“I snapped at my husband for leaving a newspaper on the front seat of the truck and yelled at my son for no reason. It was as though I was possessed, but I knew better, I was just PMSing” Shelly from Colorado explained.

Sound familiar, if so, you’re not alone. Recent statistics show that 40% of all women experience symptoms of PMS that affect their daily life with 5% reporting symptoms so severe that they have serious negative effects on both work and family life.

Sidebar: Common PMS Symptoms

Water Retention

Breast Tenderness

Absentmindedness

Headaches

Irritability

Emotional Hypersensitivity

Sleeplessness

Sluggishness

Food Cravings

Depression

Anxiety

Acne

Joint Pain

Clumsiness

Constipation

Diarrhea

Cramps

Hypoglycemia

Loss or Increase in Appetite

Decreased Libido

And many more…

Since PMS is due to hormones associated with your menstrual cycle, it’s good to take a step back and understand what happens to your body each month. Your cycle begins when the hypothalamus gland in the brain secretes a chemical to the pituitary gland, which then triggers the pituitary gland to secrete Follicle Stimulating Hormone (FSH) and Leutenizing Hormone (LH) into the bloodstream. These two hormones cause follicles, which are in essence the “egg shells,” to mature within the ovaries. During the approximate seven-day maturation, the maturing follicles will trigger the ovaries to continually release increased levels of estrogen into your bloodstream causing a gradual thickening of the endometrium (uterus). After a few days, estrogen levels peak and the hypothalamus gland then releases a hormone that causes the pituitary gland to release a large amount of Leutenizing Hormone which causes the most mature follicle to burst open and release an egg. This is called ovulation and immediately after ovulation, estrogen levels drop and progesterone levels rise. Over the next several days, the egg will travel down the fallopian tube towards the uterus. If your egg does not get fertilized, then it breaks down within two to three days and progesterone level decreases and this ultimately triggers the breakdown of the endometrium, followed a few days later by menstruation. The length of the menstrual cycle is different for many women, but typically averages about 28-35 days.

Hormones, Hormones, Hormones…

With all of these hormones “talking” to each other, there are bound to be problems once in a while. Although researchers can’t say for sure what causes PMS, it is thought to be related to an estrogen or progesterone imbalance. You see, during your cycle, estrogen levels gradually build like a smooth, steady series of waves until ovulation. When you ovulate (about day 14 of your cycle, counted backwards from day one of menstruation), your estrogen level rapidly spikes, which may be responsible for giving you that quick burst of energy and sense of euphoria that sends you on an all night cleaning frenzy. 

Unfortunately, the euphoric stage does not last for long. Soon after ovulation, estrogen levels quickly plummet which is what researchers believe may cause the more negative symptoms of PMS such as depression, fatigue, irritability, etc. The sudden drop in estrogen or even the later sudden drop in progesterone often has profound effects on the type and severity of PMS symptoms from which a woman suffers. PMS may occur up to two weeks prior to menstruation and may continue into the first few days of your period. Fortunately, the severe PMS symptoms only last a few days and typically disappear with the onset of menstruation when estrogen and progesterone levels begin to even out once again.

The Diagnosis and Treatment

It’s important not to automatically assume that you have PMS because symptoms of PMS mimic more serious disorders that require an entirely different course of treatment. Only your doctor can diagnose you with PMS. With that said, once your gynecologist has diagnosed you with PMS or the more severe version of PMS called Pre Menstrual Dysphoric Disorder, commonly known as PMDD, or a totally debilitating version of PMS, she will make a few recommendations beginning with diet and exercise and here’s why.

The typical American woman’s diet is often low in key nutrients such as B vitamins, especially B6 and B12, magnesium, calcium, manganese, Vitamin E, and lineolic acid.  These particular nutrient deficiencies have been linked to several PMS symptoms, such as water retention, breast tenderness, food cravings, depression, irritability, and more. In addition, the typical American diet is low in fiber and high in saturated fat.

Saturated fat promotes a decreased globulin level. Globulin is a blood protein that helps transport hormones throughout your body. In the simplest of terms, the more saturated fat you eat, the lower your globulin levels are, and the less estrogen will be effectively transported throughout your body. When you are PMSing, it may be due to either the estrogen spike or the “estrogen crash.” If at this time, you eat high amounts of saturated fats, your body becomes less efficient at transporting the estrogen, which may increase both the severity and duration of your PMS symptoms. 

