Are you a teen or woman who feels absolutely crazy during the week or two before your period? Do you feel irritable, anxious, depressed, weepy, or all of the above? Do you have physical symptoms such as breast tenderness, headaches/migraines, bloating, acne, brain fog, fluid retention/puffiness, aches and pains, trouble sleeping or food cravings? Learn more about why this happens by reading this article. Or, scroll right to the bottom to get to the 10 Ways to Fix Your PMS.
The definition of PMS (premenstrual syndrome) is quite broad. It can include any of these listed symptoms, up to two weeks before the first day of your period.
Did you know that PMS is not “normal?”
You may think it’s normal because roughly 75% of women have at least one PMS symptom. However, in integrative medical systems, PMS is not considered normal or healthy.
PMS symptoms are, in fact, signs that something is “off” with your hormones. Fortunately, it’s completely possible to reduce or even eradicate your PMS symptoms. And the best part is that for most women, it does not take long. It’s completely natural to be surprised when you get your period, because you had no PMS or warning symptoms!
What causes PMS and what is typically recommended?
Our understanding is that the fluctuation of your sex hormones estrogen and progesterone, that naturally occurs throughout your menstrual cycle, causes PMS symptoms in random unlucky women. The solution? Birth control pills that shut down your own hormone production. This flattening of your normal hormones does not actually solve PMS symptoms, it just overrides them while you take the pill. The underlying causes of your PMS are not addressed, plus birth control pills come with risks and side effects.
A Functional Medicine approach to PMS
In Functional Medicine, we look for root causes to “syndromes” like PMS. In fact, since there aren’t solutions to PMS in conventional medicine, this is a perfect condition to treat with complementary approaches. We view hormone fluctuations as totally normal. However, when you can’t adapt to the fluctuations, that’s when you feel symptoms.
Why would you have a hard time adapting to fluctuating estrogen and progesterone levels? Typically the causes include one or more of these:
Your progesterone levels are too low.
Progesterone is a calming hormone that acts on the GABA receptors in your nervous system. It relaxes you and helps you sleep. In a sense it’s a hormone that chills you out and takes the edge off that irritability and anxiety. It naturally lowers at the start of perimenopausal hormone changes, and there are many reasons it can also be low in younger women.
Estrogen may be too high because of estrogen dominance.
Estrogen dominance can cause PMS symptoms, especially headaches, bloating, and sore breasts. You need estrogen, but in the perfect amount. Estrogen dominance exists because of low progesterone, too much exposure from environmental estrogens, and/or poor metabolism of estrogen (which is a liver and gut microbiota issue). Note that it’s normal to have some natural estrogen dominance in your 40s, because your progesterone declines far earlier (often 10 or more years) than your estrogen. But if coupled with an existing estrogen dominant picture, then perimenopause symptoms can be exaggerated.
Inflammation is part of the picture with PMS. The best approach is to root out the cause of the inflammation. It can be a disrupted gut microbiota (dysbiosis) or even a disrupted vaginal microbiota! Foods that frequently cause inflammation include gluten, dairy, and sugar. Excess weight and insulin resistance are another common cause of inflammation.
Adrenal stress hormone dysregulation.
This is crucial for sex hormone (estrogen and progesterone) stability. If adrenal hormones are out of whack, you may have adrenaline or cortisol spikes that cause hormonal symptoms. By the way, this is one of the main reasons why women get hot flashes during perimenopause – another reason to master how you manage and perceive stress now. Regular and sufficient sleep is also important for adrenal hormones stability.
For PMS, we examine levels of B vitamins, fat soluble vitamins D, E and A, essential fatty acids, and the minerals magnesium, calcium and zinc. There are a plethora of scientific studies that show adequate levels of all of these nutrients will reduce PMS symptoms.
Other hormone levels.
Given the complex orchestra and close interaction of all your hormones, imbalances in insulin, prolactin, thyroid hormones, and adrenal hormones can cause PMS.
If your liver detox is sluggish, or you have a fatty liver (high cholesterol is a sign), then your hormones, as well as toxins and inflammatory molecules, will not metabolize well. This backup can cause PMS symptoms in various ways. In Chinese Medicine, your “liver system” governs your uterus, and “liver stagnation” is always part of the picture in PMS.
Don’t worry if all this sounds complex! Truth be told, most women usually feel a difference by exploring these 10 interventions, each of which address one or more root causes of PMS . . .
10 things to do right now to reduce or nix your pms
1. Get minerals
- 500 mg of calcium per day is the magic amount shown to improve PMS.
- Make sure you have enough zinc, in the range of 30-50 mg per day, from foods or in a multi, or alone. Especially with PCOS or acne.
- Most women are low in magnesium, and a good starting dose is 400 mg of magnesium glycinate. My first approach!
