Naturopathic Approaches to PMS

Authored by Dr. Barrett

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PMS stands for Premenstrual Syndrome. It refers to a set of physical and emotional symptoms that over 75% of people experience leading up to their menstrual period. (1) The severity of PMS symptoms varies from person to person. During the menstrual cycle the levels of estrogen and progesterone rise and fall. In the days leading up to menstruation, the levels of estrogen and progesterone drop. Serotonin, our happy neurotransmitter, is also impacted by these hormone fluctuations. 

According to the Mayo Clinic the symptoms of PMS include: (2)

Emotional and behavioral signs and symptoms

• Tension or anxiety
  
• Depressed mood
  
• Crying spells
  
• Mood swings and irritability or anger
  
• Appetite changes and food cravings
  
• Trouble falling asleep (insomnia)
  
• Social withdrawal
  
• Poor concentration
  
• Change in libido
  

Physical signs and symptoms

• Joint or muscle pain
  
• Headache
  
• Fatigue
  
• Weight gain related to fluid retention
  
• Abdominal bloating
  
• Breast tenderness
  
• Acne flare-ups
  
• Constipation or diarrhea
  
• Alcohol intolerance
  

As always we want to look into the root cause behind symptoms and some possible causes of PMS include:

• Imbalances in estrogen and progesterone
  
• Fluid and electrolyte abnormalities
  
• HPA (hypothalamus-pituitary-adrenal) axis dysregulation which is a fancy way of saying an imbalance stress response. 
  
• Neurotransmitter dysfunction
  
• Nutrient deficiencies
  
• Digestive/microbiome health imbalances. The digestive component can be overlooked and it’s an important one. We excrete estrogen through the digestive tract and if our microbiome is imbalanced we can reabsorb estrogen burdening our body with a hormone it’s already tried to get rid of. 
  

PMS can be broken down into subtypes but it’s important to note that many people experience symptoms across the subtypes. 

PMS-A (anxiety): This subtype is characterized by symptoms such as anxiety, tension, irritability, mood swings and insomnia. PMS-A is typically caused by low progesterone and elevated estrogen. 

PMS-C (cravings): This subtype is characterized by symptoms such as food cravings, especially for sweet or salty foods. They can also experience headaches, palpitations, fatigue and dizziness. PMS-C is typically caused by low magnesium and elevated PGE1. 

PMS-D (depression): This subtype is characterized by symptoms such as depression, fatigue, forgetfulness, insomnia and a lack of energy. PMS-D is typically caused by elevated progesterone and low estrogen. 

PMS-H (hydration): This subtype is characterized by symptoms such as bloating, water retention, and breast tenderness. PMS-H is typically caused by an increase in sodium retention and increases the hormone aldosterone. 

How to support your body to treat or prevent PMS

Exercise Regularly
The research is clear, people who exercise regularly do not have PMS symptoms as often as people who don’t. Even 8 weeks of regular aerobic exercise showed improvement in physical and psychological symptoms. 3

Manage Stress Levels
Stress puts strain on our adrenal glands which can lead to fluctuations in cortisol output. These fluctuations can cause a blood sugar roller coaster. It’s also important to note that the hormone aldosterone that impacts our fluid retention is also produced in the adrenal glands. One of the best ways to manage stress? Exercise!

Maintain Healthy Eating Habits

• Keep your blood sugar balanced by eating protein with each meal or snack and limiting refined/processed carbohydrates. 
  
• Cut out caffeine.
  
• Reduce or cut out alcohol.
  
• Increase your fiber intake to at least 35g per day.
  
  • 2 TBS of ground flaxseed is particularly helpful.
    

Supplements to Consider

• Magnesium glycinate: Magnesium helps relieve stress, anxiety and water retention. A standard dose for PMS is 400-600mg daily. (4)
  
• B6: many studies show a positive effect with B6 supplementation for PMS symptoms. A standard dose is 40-100mg daily. Do not take over 200mg daily for long periods of time as it can lead to neuropathy.
  
• Multivitamin: a 2020 study looked at using B6 alone vs B6 along with a multivitamin and the combination of B6 and a multivitamin achieved remission of PMS symptoms for 72% of the participants (5)
  

Botanical Medicine
There are several herbs that can help support a healthy menstrual cycle. Talk to your naturopathic doctor about which herbs may be right for you. 

Testing
The information above is simplified and some patients may benefit from hormonal testing to get the full picture and properly treat their symptoms. We utilize both functional testing, such as the DUTCH test, and conventional blood work to assess our patients. 


References:

1. Kues JN, Janda C, Kleinstäuber M, Weise C. How to measure the impact of premenstrual symptoms? Development and validation of the German PMS-Impact Questionnaire. Women Health. 2016 Oct;56(7):807-26. doi: 10.1080/03630242.2015.1118734. Epub 2015 Dec 1. PMID: 26624615.
   
2. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780 
   
3. Samadi Z, Taghian F, Valiani M. The effects of 8 weeks of regular aerobic exercise on the symptoms of premenstrual syndrome in non-athlete girls. Iran J Nurs Midwifery Res. 2013 Jan;18(1):14-9. PMID: 23983722; PMCID: PMC3748549.
   
4. Walker AF, De Souza MC, Vickers MF, Abeyasekera S, Collins ML, Trinca LA. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998 Nov;7(9):1157-65. doi: 10.1089/jwh.1998.7.1157. PMID: 9861593.
   
5. Retallick-Brown H, Blampied N, Rucklidge JJ. A Pilot Randomized Treatment-Controlled Trial Comparing Vitamin B6 with Broad-Spectrum Micronutrients for Premenstrual Syndrome. J Altern Complement Med. 2020 Feb;26(2):88-97. doi: 10.1089/acm.2019.0305. Epub 2020 Jan 10. PMID: 31928364