By Dr. McKenzie Nisbet, ND
WHY IS PMS SO COMMON?
Premenstrual syndrome (PMS) is a catch-all diagnosis for countless symptoms occurring around the luteal phase of your cycle. Symptoms may last days or weeks; typically worsening 6 days before and peaking 2 days before the start of menses.
Most women have some degree of PMS and about 20-40% of women report severe symptoms that cause disability. Though PMS is clearly very common, it is not normal.
It is not normal to have disabling symptoms for days to weeks each and every month.
As women, our hormonal regulation is highly complex. This complexity is why we are able to support another being – through pregnancy and into infancy. When this regulation becomes disrupted we experience an array of symptoms based on our unique hormonal balance and lifestyle.
The most common symptoms are breast tenderness, abdominal pain, headaches, back pain, joint or muscles aches, water retention, difficulty with sleep, digestive concerns, skin blemishes, food cravings, exhaustion, irritability, anger, and feeling down.
WHY DO WE HAVE PMS?
The actual cause of PMS is “unknown”. However, it is likely a complex combination of hormonal imbalances, neurotransmitter interactions, and lifestyle factors.
Many factors associated with PMS are extremely prevalent in the typical North American lifestyle. By being aware of these risks and making small changes you can reduce your symptoms of PMS.
YOUR DIET
Research shows that diet plays a significant role in determining who is more likely to experience PMS symptoms. Diets with less sugar, fewer refined grains/carbohydrates, and more fruits, vegetables, whole grains and fibre experience less PMS symptoms.
One study compared three different diets and concluded that PMS is more common in women consuming a “Western” dietary pattern, and is less likely in women consuming “traditional” or “healthy” dietary patterns. Though the “traditional” and “healthy” diets used in this study (below) are not perfect, this paper showed how diet alone can have a huge impact on your PMS symptoms.
- WESTERN DIETARY PATTERN: high in red and visceral meats, fast foods, vegetable oil and mayonnaise, sweets and desserts, salty snacks, refined grains, sugar and soft drinks, high-fat dairy products, spices and fried potato.
- TRADITIONAL DIETARY PATTERN: high in eggs, cooked potatoes, legumes and nuts, poultry, hydrogenated oil, cabbage, sweets and desserts
- HEALTHY DIETARY PATTERN: high in vegetables, fruits, natural juice, olive, tea and coffee, fish, low-fat dairy products, legumes and nuts.
NUTRIENT DEFICIENCIES
Certain nutrient deficiencies have been linked to PMS symptom frequency and severity. Two of the most common deficiencies are Magnesium and Vitamin B6.
MAGNEISUM
Magnesium deficiency is very common in Canadian women, with the highest level of deficiency occurring in girls 12-19 years of age. The classic North American lifestyle – filled with high levels of sodium, fat, and soda intake, coupled with high levels of stress – encourages this deficiency. Magnesium supplementation has been shown to reduce premenstrual fluid retention as well as improve muscle aches, headaches, insomnia, anxiety and low mood.
VITAMIN B6
B6 is an important cofactor in our bodies. Cofactors help enzymes complete biological transformations. For example,Vitamin B6 is a cofactor in the production of serotonin (your ‘happy hormone’). It has been shown that women who experience PMS have lower levels of serotonin during the second half of their cycle. By ensuring adequate B6 intake you can support serotonin production.
B6 is also one of the nutrients needed for the proper absorption of magnesium. It has been studied alongside magnesium and is shown to be more effective than supplementing with magnesium alone.
The dose and form of these vitamins and minerals will affect their efficacy so be sure to check with your healthcare provider before choosing your supplements.
INFLAMMATION
The North American lifestyle is pro-inflammatory; due to our poor diet, lack of activity, and our chronic internal and external stressors. Higher levels of general inflammation within the body are significantly associated with PMS symptoms – specifically mood symptoms, abdominal cramps and back pain, appetite cravings, weight gain, bloating, and breast pain. The best place to start reducing inflammation is through your diet.
STRESS LEVEL
Our life is filled with constant daily stressors. Everything from rushed mornings, long commutes, lack of job security, unsatisfying careers, financial stressors, family responsibilities, unhealthy relationships, rising costs, and the addiction to technology has put us in a chronic state of stress. This chronic stress actually has a greater impact on PMS than acute stressors.
To combat this chronic stress, mindfulness has been shown to be help reduce stress reactivity, improve coping measures, and reduce anxiety. The best stress reduction technique is the one that works for you.
Give one of these a try:
Mindful meditation. Download the app “Headspace.” This app contains guided mediations to help you master the skill of meditation.
Journaling. Use a regular notebook or one designed for mindfulness, such as “The Five Minute Journal.” Get your emotions and thoughts down on paper to help keep your mind clear.
Talk it out. Perceived social support is a strong protective factor for both depression and anxiety and helps foster coping strategies.
Nature Walks. Studies show spending time in nature can help reduce stress levels. This is also a great option for anyone who has difficulty with stationary meditation.
DIAGNOSING & TRACKING YOUR PMS
How do you know for sure that you have PMS? Technically, you can’t. There is no simple definitive blood test for diagnosing PMS. PMS is determined based on your history, the timing of your symptoms, daily rating of symptoms over multiple cycles, and ruling out other causes of your symptoms.
The best thing you can start doing today for your PMS is to track your cycle. Get to know your symptoms – when do they start and end, what makes you feel better (or worse), and how does their severity and frequency change as your cycle progresses? Everyone’s experience is unique to them. By understanding your symptom picture, we can make specific recommendations for your PMS and monitor changes between your cycles. When it comes to PMS; the more information, the better.
To take tracking one step further and really understand the hormonal component of your symptoms we can do functional lab testing. These are not your average blood tests. One of the most comprehensive functional test for cycle irregularities is the “DUTCH Complete” by Precision Analytical. This test shows us your estrogens and their metabolites, your liver’s ability to remove excess hormones from the body, progesterone marks, androgens (such as testosterone), cortisol and cortisone curves, DHEA, as well as organic acids and nutritional markers (such as Vitamin B6). This knowledge allows us to create a more focused treatment plan for your unique presentation.
To start tracking your symptoms use a free fertility tracker app such as “Kindara” or download this free “PMS Symptom Tracker.”
Remember, it is not normal to have disabling symptoms for days to weeks each and every month. To learn about why you have PMS and what we can do about it, book an appointment here and reclaim your cycle.
Resources:
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072449/; DIET: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/F2C1436021136BDA3A9CC0968C351E46/S0007114515003943a.pdf/western_dietary_pattern_is_related_to_premenstrual_syndrome_a_casecontrol_study.pdf; NUTRIENTS: https://www.ncbi.nlm.nih.gov/pubmed/9861593, http://pubmedcentralcanada.ca/pmcc/articles/PMC5372959/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455825/, https://www.ncbi.nlm.nih.gov/pubmed/11425281, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/, https://www.ncbi.nlm.nih.gov/pubmed/23853635, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452159/, https://www.ncbi.nlm.nih.gov/pubmed/11425281; INFLAMAMTION: https://www.ncbi.nlm.nih.gov/pubmed/27135720; STRESS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772979/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709294/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/
