Almost every woman who comes into my office can describe the cyclic, monthly changes in her mood and body that accompany “that time of the month.” Did you know that there are over 150 symptoms that have been ascribed to PMS? Each woman’s symptoms and experience are as unique as she is; therefore, treatments for each women should be just as uniquely tailored. Some women experience bothersome changes in mood that makes them snappy or depressed; others experience debilitating anxiety for 2 weeks prior to their period. Still others experience physical symptoms such as water retention, changes in bowel habits, breast tenderness, or headaches.

So what exactly causes PMS, and what simple changes can you make to your lifestyle and diet to smooth these cyclic changes so that they don’t disrupt your work, play, or relationships?

PMS: Identifying the Root Cause

Premenstrual syndrome (PMS) is defined as the cyclic physical symptoms and mood changes which start sometime from mid-cycle to the end of the menses but then ends either with the onset of menses or by the end of menses. The myriad of symptoms that are ascribed to PMS can include mental or emotional changes (irritability, depression, crying, anxiety, foggy brain, insomnia), physical symptoms (breast tenderness, weight gain, water retention, food cravings, dizziness, headaches, or swollen hands and feet), to name a few.

The reason why PMS occurs is poorly understood. A few theories exist as to what causes these symptoms, and indeed, the cause can be multifactorial. A treatment that might work for one woman may not necessarily work for the next; therefore, I ask careful questions and sometimes do hormone testing to better understand what may be causing your symptoms.Some theories are:

Low serum (blood) calcium. Studies show that some women with PMS have low blood calcium levels, and supplementing with calcium for 3 months can reduce depression, sadness, concentration problems and mood disorders related to PMS.

Irregular serotonin metabolism. Serotonin is our “happy” neurotransmitter. Studies show that women with PMS have a sharp decline in serotonin after ovulation, while women without PMS do not. Other studies have demonstrated the role of estrogen in the serotonin system. Abnormal serotonin secretion has been linked to depression; hence, antidepressants are sometimes prescribed to women with PMS.

Inflammation. One study found that a blood marker for inflammation (called high sensitivity C Reactive Protein, or hsCRP) was significantly associated with PMS symptoms, abdominal cramping/back pain, and breast pain. This indicates that anti-inflammatory herbs and treatments may be an intervention for some certain women with PMS.

Genetics. One study showed an association between severity of PMS symptoms and a gene responsible for Seasonal Affective Disorder. Another study demonstrated an relationship between a polymorphism in a gene for a serotonin transporter and PMS severity.

Poor liver detoxification. As a Naturopathic Physician, I always consider the role of the liver in your hormone metabolism and detoxification. The liver is responsible not only for breaking down drugs, alcohol and medication, but also hormones, old red blood cells, and a host of other cells and organisms. In particular, the liver is responsible for metabolizing estrogens. If your liver is overburdened, estrogen may not be adequately metabolized, leading to “sluggish liver function” and excess estrogen levels, sometimes termed “estrogen dominance”.

Given the varying hypotheses that exist, there is no “one right way” to treat PMS; rather, treatment must be individually tailored to the individual’s unique physiology. Below are some general guidelines for diet and lifestyle recommendations for reducing your PMS symptoms. Included also is a list of research-supported nutrient and herbal interventions for PMS; discuss with your ND which options are most indicated for you.

Diet

Examining the diet is a critical first step in addressing PMS and resolving it over the long term. On average, women with PMS consume 253% more refined sugar, 79% more dairy, and 62% more refined carbohydrates (such as white bread or flour), 53% less iron and 52% less zinc than women who did not have PMS. I always include a dietary assessment as part of my work up and treatment for my female patients struggling with PMS. Focus on choosing nutrient dense, whole foods diet, including a variety of foods listed below. Reduce your intake of sugar, and replace white refined flour and baked goods with whole grains, nut-and-seedy bread. Increase your intake of green leafy vegetables, such as kale, lettuce greens, parsley, and spinach. Incorporate colourful vegetables into your diet, such as bell peppers, squash, carrots, zucchini, eggplant, tomatoes and beets. Generously use healthy oils, such as extra virgin olive oil, on your vegetables and salads. Other specific foods or nutrients to focus on include:

Cruciferous vegetables. This family of vegetables contains Indole-3-Carbinol, a compound that improves the liver’s ability to detoxify and remove estrogens from the body. This family includes: kale, bok choy, cabbage, Brussels sprouts, broccoli, collard greens, and arugula, among others. Increase your intake to 2-4 servings per day.

