Ladies, when it’s around that time of the month do you suffer from bloating, cramping, anxiety, mood swings, irritability, depression, or breast tenderness? These are all common symptoms of Premenstrual Syndrome (PMS) that typically occur during the last week of the luteal phase (1-2 weeks before menstruation) and begin to go away within 4 days of menses.

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Did you know that 75% of reproductive aged women experience mild to moderate PMS symptoms? PMS affects millions of women worldwide, disrupting their lives with symptoms ranging from mood swings and fatigue to bloating and cramps. For many women, even mild PMS symptoms can interfere with work, parenting, or social relationships. While conventional approaches often focus on symptom management, a functional medicine perspective seeks to understand the underlying imbalances causing these symptoms.

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PMS Potential Causes:

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1. Hormonal Imbalance: When we have fluctuations in our hormones i.e. estrogen levels increasing and progesterone levels decreasing (or the ratio is off), this is when we experience PMS symptoms. Hormonal balance is also impacted by stress/thyroid hormones and neurotransmitter balance as these chemical changes can contribute to PMS symptoms such as depression, fatigue, food cravings, and issues with sleep.
2. Poor Gut Health: Imbalances in the gut microbiome or lack of diversity can lead to hormonal dysregulation, leading to increased risk for PMS symptoms.
3. Vitamin and Mineral Deficiencies: B6, vitamin D, E, A, magnesium, calcium, DHA/EPA have an inverse relationship with PMS severity.
4. Endocrine Disrupting Chemicals: Chemicals found in our environment can interfere with our endocrine system and promote hormone imbalance, contributing to worsening PMS symptoms.

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Understanding PMS from a Functional Medicine Perspective:

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In functional medicine, we view PMS as a manifestation of underlying imbalances within the body’s systems, including hormonal fluctuations, neurotransmitter dysregulation, inflammation, gut health issues, and lifestyle factors. By identifying and addressing these imbalances, we can alleviate PMS symptoms and work on feeling our best selves. Sometimes improving just one factor in our lives can be enough to alleviate PMS symptoms but most often we find that a combination approach is best.

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The PMS Rx:

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1) Focus on your nutrition:

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• Nutrition plays a crucial role in hormone production and metabolism, making dietary interventions a key component of the functional medicine prescription for PMS.
• Embrace: a whole foods-based diet rich in fruits, vegetables, lean proteins, and healthy fats to provide essential nutrients and support hormonal balance. Certain nutrients such as magnesium, vitamin B6, and omega-3 fatty acids have been shown to help reducePMS symptoms. Omega-3 fatty acids in particular can be very helpful in reducing both mood symptoms associated with PMS (depression, anxiety, lack of focus) as well as physical symptoms (bloating, headache, breast tenderness).
• Avoid: Alcohol, smoking cigarettes, and eating high fat/sugary foods as they have been associated with increased risk of PMS. In fact, higher doses of maltose (found in beer, yams, tomato sauce, cereals) have also been identified as a potential risk factor for PMS.

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2) Optimize your gut health:

The gut-brain axis plays a significant role in PMS, with imbalances in gut microbiota contributing to inflammation and hormonal dysregulation. It is so essential to protect our microbiome through dietary changes, pre and probiotics, and targeted supplements to keep both digestion and elimination running smoothly. Restoring balance to our gut microbiome, contributes to proper hormone functioning and can play a role in alleviating PMS symptoms and thus, promote overall well-being.

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‍3) Achieve hormonal balance with supplements and herbs:

• A fundamental aspect of the functional medicine approach to PMS is restoring hormonal balance. This involves evaluating hormone levels, particularly estrogen and progesterone, and addressing any imbalances through targeted interventions.
• Helpful supplements include: vitamin D, calcium, vitamin B6, and magnesium. Lower levels of vitamin D and calcium during the luteal phase and (intracellular) magnesium are reportedly lower in women with PMS. Vitamin B6 is both an anti-anxiety, anti-inflammatory, and aids in glucose regulation, making it a very important vitamin for women who suffer from PMS to make part of their daily regimen. You should consider taking magnesium (at least 200mg daily) if you suffer from headaches, fluid retention, mood instability, aches and pains. Also, if your diet does not include many plant foods (the best source of magnesium) and you are stressed you need magnesium in your life as magnesium is “wasted” when we are stressed!
• Herbal remedies such as chasteberry (Vitex agnus-castus) is the most widely supported herb by the literature to help in regulating hormones when treating PMS. Vitex helps to relieve breast tenderness, swelling, cramps, food cravings and has been comparable to fluoxetine for PMDD (PMS’s more severe cousin).
• Other botanicals like curcumin and ginger can be helpful with symptoms of breast tenderness, headaches, swelling/inflammation and mood changes and the cooking herb, saffron, can be helpful with PMS associated depression.
• Other stress relieving herbs like passion flower or St John’s wort and adaptogens like ashwagandha, reishi, holy basil, and schisandra can increase our stress resilience, allowing both our mind and bodies to achieve balance (especially during that time of the month).
• If there is no relief with supplements, you may consider talking to your healthcare provider about pharmaceutical options. Women may find relief of PMS symptoms by taking progesterone cream or oral progesterone during day 14-28 of their cycle, oral contraceptives, or antidepressants (selective serotonin reuptake inhibitors) taken either daily or 2 weeks before menstruation begins.

4) Stress less:

• Chronic stress can exacerbate PMS symptoms by disrupting hormone balance and exacerbating inflammation in the body. Stress management techniques such as meditation, yoga, deep breathing exercises, and mindfulness-based stress reduction (MBSR) can help regulate cortisol levels and reduce the severity of PMS symptoms. Yoga has been shown to be of particular benefit.

‍5) Work on lifestyle modifications:

• In addition to stress management, lifestyle modifications such as regular physical activity, adequate sleep, reducing toxin exposure, and maintaining a healthy weight can help alleviate PMS symptoms. Exercise has been shown to improve mood, reduce stress, and balance hormones, making it an essential component of the functional medicine prescription for PMS. Try to find activities that you enjoy and incorporate them into their daily routine. Not sure where to start? Play your favorite song and start moving and grooving! ‍

6) Go with your flow:

• Tune into how you are feeling and simply notice. Rather than fight against what you are feeling, lean into it! Set special time aside just for you the week before your period and nurture your body, mind, and soul. Maybe schedule a massage, schedule a dinner with friends, walk in nature, take a bath or enjoy a soothing hot cup of tea in your favorite robe.

7) Consider adverse childhood events (ACE’s)

• ACE's are associated with increased risk of experiencing several hormonal conditions later in life including PMS and PMDD. It is never too late to get help and deal with previous traumas. Please check out Psychology Today or Zencare when you are ready for support and keep a lookout for my next article that will dive into how trauma impacts our health.

If you have not yet tried a comprehensive and holistic approach to addressing PMS symptoms, I urge you to begin your journey! By restoring hormonal balance, optimizing gut health, managing stress, and making lifestyle modifications, you can experience true relief from PMS symptoms and reclaim control over both your mind and body.

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