive
• Excessive crying, crying for no reason
• Strong feelings of overwhelm
• Fear of rejection and judgment, paranoia
• Difficulty concentrating
• Brain fog
• Increased or decreased appetite
• Discomfort, cramps, headaches, body aches, tender breasts
• Bloating

What causes PMS?

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:

• Poor nutrition
• Lack of exercise and activity
• Environmental toxins
• Stress
• Poor sleeping habits

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.

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Risk factors for PMS and PMDD

PMS and PMDD are more common in people with the following:

• Age between late 20s and early 40s
• Having at least one child
• Personal or family history of mood disorders – depression, anxiety, bipolar disorder
• Bacterial of fungal overgrowth of gut
• SIBO
• Methylation imbalances
• Impaired detoxification pathways
• History of postpartum depression or psychotic episodes
• Stress
• Adrenal fatigue
• Excessive consumption of caffeine, salt, chocolate, tobacco and alcohol
• History of other reproductive disorders – endometriosis, PCOS, painful periods
• Blood glucose imbalance or insulin resistance
• Nutritional deficiencies
• Poor liver or lymphatic function
• High glycaemic load diet
• High BMI
• Increased toxic load
• Smoking
• Oestrogen metabolism dysfunction
• Hypothyroidism
• Constipation

Natural vs conventional PMS treatments

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.

The Melbourne Functional Medicine approach

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:

• High oestrogen
• Low progesterone
• Decreased serotonin
• Increased prolactin
• Low endorphins
• Increased inflammation
• Electrolyte imbalance

Our practitioners will then provide a tailored treatment plan addressing each of these factors, which may include:

Reducing inflammation

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.

Reduce histamine: Avoiding and eliminating allergens and aggravating foods like alcohol, dairy and caffeine may help to reduce mast cell activation involvement in PMS and PMDD.

Supporting hormone balance

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

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.

Nutritional therapy

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.

Lifestyle

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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