It is not a surprise that pre-menstrual syndrome (PMS) has been called one of the most significant challenges in women’s health. Up to 80% of women suffer at least one symptom of PMS with 5-8% suffering severe symptoms.
On average a woman will begin menstruating (menarche) around age 12 years and will cease (menopause) around age 51 years. In the years between menarche and menopause she will have around 350-400 menstrual cycles. This is a significant amount of time for a woman if PMS is impacting family, social and work relationships.
What causes PMS?
The exact cause is still unclear but several theories exist. These include fluctuations in the hormones estrogen and progesterone, neurochemical changes in the brain, prostaglandins, diet, lifestyle, and social and cultural influences. It is likely a combination of some or all of these factors.
Hormones are the chemical messenger systems in our bodies. Some hormones have their own natural rhythm, rising and falling predictably on a set schedule. Other hormones, however, are more responsive and reactive to our immediate and long-term environment.
Fascinating studies continue to be released describing the intimate interplay between the various hormones, highlighting the complexity that exists. Hormonal rhythms are pretty robust, some being genetically predetermined. However, we know that sometimes diet, lifestyle and environmental factors may disrupt their natural rhythms, creating a domino effect across the other hormones.
Symptoms of PMS
Symptoms vary between individuals and can be physical and/or emotional. The most common symptoms include mood sensitivity, sadness, anger, depression, breast tenderness, bloating, acne, appetite changes, and fatigue. These symptoms can impact work, family and social life as well as reduce accuracy when performing certain tasks.
For most women who have a regular 28-day cycle, it is possible to predict the onset of PMS symptoms as beginning anywhere during the 14 days between ovulation and the onset of menstruation. Symptoms subside around the onset of menstruation.
Natural Approaches to PMS
As our bodies strive to maintain equilibrium, how can we support ourselves in ways that honour our experience as complex beings? What can we do to find a way that allows us to function optimally and in harmony with our background hormonal rhythms?
Embracing the flow
Most women have predictability on their side when it comes to their monthly cycle. A woman’s cycle is naturally divided by ovulation into two phases.
Phase one begins with the onset of menstruation and ends with ovulation. This is a time when a woman may have more energy, more focus and is generally more social. Ovulation is when many women feel at their peak.
Phase two begins with ovulation and ends with the onset of menstruation. This is the time where a woman may experience some of the emotional and physical changes associated with PMS symptoms.
By leveraging the gifts of these two phases, and recognising the strengths in each, a woman can aim, as far as is possible, to adjust her calendar accordingly. Consider including and planning activities that respect the ebb and flow of the two phases. It is like breathing in and breathing out with every cycle.
During phase one, planning activities that call for more outgoing traits such as social functions, presentations, kids birthday parties and big projects, may be more appropriate. While during phase two it’s important to set aside time for some slower paced and more nurturing activities.
Of course, the reality is that some of those choices are completely outside of our control. However, being mindful of our own place in the cycle can guide us and prevent us from becoming overwhelmed, by playing with those moments that are under our control.
Planning nurturing moments and creating space
Phase two offers the opportunity for deeper reflection, and can be a time for creative thinking and connection. At different times in history and in different cultures, women have been seen as very powerful during this time.
Hot baths using relaxing essential oils - geranium, lavender, bergamot, or rose
Warm nourishing herbal teas - chamomile, rose, nettle, earl grey, chai spice
Meeting with close friends
Reading a book
Spending time outdoors in green space
Exercise, even regular gentle walking has the potential to impact many PMS symptoms. There is some evidence that women who include regular exercise in their lives have fewer symptoms of PMS. Exercise also improves circulation to the reproductive organs, improves mood, enhances sleep quality, assists digestion, and improves self-esteem and feelings of empowerment. Creating time for regular movement of any kind has immense benefits and contributes to our self-care capacity
There is evidence to suggest that some of the hormonal changes seen during phase two of a woman’s cycle may be responsible for altered appetite and change in food preferences. Indeed, many women experience cravings at this time and are drawn towards foods higher in fat and refined carbohydrates.
Blood sugar and hormones
The trick is to try to prevent swings in hormonal responses to food by making choices that help maintain an even blood sugar.
