The most common answer I get to the question ‘do you have PMS symptoms?’ is: ‘ask my partner…’ meaning, yes, I get irritable before I get my period. This isn’t surprising as up to 75% of menstruating women get PMS symptoms, even women who have had a partial hysterectomy (removal of the uterus only) get PMS symptoms, and there are more than 100 symptoms associated with PMS.

These include:

Irritability, everything is annoying
Feeling increased anxiety or depression
Insomnia
Breast tenderness and increased breast size
Weight gain and/or water retention
Increased cravings (chocolate is one of the most common ones)
Cramping
Headaches / migraines
Acne flare-up
Abdominal bloating

What causes PMS?

In PMS, there are usually many causes overlapping, and it’s important to address all of them. Knowing what symptoms are present and when they occur can also help give a great deal of insight into imbalances. Causes of PMS include:

Nutrient deficiency, especially vitamin B6, magnesium, calcium, vitamin E, vitamin D.
Hormone imbalance (progesterone, estrogen, testosterone. thyroid hormone) - this can have many causes ranging from decreased production, decreased detoxification in the liver and/or digestive system, increased exposure, etc.
Blood sugar dysregulation
High stress
Neurotransmitter imbalance
Environmental factors (hormone disrupting chemicals)

How do we address these?

Once causes have been identified, there are many important strategies used to correct imbalances and ease symptoms. Some important nutrients to consider are a B-complex with extra vitamin B6, magnesium alone or magnesium with calcium and omega 3 fatty acids. These alone can bring great improvements to symptoms.

Hint: Chocolate cravings may indicate a magnesium deficiency.

Diet must also be evaluated, which means ensuring a diet that keeps blood sugar balanced. This type of diet generally includes a healthy fat and source of protein at every meal, starting the day with a nourishing breakfast that is low in sugar, and a diet that is generally low in processed foods, refined flours and sugar. Avoiding dairy is also important, especially in the treatment of acne. For breast tenderness, removing coffee from the diet has been found to bring significant improvement.

Ensuring a diet high in fibre, using chia seeds, flaxseeds or psyllium husks to help proper elimination from the bowels also plays an essential role in treating PMS symptoms or any hormone imbalance.

Lifestyle is another factor to take into consideration. Keeping a journal can be helpful. Every phase of the menstrual cycle will bring a slightly varied mood, which is natural and ok. Estrogen brings on a much more productive mood while progesterone bring on a more calming mood. Journalling about these can help identify what is normal and help understand why we are feeling a certain way on a certain day and get a clearer picture of how closely any mood changes are related with the menstrual cycle.

Exercise is also important and has been found to greatly improve PMS symptoms. Exercise doesn’t mean going to the gym for two hours per day. Exercise that slightly elevates your heart rate is greatly beneficial, and 30 minutes is often a good length of time for exercise.

Taking a good look at stressors and making sure you have enough time to relax is important in balancing neurotransmitters and hormones and can help the healing process. Taking an Epsom salt bath, deep breathing exercises, sitting down for a meal at the end of the day or spending time outside are some good ways to de-stress! It’s important to remember that the activity you use to decrease stress shouldn’t cause more stress, so for example, if rushing to a yoga class causes more stress, it may not be such a good idea to go everyday!

Herbs are also commonly used as a part of the treatment of PMS symptoms. The most commonly used herb is Vitex agnus-castus or Chasteberry. This herb can be taken in tincture (liquid alcohol extract) or dried (capsule/tablet), and is best taken in the morning. Vitex helps by supporting progesterone production, which is commonly low, and it can often be helpful for breast tenderness, insomnia, increase anxiety and acne flares. It’s also important to remember that progesterone is linked with GABA production, a calming neurotransmitter, so if progesterone is low, anxiety usually shows up and Vitex can be helpful here too.

Another commonly used herb is Angelica sinensis (Dong quai), which has been found to be helpful for cramping, mood swings, headaches and migraines as well as bloating and water retention.

Evening primrose oil is commonly used to as well and seems to provide benefit for breast tenderness.

Supporting detoxification is another important part of a holistic PMS treatment. Supporting detoxification basically means helping our body metabolize our hormones in order to adequately get rid of them so they don’t build up and cause more symptoms. Some things that are often used to support detoxification are:

Ensuring adequate hydration
Ensuring adequate fibre (25g per day) and proper elimination (bowel movements)
Supporting a healthy gut flora (diet is important here as well as probiotics)
Liver supporting herbs (Milk thistle, Dandelion root)
Estrogen detox support (Indole-3-carbinol, DIM, Calcium-D-glucarate)*

*Hint: When using these, testing is important as using them when not indicated can sometimes make things worse.

Supporting neurotransmitters is also an important piece to consider here. This is where we can see the fastest improvements for mood changes associated with PMS. Right before you get your period, estrogen is at its lowest. This is important for neurotransmitters as estrogen has a strong effect on serotonin production - serotonin being associated with feeling positive, confident, calm and happy. It’s also important in memory and sleep. To support serotonin, I’ll use either:

5-HTP**
L-tryptophan**
St-John’s Wort**

**not to be taken if you are taking an anti-depressant medication

PMS, or pre-menstrual syndrome, is normal to a certain extent as our mood does change throughout our menstrual cycle. But when PMS affects our work or home life, our relationships, or affects our self-esteem or self-confidence, it’s usually a sign it’s time to do something about it. The treatment options outlined in this article are often used with great success, but not all bodies are the same, not all symptoms are the same and not all hormone imbalances are the same. In some cases, PMS symptoms improve significantly by simply making a small dietary change or adding in a supplement, but in other cases, hormone testing and addressing the cause with a trusted and knowledgeable healthcare provider is important to help get a clear picture of what it going on!