Let’s talk about PMS!! Specifically, why we get PMS – cramps, pain, anxiety, breast tenderness, mood swings – and what root causes contribute to our PMS (think diet and lifestyle).

Because let’s face it: PMS is a struggle. It seems like a pretty raw deal to think that 2 weeks out of every month are lost to feeling anything from (at best) less than fabulous to (at worst) like a completely different person (one who is moody, angry, and in pain).

Not awesome. The mood swings, the emotional volatility, the anxiety and depression, the headaches, the water retention, the sore breasts, the skin breakouts – they all make life harder and quite frankly, most of the time it’s already hard enough.

But, there is hope! There are ways to reduce PMS and even to get rid of it entirely. First we’ll talk about why we get PMS, and then in my next post, we’ll talk about how to use nutrition to deal with PMS.

What is PMS?

PMS, or premenstrual syndrome, is really a collection of symptoms that occur in the two weeks to few days before you get your actual menstrual flow (menses). Menses itself might come with its own frustrations – things like cramping, clotting, heavy flow – and we’ll talk about those in a later post. For now, take heart that nutrition help for PMS will make your entire menstrual experience better.

PMS symptoms are very diverse, and can include any of the following:

• emotional volatility and mood swings
• weepiness
• headache
• fatigue
• fluid retention/water weight
• constipation
• sugar cravings
• weight gain
• acne
• backache/muscle aches
• low libido
• increased anxiety, depression, low moods, or panic attacks
• abdominal cramps

Some women experience certain clusters of symptoms – some might have headaches and only headaches, some might only experience the mood issues (anxiety, depression, emotional volatility) – but it’s possible to experience any combination of the symptoms. You’ll likely know what your particular symptoms are.

 

Is PMS normal?

Before we talk about why we even get PMS, let’s discuss this question: is PMS normal?

When I was studying nutrition, I remember asking during one of my classes a question that had never occurred to me before: is it possible to have a menstrual cycle with no PMS symptoms and no pain?

Until that moment, such a concept had seemed impossible to me. I thought that cramps, mood swings, pain, irritability, and so on were all just natural parts of the menstrual cycle, and that women just had to ‘put up with it’ as part of the whole deal.

Not so.

I’ve come to understand, as with acne, that PMS tells you that something is out of balance in your body. And while PMS is extremely normal in the sense that it is COMMON, it is not normal in the sense that it is natural or inevitable. It is possible to have a menstrual cycle that comes upon you almost unexpectedly – no breast tenderness, no moodiness, no anxiety, no cravings, etc.

 

So if PMS isn’t normal, why do we get it?

This is where we dig into the root causes of PMS. As you’ll remember from my root causes of acne post, a root cause is the underlying reason for a health problem. From a holistic nutrition perspective, usually we talk about root causes as imbalances in certain body systems.

The imbalances that can contribute to PMS are extremely common (particularly the hormonal stuff). If you look over this list, see what root causes jump out as possibilities for you.

 

Let’s Dive In: The Root Causes of PMS

 

Root Cause #1: Hormone Imbalances

Estrogen dominance, or unopposed estrogen, is a VERY common root cause for many women’s PMS. I’ve written a full post on estrogen dominance that you might find helpful and I’d encourage you to check it out.

For now, here’s a quick summary: Estrogen dominance or unopposed estrogen can occur if you have too much estrogen in your body, or, too little progesterone. Estrogen and progesterone are the hormones that govern and regulate your menstrual cycle, and play a huge role in your general reproductive health – and they work in a balance or ratio. If you have too much unopposed estrogen (i.e. the balance/ratio of estrogen to progesterone is off), you might see health concerns across the entire reproductive spectrum including PMS, but also fibroids, cysts, and more.

High/unopposed estrogen also contributes to water retention, reduced Vitamin B6 activity (B6 is important for the manufacture of serotonin, and low serotonin is a root cause of PMS – see below), and increased breast pain.

Reasons why you might have estrogen dominance issues:

• you’re exposed to lots of outside sources of estrogens like plastics, hormones in conventional meat or dairy products, endocrine disruptor chemicals like BPA (often found on receipts), and so on.
  • These estrogens (called xenoestrogens) tend to be stronger then the body’s estrogen and they amplify its effects. Bingo bango, too much estrogen.
• you’re not not clearing estrogen from your body effectively – i.e. either your liver is having some troubles, or you’re having constipation issues, or both.
  • In this case, you might have normal amounts of estrogen but the balance is off because you’re not able to get rid of it after its done its work. For estrogen detoxification to be working properly you need to support your liver, which is the body’s primary detoxifier when it comes to estrogen, and ensure you’re getting enough fibre so that you’re moving that detoxified estrogen out of your body via your poop.
• you don’t have enough progesterone (probably because you’re stressed).
  • Estrogen and progesterone work in a balanced ratio. The primary reason you might not make enough progesterone (outside of things like not ovulating in the first place – a topic for another time) would be stress. When you’re stressed, your body favours the production of your stress hormone cortisol over the production of your reproductive hormone progesterone. That means you have less progesterone to balance the effects of estrogen, meaning you might become ‘estrogen dominant.