A recent study by Georgetown University in Washington D.C. found that women who ate a low-fat vegetarian diet suffered less severe PMS symptoms, including cramping and bloating than women who ate a more typical American diet. Vegetarian diets, or diets high in plant foods that contain Omega 3 fatty acids, increase globulin levels to help decrease the PMSy effects of both the estrogen spike and subsequent crash. If you’re interested in obtaining a copy of this study, you can email your request to: pcrm@pcrm.org. 

The lesson here is to eat your fruits and vegetables while avoiding high fat foods and red meat. Instead, eat fatty fish such as salmon, herring, and (low salt) sardines, chicken, turkey, and unprocessed meats low in fat, salt, and sugar. Speaking of sugar, when hormone levels rise before menstruation, cells become more receptive to insulin, which can cause problems with hypoglycemia (low blood sugar) and can contribute to moodiness. For this reason, it’s important to avoid sugar, especially refined white sugar, simple carbohydrates such as white flours and “junk” foods, alcohol, and salt while eating four to six smaller complex carbohydrate/lean protein meals spaced evenly throughout the day.  Keeping your blood sugar levels more constant can significantly stave off “junk food” cravings and will keep you feeling more alert throughout the day.

Even with a well balanced diet, it still may be necessary for supplementation. Due to the variety of nutrient deficiencies, many gynecologists are now recommending that women who suffer from PMS take:

400 I.U. of Vitamin E for breast tenderness.

B complex containing 50-100 mcg of Vitamin B6 to help alleviate irritability and carbohydrate cravings.

1,200-1,500 mg of Calcium.

300 mg Magnesium for water retention.

1000 IU Flax Seed Oil which contains lineolic acid and other Omega 3 fatty acids that help increase certain prostaglandins that cause muscle relaxation and may aid in reducing menstrual cramping.

Before you begin any vitamin, mineral supplementation, talk to your doctor to make sure that it’s right for you. It is possible to overdose on vitamins and minerals and certain vitamins and minerals react adversely with certain other over-the-counter or prescription drugs, so it’s essential that you work closely with your physician to determine the correct amounts of each vitamin and mineral you need based on your current diet and medications.

Dietary changes and supplementation do not come as a magic cure all for PMS. Along with these changes, you have to be willing to commit to a regular aerobic exercise program in order to get the best results. Studies show that 20-30 minutes of aerobic exercise four to six times per week can help significantly reduce PMS symptoms. Exercising reduces stress and it may also help to release chemicals in your brain that provide a calming effect on your body. In addition, if you are overweight, you’re more likely to suffer from hormone imbalances, so your physician may suggest that you lose weight. Exercise is not only good for relaxation and stress management, but it’s an essential part of any healthy lifestyle and weight loss program. As always, talk to your doctor before you begin any type of exercise program.

If after two to four cycles diet, exercise, supplementation, and weight loss (if necessary) don’t work, then don’t give up, there are pharmacological options. Of course, these options all come with the potential of serious, even deadly side-effects that must be thoroughly discussed and understood before you choose whether or not they’re right for you.

The Birth Control Pill, Patch, or Depro Provera: Hormone-regulating birth control, whether “the pill,” a patch, or a shot, evens out hormone levels throughout the month and has been shown to be an effective way to treat PMS. When you’re on the pill, you no longer ovulate and estrogen levels remain fairly constant throughout your cycle, so there’s no longer a spike followed by a dramatic drop a few days later. Birth control pills, the patch, and Depro Provera shots are the most preferred method of PMS treatment following diet, exercise, nutrient supplementation and weight loss. Talk with your doctor about which, if any, option is best for you. Since there are so many brands of “the pill” on the market, it may take some experimenting before you find one that works best for your PMS symptoms.

Anti-depressants: A mild, low-dose anti-depressant drug may be prescribed for you to take near ovulation and through menstruation. Anti-depressants used during PMS help to keep the brain chemical serotonin at more constant levels. Since serotonin has a calming effect on the body, it has proven itself to be a very effective PMS treatment option. The problem with anti-depressants is that there are so many different types on the market that it may take a very long time before you and your doctor find one that works for you.

PMS Treatment Options to Discuss with Your Doctor

1. Diet and other lifestyle changes that include regular aerobic exercise and possible weight loss.

2. Vitamin, mineral, and Omega 3 Fatty Acid supplementation.

3. The Birth Control Pill, Patch, or Depro Provera shot.

4. Hormone Therapies.

5. Solitary Confinement (just kidding).

6. Anti-depressants.

Don’t get discouraged if you try something and it doesn’t give you an immediate cure. For example, studies show that magnesium and other vitamin and mineral supplementation takes at least two months before women begin to notice an improvement in their symptoms. The same can be said for Omega 3 fatty acids as well as dietary changes and exercise. Anti-depressants and birth control pills also may take at least two cycles before you begin to feel some relief. In addition, there are so many different hormonal birth control options and anti-depressants on the market that you may spend a lot of time working with your doctor to figure out which one is best for you.

