7 Root Causes of PMS

Are you a teen or woman who suffers from PMS (premenstrual syndrome) for a few days, a week, or even up to two weeks before your period? Do you feel irritable, anxious, depressed, weepy, or all of the above? What about breast tenderness, headaches, bloating, acne, brain fog, puffiness, aches and pains, or food cravings? If so, you’re not alone.

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. You may feel at the mercy of your hormones. However, in integrative, holistic medical systems, PMS is not considered normal or healthy.

PMS symptoms are, in fact, a sign that something needs to be addressed. Fortunately, it’s completely possible to reduce or even eradicate your PMS symptoms. It’s completely natural to be surprised when you get your period because you had no PMS or warning symptoms.

A root-cause approach to PMS

The fluctuation of your sex hormones estrogen and progesterone, which naturally occurs throughout your menstrual cycle, causes PMS symptoms in random unlucky women.

Hormone fluctuations are normal. However, when you can’t adapt to the fluctuations, that’s when you feel symptoms. So, we functional doctors ask the root-cause question: Why would you have a hard time adapting to fluctuating estrogen and progesterone levels? We want to nail down the answer for you, so we can use the right treatment. Here’s an outline of seven common root causes:

1. Nutrient deficiencies

Always start here, because if you are deficient in certain nutrients, nothing will fix that except to replenish them. There’s good research on a variety of nutrients (minerals, vitamins, and fatty acids) that help PMS. Check out this blog post to get your nutrients in order first and foremost.

2. Low progesterone levels and PMS

Progesterone is a calming hormone that relaxes you and helps you sleep. It chills you out and takes the edge off irritability and anxiety. It naturally lowers at the start of perimenopause, however, it is sometimes low in younger women. Low progesterone can cause PMS symptoms. Signs of low progesterone can include a cycle under 28 days, a period that begins with spotting, and PMS with insomnia or emotional lability.

What to do?

  1. Test progesterone and prolactin levels.
  2. Support progesterone with these essential nutrients as a start.
  3. Use bioidentical progesterone to adjunct your own production.
  4. Try Vitex (Chaste Tree). Vitex does not directly raise progesterone, instead, it blocks prolactin. High prolactin (common in PCOS) can block ovulation and therefore lower progesterone (ovulation = progesterone production). Vitex can also help PMS because it has opiate-like effects.

3. Estrogen dominance and PMS

Excess estrogen can cause PMS symptoms, especially headaches, bloating, and sore breasts. You need estrogen in the perfect amount. Unfortunately, we are all exposed to xenoestrogens from the chemicals in our environment, and these muck with our own healthy estrogen levels. Women in perimenopause with declining progesterone will naturally have an excess of estrogen relative to progesterone. Women of all ages can have impaired estrogen processing, as we need efficient liver detoxification and the right gut bacteria to take care of excess estrogen.

What to do?

  1. Do a GI Map test to check out gut bacteria. The marker you are looking for is beta-glucuronidase, which is an enzyme produced by gut bacteria that breaks down estrogen so it’s not reabsorbed.
  2. Do a Dutch Complete Hormone test to investigate how you metabolize estrogen, and use the findings to support phase 1 or phase 2 estrogen metabolism through your liver, if needed.
  3. Block xenoestrogens with supportive phyto (plant) estrogens.
  4. Raise progesterone (see above).
  5. Ditch plastics from your kitchen, get clean body products and household cleaners, and avoid pesticides.
  6. Do a focused detox on a regular basis – 4 times a year.

4. Inflammation

Inflammation is always part of the picture with PMS. The best approach is to root out the causes of your inflammation. It can be a disrupted gut microbiota (dysbiosis). Excess weight, chronic stress, and insulin resistance cause inflammation. Foods that frequently cause inflammation include gluten, dairy, and sugar. Many women feel significantly better when they get these three culprits out of their regular diet.

What to do?

  1. Measure inflammation markers such as hsCRP and Reverse T3.
  2. Root out the causes of inflammation for you.
  3. Use botanicals like curcumin, ginger, green tea, quercetin, or skullcap – all these are broad-spectrum anti-inflammatories.
  4. Take essential fats with glutathione to reduce inflammatory prostaglandins.

5. Adrenal stress

If adrenal stress hormones are too high or unstable, you can have adrenaline or cortisol spikes that cause PMS 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 stress and sleep now.

What to do?

  1. Take an adrenal test cortisol test (saliva or urine) and treat the findings.
  2. You can never go wrong with adrenal adaptogens which protect your body from stress chemistry, such as Ashwagandha or Siberian Ginseng.
  3. Adrenals gobble up vitamin C, magnesium, and vitamins B5 and B6.
  4. You need to address sleep, exercise, and stress – as you can’t just “supplement your way out” of adrenal disruption.

6. Blood sugar imbalance

Blood sugar imbalance (hypoglycemia, hyperglycemia, and insulin resistance) exacerbates PMS. These conditions require a root-cause approach as to what is causing them and targeted nutrition.

What to do?

  1. Test fasting insulin, glucose, triglycerides, and hemoglobin A1C.
  2. Get help with a hypoglycemia or insulin resistance eating and supplement plan.
  3. Eat whole foods, lots of vegetables, good quality fats, and sufficient protein.
  4. Avoid or minimize flour products, refined carbohydrates, fruit juice, dried fruit, added sugars, and alcohol.

7. Sluggish liver function

If you have excess belly fat, it’s likely you have a “fatty liver.” Other signs of impaired liver function are high liver enzymes, high triglycerides, difficulty digesting fat, bloating, acne, chemical sensitivities, high histamine, and headaches. In Chinese Medicine, your “liver system” governs your uterus, and “liver stagnation” is always part of the picture in PMS.

What do do?

  1. Test your liver function with bloodwork.
  2. Do a functional medicine cleanse or detox. Read how here.
  3. Take the herb milk thistle, which has broad-spectrum liver support.

Hopefully, this post was informative and not overwhelming. If you want some help figuring this out, we’re here.

I welcome your input below,

paris healing arts, doctor laura paris, dr. laura paris, dr laura paris

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  1. What a great article. Love the tips on how to Increase Progesterone, and to balance estrogen levels. Did not think about Rhodiola. It’s in my adrenal tonic that I take, which I find helps a lot.

  2. Hello, I’m going through menopause and have tried different supplements to get through the hot flashes and fatigue. I have trouble sleeping most the time and am confused as to which supplements, brand to use. I asked my doctor and they said any brand will do. How do I know which ‘brand’ will work for me? I feel like the supplements are not being absorbed in my body. My stomaches bloats when I eat or drink, (including water) I feel I’m going downhill. I will be 60 this year. I don’t want to be taking a handful of pills. What brand of supplements are easily absorbed and is there one that will work for me? Thank you for your time

    1. Hi Jeannie,

      I sounds like it’s not the supplements, it’s your gut that is problematic – key signs are bloating when you eat or drink. This should be addressed before piling on supplements. Good tests include the GI Map and the SIBO breath test.



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