That brings us to root cause #2…

Root Cause #2: Stress 

Dammit, must stress appear as a root cause for everything? I’m sorry, but yes. According to one of my favourite period books, The Period Repair Manual:

“A high level of perceived stress doubles the risk of severe PMS”.

Why might this be? Well, consider the following:

• stress contributes to lower progesterone (see above) which in turn can contribute to greater feelings of anxiety and irritability (progesterone has a calming influence in the body), but also, a greater sensitivity to stress. Lower progesterone is also a factor in estrogen dominance (also discussed above), which is a root cause of PMS.
• stress lowers endorphins, and endorphins help us with pain (specifically with feeling less of it). So fewer endorphins means we’re more sensitive to pain, including the pain of PMS.
• stress causes your body to release more cortisol. Cortisol reduces the amino acid tryptophan, which is what your body uses to make serotonin. More stress = more cortisol = less tryptophan = less serotonin (and low serotonin is another root cause of PMS).
  • Further Reading: Stress and the cortisol-tryptophan relationship, also known as Tryptophan Steal.
• According to The Period Repair Manual, “over the longer term stress also impairs ovulation.” Ovulation is how your body produces progesterone. Impaired ovulation = less (or no) progesterone = hormonal imbalance and all of the low progesterone issues mentioned above.
• Stress appears to increase the hormone prolactin, which in turn contributes to breast tenderness.

Interesting side note: The impacts of a stressful time might not be felt in an immediate way, depending on where your body is in your cycle. The Period Repair Manual calls it a ‘delayed effect,’ noting on p216:

“Stress NOW can lead to PMS weeks later”.

Root Cause #3: Deficiencies in Key Nutrients

Deficiencies in key nutrients like Vitamin B6 or magnesium can contribute to PMS issues. Here’s why:

• Your body needs Vitamin B6 to manufacture serotonin, and not making enough serotonin can contribute to PMS symptoms like anxiety, cravings, and even constipation (see Root Cause #6). B6 also helps reduce inflammatory prostaglandins (see Root Cause #4) and helps with the detoxification of estrogen (see Root Cause #1). It’s also useful in the manufacture of your sex hormones, including progesterone.
• Magnesium is valuable as an ‘anti-stress’ mineral. It works on your nervous system to help you feel relaxed, and it’s easily depleted by stress. I find it helps with sleep, and also with cramps and muscle aches, as well as anxiety (all PMS symptoms). It’s estimated that more than 60% of the population (in North America) is deficient in magnesium, so it’s really common.
• PMS might also be worsened by deficiencies in iron, zinc, and potassium, among others.

Reasons why you might be deficient in key nutrients:

• you eat a diet that is nutrient-poor (highly processed, highly refined, lots of white flour and sugar)
• you eat well, but you’re still missing key nutrients or not absorbing them properly (low stomach acid, compromised digestion)
• you’re not eating a wide variety of plant-based foods including fruits and veggies
• you’re stressed out and depleting your nutrients
• you consume substances that might deplete your nutrients, like sugar and alcohol, or that might interfere with their absorption, like coffee

Root Cause #4: Prostaglandin Imbalances

Prostaglandins are short-acting little messengers in the body. They serve a few purposes, and in terms of your menstrual cycle their main purpose is to help your uterus contract in order to help it shed and clear the lining it no longer needs. They also play a role in ovulation, and if you were pregnant, prostaglandins help get the uterus contracting for labour. This is all good stuff.

The downsides of prostaglandins is that they increase pain, swelling, and inflammation. Prostaglandins might be behind things like muscle aches, quivery legs, and so on – the things that happen around or before your period arrives where suddenly you’re a walking pain machine.

Prostaglandins play an important, healing role in the body. The problems arise when you have too many prostaglandins, or more specifically, too many of a certain kind. There are three main types of prostaglandins – E1, E2, and E3. You don’t have to worry much about the names – just know that E1 and E3 are anti-inflammatory, while E2 is pro-inflammatory. You want your prostaglandins to be balanced in order to avoid the pain-promoting effects.

Reasons why you might have prostaglandin imbalances:

• you eat a diet that’s rich in pro-inflammatory foods, like sugar, alcohol, refined/white flour foods, refined vegetable oils, margarines, hydrogenated fats, poor quality meats, or conventional dairy
• you don’t eat enough fibre
• you don’t eat anti-inflammatory omega 3 fats and anti-inflammatory foods, like from fatty fish like salmon, chia seeds, walnuts, turmeric, or an omega-3 oil supplement
• you consume lots of (conventionally-raised) animal fats, which are generally saturated and contribute to the production of the pro-inflammatory pain prostaglandin E2
  • (Note: some people might take issue with this – if you love animal fats and your health has never been better, power on! Every body is different. Just seek out the best quality fats you can find – pastured, organic, grass-fed etc. These types have fat that is higher in omega 3 fatty acids, which are the anti-inflammatory kind).