Choose whole grains, beans, vegetables and fruits.
Note: Whole grains have the added benefit of assisting in the removal of estrogen from the body via the digestive tract.
Try to eat smaller and more frequent meals
Include protein with meals: a little meat, cold water fish, eggs, nuts, beans
Include healthy fats with meals: Olive oil, avocado, nuts, hemp oil
Flaxseeds - 2 tablespoons ground flaxseeds daily
Add cinnamon to cereals and smoothies
Specific nutrients and their sources
Several nutrients have shown some benefits in alleviating symptoms of PMS. They each play integral roles in energy production, hormonal production and sleep. When possible, it is optimal to get these nutrients from food. However, sometimes a supplement is more convenient when you know you are eating less than optimally*.
Magnesium: Beans, tempeh, seeds such as pumpkin and flax, green leafy veg, avocado, dark chocolate (over 70%)
Calcium: Extra firm tofu, organic milk products or calcium fortified plant beverages, almonds, canned salmon and sardines (including the bones), leafy greens
Vitamin D: Spend time outdoors in the summer months and consider supplementation through the winter months.
Vitamin B6: Chickpeas, salmon, tuna (yellow fin or skipjack), organ meats, potato, sweet potato, and fortified breakfast cereals
Vitamin B1: Whole grains, meatless soy products, edamame, black beans, pork, yeast extract
Omega 3: Evidence supports improved mood with a higher omega-3 intake.
Cold-water fish such as salmon, sardines, mackerel, tuna, krill. Krill may be more easily absorbed than the others. Plant sources include flaxseeds, hempseeds, and walnuts. Plant sources have to be further modified in the body and so may not be as effective as a source of omega-3 as fish sources. Grass fed beef is higher in omega-3, but again, needs to be further modified in the body. Other sources include foods that have been fortified with omega 3 such as eggs or soy beverage.
Sodium: Reducing salt intake helps reduce bloating
Herbal Aproaches for PMS
Herbs to support the liver
Hormones are broken down and cleared by the liver, and herbs that stimulate and support liver function are often included in formulas for PMS. This is especially true where constipation exists or skin eruptions occur. Choice of herbs may include dandelion root, artichoke, milk thistle or yellow dock
Chasteberry is the fruit of a small tree-like shrub found in the Mediterranean region of Europe and central Asia. It is a herb commonly prescribed by herbalists for PMS, especially where emotional symptoms and breast tenderness predominate. Recent studies continue to confirm its benefits in alleviating symptoms of PMS. Wild yam and black cohosh and blue cohosh may also be prescribed.
Herbs to support the nervous system
Some herbs may be added to support the nervous system, reduce feelings of stress and to aid sleep. Choices may include passionflower, lemon balm, chamomile, valerian, or vervain.
Other PMS symptoms and some of the herbs that may be included in a formula
Breast swelling and tenderness - calendula, poke root, or cleavers
Headaches –feverfew or wood betony
Fluid retention – dandelion leaf, or nettle
It can take about three cycles (months) to feel the full benefits but overall PMS is very responsive to a combined herbal, nutritional and lifestyle approach.
*Talk with your health care provider to assess your diet for adequate intake of the important and specific nutrients mentioned above.
Alternatively, use the free eaTracker tool on the ‘Resources’ page to assess your dietary intake. It will give you a full breakdown of your nutrient intake for the day as well as providing a number of other useful and fun features to play around with eaTracker is also available as an app.
**Herbs with hormonal activity should be used under the guidance of a qualified herbalist. Some herbs may increase fertility, interfere with the effectiveness of hormonal contraceptives or should not be taken during pregnancy.
Although herbs are generally considered safe, they can have contra-indications or can interact with some medications. A qualified herbalist recognises potential herb and drug interactions and can provide safe advice accordingly.
If you have any questions or you think you could benefit from a herbal and nutritional approach to PMS, please don’t hesitate to contact me.
All content provided on this website is for general information purposes only and is not intended to replace medical or specialist advice.
A qualified Medical Herbalist is always your best resource for information related to herbal medicines.
Registered Dietitians are a reliable and trusted resource for nutrition related information, always up to date and always ready to work with you to realise your goals.