Calcium. Increase your food sources of calcium, including: leafy green vegetables, legumes, milk (if tolerated), cheese, yoghurt, and seafood.

Magnesium. Increase your food sources of magnesium, including: green leafy vegetables, nuts, seeds, fish, beans, whole grains, avocados, yoghurt, bananas, dried fruit, and dark chocolate.

Flax seeds. Ensure that you are having regular bowel movements (1-3 per day). Flax has lignans that help to bind and remove estrogen from the gut. I recommend 2Tbsp of ground flax seeds per day, sprinkled on oatmeal, vegetables, or added to smoothies.

Reduce or eliminate caffeine. One study demonstrated that eliminating caffeine reduce cyclical breast pain symptoms compared to a control group. Try substituting decaf coffee, or herbal tea.

Incorporate specific herbs into your diet. Cinnamon has been studied for its positive effect in PMS nausea, vomiting and menstrual pain. The Indian herb turmeric contains curcumin, which has anti-inflammatory properties and help modulate neurotransmitters and inflammatory prostaglandins. Use turmeric generously in your cooking, add a teaspoon to smoothies, or incorporate turmeric tea lattes into your routine. See below section on herbs for more information.

Exercise

Regular exercise, particularly aerobic exercise, helps to reduce the symptoms of PMS. Aim for aerobic-type exercise 4 or more times a week. Ideally, get outside into the mountains or by the ocean to take advantage of the stress-relieving impact that nature has on your physiology.

Lifestyle

Detox. Your liver plays an important role in breaking down hormone metabolites and excreting them through the bowels. In today’s environment, our livers have an increased demand to also remove other compounds from the body, including pesticides, herbicides, and other chemicals (such as plastics) that are ubiquitous in our world. Reduce the load on your liver by choose natural skin products and laundry detergent, avoiding parabens and PCBs in plastic products, choosing glass and metal food containers over plastic, avoiding canned goods.

Reduce stress. The stress hormone cortisol, when high or dysregulated, can negatively affect your hormone balance. Consider a daily ritual such as a walk, meditation, or exercise, or consider specific herbal support for stress management.

Targeted Nutrient Therapy

There are many different studies that demonstrate the positive effect that specific, high dose nutrients can have on PMS symptoms. Depending on the root cause of your unique hormonal picture, certain supplement(s) may work better than others. Discussing your symptoms thoroughly with your ND will help focus your time, energy and money on the supplements that are most likely to help, which reduces the trial-and-error. Below is a list of evidence-supported supplements that have been shown to reduce the symptoms of PMS.

Multivitamin. In one study, a simple intervention of a full-spectrum multivitamin was helpful in reducing PMS symptoms. If your diet does not consistently provide the nutrients your body needs, a multivitamin may be helpful.

Vitamin B6. Many studies have investigated vitamin B6 as an intervention, using a wide range of doses; some have been successful, others less so. In women who are on or have historically taken oral birth control, vitamin B6 levels are depleted.

Evening Primrose Oil (EPO). EPO contain gamma-linolenic acid, which helps to regulate essential fatty acids that are involved in inflammation. Dosing ranges from 1-3g per day, and can be sourced from EPO, borage oil, blackcurrant oil, or rapeseed oil.

Magnesium. Magnesium plays a role in essential fatty acid and vitamin B6 metabolism; dosing ranges from 300-900mg a day.

Curcumin. This is a compound found in turmeric, which has potent anti-inflammatory properties, and modulates prostaglandins and neurotransmitters involved in PMS. One RCT demonstrated that 100mg curcumin every 12 hours, from 7 days before and until 3 days after the onset of menstrual bleeding and for 3 consecutive menstrual cycles, reduced PMS symptoms significantly compared to the control group.

