Updated: May 15, 2019
If you are a woman then there is a great chance that you have experienced symptoms of mood, weight and appetite change during your menstrual cycle. It is important for you to know that these symptoms are a normal part of your cycle and you are not alone. Premenstrual syndrome (PMS) affects nearly 20-30% of women each month with 2-10% of women being affected by a more serious version of PMS known as Premenstrual Dysphoric Disorder (PMDD).
Understanding PMS & PMDD
PMS is a syndrome of physical and behavioral symptoms that occur in a cyclic pattern during the luteal phase of the menstrual cycle. The luteal phase occurs after ovulation as it prepares your uterus for pregnancy or the beginning of a new cycle. The physiology of this stage involves the uterus lining becoming thicker. It also involves the hormone progesterone, which increases and then decreases rapidly before the beginning of the next cycle. The progesterone hormone is what is responsible for preparing the endometrium for either implantation or endometrial wall shedding and bleeding.
Symptoms of PMS
With PMS, the symptoms that you may generally experience are: bloating, breast tenderness, fatigue, and a change in your normal habit of eating and sleeping. These symptoms are due to the fluctuations of the hormones estrogen and progesterone as they work to regulate the menstrual cycle.
What is PMDD?
Premenstrual Dysphoric Disorder or PMDD is considered a more severe form of PMS because there are psychological symptoms associated with it in addition to the physiologic symptoms of PMS. In order to be diagnosed with PMDD you must display at least one psychological symptoms 5 days before a new menstrual cycle begins. Those psychological symptoms include: depression, anxiety, extreme moodiness, or uncontrollable anger.
What Causes PMS and PMDD?
PMS and PMDD are due to the normal ovarian activities that occurs throughout the cycle. The normal menstrual cycle has normal surges and dips of the hormones, estrogen and progesterone, which are responsible for the symptoms associated with the two syndromes. The fluctuations in the hormones can further affect neurotransmitters such as serotonin and gamma-aminobutyric acid (GABA). These two neurotransmitters may be responsible for the variations in an individual's mood and affect.
When it comes to diagnosing symptoms related to PMS or PMDD, there is no specific testing to ensure that you have either. However, one thing that can be done is symptom charting. Symptom charting is where a client records the symptoms experienced every day of the menstrual cycle in order to report it to his or her health care provider for more accurate diagnosing. If the client has at least one symptom that is psychological and physiological, the doctor could possibly diagnose a client with either PMS or PMDD based on the specific symptoms and client history as long as there are no signs of underlying conditions. Therefore, the diagnosis of those conditions is dependent on you and what you choose to tell your health care provider . If the reported symptoms are similar to those of PMS and PMDD, you can expect the healthcare practitioner to confirm the diagnosis and create a treatment plan that most likely includes therapeutic lifestyle changes and hormone replacement therapy (birth control).
Other differential diagnoses that may need be ruled out according to the history and symptoms reported are: mood and psychiatric disorders, post traumatic stress disorder, schizophrenia, metabolic disorder, endometriosis, oral contraceptive side effects, migraines or anemia.
When it comes to managing the symptoms associated with PMS, there are not many medical interventions that are usually advised. As stated before, PMS is a result of normal ovarian function and hormonal fluctuation. There is an option for oral contraceptive use to normalize the hormones for severe symptoms, but for the individuals who prefer holistic and non-pharmacological methods, there are several effective therapeutic lifestyle choices as well. The therapeutic lifestyle choices that have shown promise in the management of PMS and PMDD symptoms include exercise, diet, herbs and supplements.
Maintaining regular exercise may reduce the severity of the symptoms associated with both PMS and PMDD. Studies have shown that maintaining 60 minute aerobic exercise sessions at least 3 days a week, may decrease symptoms associated with PMS and PMDD and improve quality of life . Aerobic exercises to consider are walking, swimming, running, stair climbing, or biking. It can be as simple of a regimen as you desire it to be. Even a daily half-hour walk, on your worse days, can both reduce and prevent symptoms .
The food that you are consuming throughout your cycle can have a tremendous effect on the symptoms you experience during the latter part of the cycle. For instance, a diet high in inorganic meat, fat, sugar, and salt may cause hormones to fluctuate even more than usual, which in turn will intensify the PMS symptoms. It has been shown that vegetarian women have less circulating free estrogen in their blood than non-vegetarians which results in a decrease in the intensity of symptoms. Other food items that may cause symptoms to worsen are: dairy, margarine, partially hydrogenated oils, caffeine, and alcohol.
