If you are like most women (80%) you recognize that your period is coming by the changes you feel, emotionally and physically. Premenstrual Syndrome (PMS) refers to more than 150 symptoms that occur in the 2nd half of your cycle, after ovulation. Most women report increasing symptoms in their 30’s and 40’s, which makes sense given that most women are estrogen dominant as they approach menopause. There are 4 categories of PMS:
PMS – A: Anxiety (65-75%of PMS sufferers)
- Anxiety, tension, feeling “on edge”
- Irritability, anger
- Mood swings, Insomnia, Depression
- Feeling overwhelmed
- Sensitive to Criticism
PMS – C: Cravings (30% of PMS sufferers)
- Cravings for sweets and carbohydrates
- Increased appetite
- Heart Palpitations
PMS – D: Depression (25-35% of PMS sufferers)
- Forgetfulness, confusion
- Withdrawal and disinterest in usual activities
PMS – H: Hyperhydration/Water Retention (50% of PMS sufferers)
- Breast swelling and tenderness
- Abdominal bloating
- Weight gain of over 3 lbs
- Swelling of the face, hands, fingers and ankles.
Other symptoms common to all types of PMS can include: bowel changes (constipation, diarrhea), cramping, changes in libido, backache, headache, acne and other skin changes, night sweats, insomnia and nausea.
Most women fall into one or more categories, but find that one of the above categories best matches their symptoms. This is useful as it helps us to identify underlying causes, as well as manage symptoms until we get to the root cause.
What is the root cause?
As I said earlier, most women know their period is on its way based on how they are feeling. That part is normal. What isn’t normal is for symptoms to begin more than 1-2 days before the period starts, begin immediately after ovulation, cause major disruptions in life, or cause enough discomfort to require pain medication.
Finding the root cause can be tricky, but most of the time estrogen dominance is to blame. Estrogen dominance is when estrogen is high relative to progesterone. This can be a “true” dominance (estrogen is high, progesterone is normal) or a relative dominance (estrogen is normal, progesterone is low). Women who have been on hormonal birth control for many years, or have known exposure to xenoestrogens (ie, plastics, pesticides) often have a “true” dominance picture. In that case, we support the liver’s detoxification of estrogens and use foods to influence the balance of estrogen and progesterone (ie phytoestrogens). In cases of “relative” dominance, which is most common in peri-menopause when progesterone levels start to decline, we use herbs like Vitex to support the production of progesterone. Treating estrogen dominance usually takes 3-6 months, but most women begin to feel better after just 4-6 weeks.
Treating the “branches”
While the “root” cause is often estrogen dominance, the “branches” aka symptoms, can also be treated while we wait for the root to heal. The most common symptoms I see related to PMS are:
- Anxiety/Irritability/Mood Changes
- Insomnia/Sleep changes (especially during peri-menopause)
There are a number of therapies that can be used to successfully manage the “branches”, including melatonin, 5-HTP, l-theanine, inositol and/or herbs that support adrenal health such as licorice, eleuthrococcus and ashwaganda. Many patients feel very discouraged by the time they seek out naturopathic care, having suffered for many years. Many women are also concerned that their symptoms are becoming more severe as they get older. In most cases, my patients report a 75% improvement in symptoms by 3 months, with many reporting significant improvement in just 1 month!
Correcting the imbalance
- Include phytoestrogens in your diet: beans, lentils, flax (2 tbsp/day). Some women also benefit from including soy foods (soy milk, soy beans, soy nuts, tofu).
- Reduce red meat consumption to less than 2x/month
- Reduce caffeine, sugar and alcohol
- Manage stress levels. Cortisol and progesterone come from the same precursor – your body will make cortisol at the expense of progesterone when under stress (physical/mental/emotional), making estrogen dominance worse.
- Choose organic foods most often, especially the “Dirty Dozen“.
- Avoid using plastics.
- See an ND to ensure a proper diagnosis and treatment plan.
PMS may be common, but it isn’t normal! It’s just a symptom of an underlying hormone imbalance that can easily be corrected with the right kind of treatment.