Cinnamon. One study demonstrated that 420mg dried cinnamon bark, 2 capsules given 3 times a day for the 3 first days of menses significantly reduced nausea, vomiting, menstrual pain and bleeding compared to placebo.

Vitamin D3. One study demonstrated that low blood levels of vitamin D were correlated with increased menstrual pain. When treated with a vitamin D supplement for 2 months, menstrual pain was reduced compared to placebo. I recommend testing your blood vitamin D status prior to treating.

Chaste Tree Berry (Vitex agnus–castus). Chaste tree has been extensively studied for its effect on PMS symptoms. A systematic review concluded that 7 out of 8 studies demonstrated that chaste tree was beneficial in the treatment of PMS, and one study demonstrated chaste tree to be as effective as fluoxitine (an anti-depressant) in the treatment of Premenstrual Dysmorphic Disorder, which is a more severe form of PMS.

Indole-3-Carbinol (I3C). This is a compound found in cruciferous vegetables and helps regular estrogen metabolism in the liver.

Calcium. One study examined the effect of a daily dose of 1200mg calcium carbonate for women with PMS. After 3 months, 48% of all symptoms were reduced.

Other Options

For women who are comfortable with needles, there are a few other treatments that I have found to be effective in helping to balance hormones and reduce PMS symptoms.

Acupuncture. Weekly acupuncture for 6-12 weeks has been demonstrated in some studies to be beneficial for regulating hormone imbalances and reducing PMS.

Intravenous (IV) Therapy. For those who have PMS possibly due to nutritional deficiencies or compromised digestion, such as in bowel diseases, IV therapy can be an effective way to deliver high doses of vitamins, calcium, magnesium and trace minerals into the body to help reduce PMS symptoms.

So, what’s next, my dear?

If you have been struggling with bothersome mood changes, monthly pain, or other PMS symptoms that you think are preventing you from living and functioning at your highest potential, let’s talk. This article contains some starting points for you. My goal is to support you in feeling vibrant and energized, no matter what time of the month it is. To learn more about how to get in touch with me, or where to find me, click here. To stay in touch and get more articles about using natural medicine to support your hormones, scroll to the bottom of this page and subscribe. I look forward to keeping in touch!

References

Hudson, T. (2015) Curcumin and premenstrual syndrome: a new herbal approach. Obtained online.

Hudson, T. (2008) Chapter 17: Premenstrual Syndrome. Women’s Encyclopedia of Natural Medicine: Alternative Therapties and Integrative Medicine for Total Health and Wellness.

Jaafarpour M, Hatefi M, Najafi F, Khajavikhan J, Khani A. The effect of cinnamon on menstrual bleeding and systemic symptoms with primary dysmenorrhea. Iran Red Crescent Med J. 2015;17(4):e27032.

Moini A, Ebrahimi T, Shirzad N, et al. The effect of vitamin D on primary dysmenorrhea with vitamin D deficiency: a randomized double-blind controlled clinical trial. Gynecological Endocrinology 2016.

Diana van Die et al. (2013) Vitex agnus-castus extracts for female reproductive disorders: a systematic review. Planta Med, 79, 562-75.

Susan Thys-Jacobs, MD, Starkey P, MD, Bernstein D, PhD, Jason Tian, PhD (1998) Calcium carbonate and the premenstrual syndrome: Effects on premenstrual and menstrual symptoms. Am J OBGYN, 179(2), 444-452.

Ernster V, Mason L, Goodson W, et al. “Effects of caffeine-free diet on benign breast disease: a randomized trial.” Surg 1982;912:263-267.

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Ellen B. Gold, PhD, Craig Wells, BA, and Marianne O’Neill Rasor, MA. The Association of inflammation with premenstrual syndrome. J Women’s Health, 2016

Ghanbari, Z., Haghollahi, F., Shariat, M., Foroshani, A. R., & Ashrafi, M. (2009). Effects of Calcium Supplement Therapy in Women with Premenstrual Syndrome. Taiwanese Journal of Obstetrics and Gynecology, 48(2), 124-129. doi:10.1016/s1028-4559(09)60271-0.