- Iodine is essential. We often don’t get enough nowadays, with eating whole foods and not using iodized salt. The RDA (amount not to be sick) for women is 150 mcg, 220 while pregnant, and 290 while breast-feeding. Take some if it’s not in your multi. Helps fibroids, lumpy fibrous breasts, tender breasts, endometriosis, and your thyroid! Take up to 800 mcg. If you have Hashimoto’s, stick with the RDA as it may stimulate your thyroid too much to go higher.
- Always make sure you get selenium – especially to “balance” iodine. 100 mcg is usually sufficient because you’ll get some in foods. 200 mcg daily from all sources is ideal.
2. Take vitamin B6
All B vitamins are important, but vitamin B6 is especially important to nurture progesterone and stabilize estrogen. Try 50 mg twice a day. This is a B vitamin not to overdo – do not take above 2000 mg per day. B6 WITH magnesium shows even better results.
3. Increase progesterone
- Vitex (Chaste Tree) is a well-known herb for increasing progesterone. The dose is 200 mg, once per day – some women get better results by taking it in the morning. You need to give it a few months to gauge results. Vitex works on the level of your pituitary gland, by reducing prolactin levels. If you don’t need prolactin lowered, or if prolactin is already low, it probably won’t work.
- Pregnenolone drops can support progesterone, especially with adrenal stress dysregulation – chronic stress lowers progesterone. Pregnenolone, as a top level adrenal steroid hormone, can trickle down to support adrenal hormones and fill in low progesterone lows. Since this is a hormone, best to do this under the care of a provider.
- Bio-identical progesterone in oral drops or topical cream is an option. Start with 25 mg daily for the two weeks before your period. Again, best to under the care of a provider.
4. Stabilize and metabolize estrogen
- Soy is a phytoestrogen (weak plant estrogens that are good because they block harmful estrogens). There are other phytoestrogens, but soy particular has been shown to improve PMS.
- Flaxseed (another phytoestrogen) contains lignans, which bind to estrogen metabolites to get them out of your body so they don’t recirculate. Try 1 TBSP ground flax seeds once or twice daily. Grind them fresh or buy freshly ground and keep in the fridge. Use in smoothies, mix with oatmeal, sprinkle over salads.
- Calcium-D-glucarate removes excess bad estrogens. This works on two levels – in your liver and in your G.I. tract. If you’ve ever taken a Functional Medicine stool test, and an enzyme called glucuronidase is high – that’s a sign that calcium-D-glucarate can help. 1000 – 1500 mg per day.
- Improve your gut bacteria so they can metabolize your estrogen better. Test your microbes with a Functional Medicine stool test. Or simply feed your microbes with a variety of prebiotic food and take a good probiotic.
- Improve liver detoxification of estrogen AND toxins that interfere with estrogen. If you like shakes, use a detox powder in your daily shake (good brands include Apex, Metagenics, Designs for Health, and Thorne). As an alternative, you can take other liver supports such as the herb milk thistle or a well-absorbed form of glutathione. You can also up your intake of cruciferous vegetables (think cauliflower, cabbage, kale, bok choy, broccoli, and Brussels sprouts), which support your liver to metabolize estrogen.
5. Get your fat soluble vitamins.
These are A, D, E and K. Real vitamin A (retinal, not beta-carotene) supports progesterone (aim for 5-10,000 iu daily). Vitamins D and E have been shown to reduce PMS. Fat soluble vitamins are essential for hormone regulation, and they also have hormone-like actions. You can get these in a good multivitamin, or take them independently. Research shows that vitamin E in the dose of 200 iu reduces PMS and menstrual migraines.
6. Remember essential fatty acids.
Research shows that raising levels of an anti-inflammatory molecule called prostaglandin 1 (PG1) decreases PMS. Specifically, 2000 mg per day of a combination of omega-3 fats from fish oil combined with GLA (which comes from borage or primrose) helps PMS.
7. Regulate your heart rate variability.
Why? To regulate your adrenal stress hormones. Research shows that this helps PMS! The best tool to do this is an app called Heartmath. You purchase a sensor from the company, and then use their app on your smart phone. It’s super easy and immediately effective.
8. Try the Chinese herbal remedy Xiao Yao San.
This is a classic PMS formula, translated as “Relaxed Wanderer.” Get it from a reputable company. We use Kan herbals.
9. Take a break from gluten, cow’s milk, and sugar.
All of these can exacerbate PMS by causing inflammation and bloating. You may get immediate and significant results by nixing one or all of these. Experiment!
10. Try rhodiola.
This is an adrenal adaptagen herb that also soothes the emotions of PMS. The active ingredient is rosvarin. Take 150-300 mg divided between morning and night.
We provide most of the above remedies on our dispensary. If you are interested, you can contact us to get the insider’s code.
Most women will get improvement with these 10 suggestions. However, if you are confused about what’s right for you, or if these don’t work because your root causes are more complex, or you have PMDD (premenstrual dysphoric disorder), apply for a free consult to get help!
I welcome your comments and questions below.