Since PMS is different for every woman, it’s essential that you chart your symptoms, their severity, when menstruation begins and ends, daily diet, exercise, and supplementation, etc. on a calendar so that you and your doctor can easily determine the best treatment options for your symptoms. Tracking your symptoms is also a great way to determine objectively whether or not a specific treatment is having a positive effect on your symptoms or if you need to try something else.

When you’re being treated for PMS, be patient and realize that although there are many treatment options available, PMS still isn’t fully understood by the medical community and it’s going to take a lot of patience and hard work on your part to figure what works best for you. Don’t get discouraged, though, because in the end, conquering PMS is well worth the effort.

Foods that Contribute to PMS

Caffeine and Chocolate: Irritability

Simple Carbohydrates and Refined Sugars: Water Retention, Moodiness, Fatigue

Salt: Water Retention

Alcohol: Depression

Cramp Relief

During cramping, avoid wheat, dairy products, alcohol, caffeine, and refined sugar.

Put a heating pad on your abdomen.

Take a hot bath.

Massage your back and abdomen if possible.

Eat veggies, fruits, nuts and seeds.

Add cayenne pepper to your food.

Try meditation.

Try avoiding Nutra-Sweet

Natural Ways to Deal with PMS

1. Restrict your intake of refined sugars, simple carbohydrates (sugars, white rice, white flour, starchy foods), salt, caffeine, red meat, and alcohol. If you can’t manage to restrict these foods all month, then make sure you cut back on them at least two weeks prior to your period and stop smoking.

2. Follow a well-balanced diet. Eat plenty of complex carbs such as brown rice, whole grain breads, bran, pasta, and calcium-fortified foods, along with fresh fruits and vegetables. In addition to being good for you, these foods are high in fiber, which helps prevent constipation, and water retention.

3. Eat four to six small meals daily. Since estrogen can lower your blood sugar, it’s important to eat nutritious meals frequently throughout the day to maintain your blood sugar levels and prevent PMS-related starvation binging and food cravings. 

4. Exercise. With your physician’s approval, exercise aerobically at least 20-30 minutes, four to six times per week.  Choose fun activities like aerobics classes, jogging, swimming, using an elliptical trainer, etc. Try lifting weights, too! Exercise is a great way to reduce stress, improve circulation, and it elevates your mood, so get moving!

5. Sleep. Get at least eight hours of sleep each night. Sleep deprivation causes all sorts of chemical imbalances in your brain and with PMS already taking possession of your body, you don’t need anything else making you nuts.

6. Seek support from your friends and family. Talk to them about what you go through each month so that they understand that when you snap and say you want to be left alone, that it’s probably nothing they did, but that you just need some space to deal with a hurricane of hormone based emotions that happen to be bombarding your body.

7. Keep accurate records of your cycle, PMS symptoms, their severity, duration, your diet, supplementation, exercise, and any other treatment option you’ve chosen so that you and your physician can work together to see what works and what doesn’t when it comes to treating your PMS.

8. Work vigilantly with your physician and don’t give up. Every woman’s body is different so what might work for your friend, might not work for you.

Resources:

1. Barnard, Neil, Scialli, Anthony, Hurlock, Donna, Bertron, Patricia. Diet and Sex-Hormone Binding Globulin, Dysmenorrhea and Premenstrual Symptoms. The Physicians Committee for Responsible Medicine, Washington DC, the Department of Obstetrics and Gynecology. Georgetown University School of Medicine, Washington, DC. Vol 9S, NO. 2, February 2000.

2. http://www.pmsinst.com/. Berke, Michael L. MD., P.C., Treating Women with Menstrual Distress. Premenstrual Institute. Access Date: April 10, 2003.

3. http://www.premenstrualsyndrome.com/listeningpms.htm. The Female Cycle. Access Date: May 22, 2003.

4. http://www.mckinley.uiuc.edu/health-info/womenhlt/ir-mense.html.  Irregular Menses, McKinley Health Center University of Illinois. Copyright: The Board of Trustees of the University of Illinois, 2001. Rev. 03-20-01. Access Date: May 22, 2003.

5. http://www.fwhc.org/health/moon.htm. Menstrual Cycles: What Really Happens in those 28 Days?!  Copyright 1996-2003 Feminist Women’s Health Center. Access Date: May 22, 2003.