 

Root Cause #5: Thyroid Issues 

Low thyroid function (hypothyroidism) and painful PMS/menses often go hand-in-hand, so if you’re experiencing other symptoms of thyroid issues, like fatigue, hair loss, weight gain, sluggishness, dry skin, etc, speak to your doctor or naturopath about blood work to check about your thyroid function. Your naturopath will probably run a full panel, but your doctor might not. Do some investigation and try to push for a full thryoid panel of TSH, free T3, free T4, reverse T3 (and possibly antibodies to see if there is any autoimmune component to the thyroid issues).

 

Root Cause #6: Low Serotonin

Serotonin is a chemical messenger in your body – a specific kind called a neurotransmitter. It helps your brain communicate with your nervous system, and helps your nervous system communicate with your entire body. It plays a role in lots of body functions (appetite, sleep, clear thinking, memory) and it also influences your feelings of well-being, calm, and happiness. You make almost 90 or 95% of your body’s serotonin in your gut (yet another reason why you want a happy, healthy gut).

With respect to PMS, during your menstrual cycle estrogen rises for the first two weeks, then falls; for the second two weeks, progesterone rises and then falls (this is a bit of an oversimplification but you get the idea). Ideally, serotonin remains steady through this process – for women with PMS, the thinking is that your serotonin drops with your estrogen, which means for the second two weeks of your cycle, you have LOW serotonin. Some ladies have systems where the estrogen-serotonin relationship is just more sensitive like that.

So who gives a flying sweet potato if you have low serotonin? Your body, for one. Lower serotonin can lead to:

• cravings for sweet or starchy foods (since they can temporarily raise serotonin levels)
• sleep problems
• anxiety
• depression/low mood
• poor memory
• constipation or bowel issues

Basically sounds just like PMS, doesn’t it? That’s because in this case, the low serotonin IS the cause of the PMS symptoms.

NOTE: if you struggle with depression, or more serious mood issues around your period (suicidal thoughts, aggression, panic attacks, or more) talk to a health practitioner. This could be something called premenstrual dysphoric disorder (PMDD) and it’s like PMS on steroids. This is a serious health concern and there is help out there for you.

Ok, I understand why I don’t want low serotonin. What things deplete my serotonin?

There are a few things that deplete serotonin levels – see if any fit for you:

• prolonged periods of stress
• fast-paced, busy, go go go living
• poor diet or a diet low in key nutrients
  • We make serotonin from proteins, along with certain minerals and vitamins. If you aren’t getting enough quality nutrients, you won’t be able to make serotonin.
• consumption of certain substances like artificial sweeteners, coffee, alcohol, nicotine
  • These may all deplete serotonin levels
• hormonal changes/hormonal influences
  • Consider what we discussed above about estrogen’s influence on serotonin. Estrogen helps boost the effects of serotonin by protecting it from breaking down, meaning, its effects last longer. When estrogen drops, as it does in the second half our cycle, that protective benefit goes away and serotonin drops too.
  • Further reading: The Dance of Hormones and Neurotransmitters
• heavy metals (like mercury)
  • Certain heavy metals are thought to damage some of the cells that manufacture serotonin. This could be from mercury fillings, the heavy metals in fish, heavy metals in drinking water, etc.
• lack of sunlight
  • As in a cold Canadian winter – think Seasonal Affective Disorder. Exposure to sunlight is thought to boost the brain’s release of serotonin. There is also the possibility we make some through our skin. Covered up skin/no sunlight means less serotonin.
• issues with your gut microbiome
  • 90-95% of your serotonin is manufactured in your gut by your microbiome (gut bacteria). Imbalances in your microbiome might influence your serotonin production. Once again, the gut is key to so much.
  • How do you know if you have gut issues, and therefore maybe serotonin issues? Consider if you have any digestive problems (bloating, gas, constipation), or any skin issues (acne, psoriasis, eczema), or have taken antibiotics recently, and so on. If so, likely yes to gut issues. Check here for more gut health info.

 

To Sum It Up:

Ah, PMS, that great monthly frustration. If you’re a woman between the ages of 11 and 55, I’m betting you know something about the pain of PMS.

That said, it’s important to remember that PMS might be common, but it isn’t necessarily inevitable. It is possible to experience a pain-free, symptom-free menstrual cycle.

There are several root causes for PMS – estrogen dominance, low serotonin, nutrient deficiencies, etc.

If you’re still feeling confused, consider that PMS causes really boil down to this:

• poor diet (with too much sugar, alcohol, conventional meat or dairy, or other inflammatory foods, and not enough fruits and veggies),
• possible deficiencies in minerals like magnesium (for which supplementation might be required)
• constipation or poor bowel function (either from poor diet or from other health issues)
• stress
• not enough fibre, sunlight, or movement; and
• a liver that needs more support and is having trouble detoxifying.

In my next post, we’ll review how to use nutrition to improve all of these areas so you can say farewell to PMS (or at least, seriously minimize it).

To your most vibrant health,

Emily

© Emily Joldersma, R.H.N. Eat Well, Live Vibrantly

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