In place of those unhealthy food items, there is recommendation to increase the intake of nutrient dense foods, including: whole foods, high fiber foods, complex carbohydrates, fruit, vegetables, whole grains, legumes, herbs, nuts, and seeds. If you have to consume any animal product, it is important to make sure that it is organic, antibiotic free and hormone free.
In addition, it is most common for individuals experiencing PMS and PMDD to either eat too little of what they need or eat too much of the wrong thing. During your menstrual cycle, try to sustain your appetite and food consumption. Your body needs all of the nutrients that it can get especially during this time, so maintain food intake by eating smaller and more frequent meals.
Herbs & Supplements
Traditionally, before the creation of synthetic hormones that mimic the natural hormones of the body, there were several herbs used that have shown effectiveness in relieving many symptoms associated with both PMS and PMDD. Many of these herbs are still currently effective, which is why many health care practitioners continue to recommend them .
Chaste tree berry (vitex)- is considered a reproductive tonic for balancing hormones, relieving depression and anxiety, decreasing irritability, reducing mood swings and relieving headaches.Improvements are noted within 2 cycles.Take daily for 4-6 months. Do not take if you are on birth control.
Raspberry leaf is also a reproductive tonic that provides nutrients to tone and strengthen the entire reproductive and urinary system. It is also one of the richest sources of iron, niacin and magnesium. It helps to reduce excessive bleeding during menstruation and it is a supertonic for pregnancy and birth.
Cramp bark is considered the best female regulator and relaxant for the uterus and ovaries. It is perfect for painful and difficult menstruation and traditionally used for nervous afflictions that threaten abortion during pregnancy. Additionally, it is especially helpful in menopausal women .
Dong Quai is considered the female ginseng and it works to strengthen and balance the uterus. It also may nourish the blood and cleanse the liver. Do not use during pregnancy or menstruation .
Dandelion is one of safest diuretic like herbs and it has been traditionally used to aid in proper water elimination and relieve bloating.
Motherwort is considered 'the best herb for all women', including those who are menopausal. It is valued for its benefits against water retention, uterine cramps, scanty menses (oligomenorrhea), hot flashes and mood swings.
Ensuring the intake of essential vitamins, minerals and antioxidants is also important throughout the menstrual cycle. With the shedding of tissue and blood that happens during menstruation, there is also the loss of many of these nutrients. That is why it is important to replenish the body with them using food, herbs and supplements.
Calcium 1200 mg daily - increasing Calcium reduces negative behavioral symptoms, reduces pain and reduces water retention during the menstrual cycle
Vitamin B6 - Numerous studies have shown that this vitamin decreases symptoms of PMS
Magnesium 200-300 mg daily - lower magnesium levels lead to increased negative behavioral symptoms and pain
Vitamin E 400 IU daily- this vitamin works along with other minerals to promote hormonal health
Iron 325 mg daily - this mineral decreases the severity of PMS and PMDD
Omega 3 Fatty Acids - use of Omega 3 has shown to reduce the occurrence of psychological symptoms associated with PMDD.
Remember, when it comes to your menstrual cycle, it does not have to be dreadful. Keep in mind that there are thousands of women that are going through the same thing that you are going through. However, in order to reduce or prevent your symptoms, all you need to do is take appropriate action before , follow the tips provided and remain consistent in your regimen so you can have control over your cycle.
Balch, J., & Stengler, M. (2010). Prescription for Natural Cures. Newark: John Wiley & Sons.
Cerqueira, R., Frey, B., Leclerc, E., & Brietzke, E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives Of Women's Mental Health, 20(6), 713-719. doi: 10.1007/s00737-017-0791-0
Dunphy, L. (2015). Primary care.
Fitzgerald, M. (2017). Nurse practitioner certification examination and practice preparation(5th ed.).
Gladstar, R. (2009). Rosemary Gladstar's herbal recipes for vibrant health. Pownal, Vt.: Storey.
Penland, J., & Johnson, P. (1993). Dietary calcium and manganese effects on menstrual cycle symptoms. American Journal Of Obstetrics And Gynecology, 168(5), 1417-1423. doi: 10.1016/s0002-9378(11)90775-3
Samadi, Z., Taghian, F., & Valiani, M. (2013). The effects of 8 weeks of regular aerobic exercise on the symptoms of premenstrual syndrome in non-athlete girls. Iranian Journal of Nursing and Midwifery Research, 18(1), 14–19.
Sohrabi, N., Kashanian, M., Ghafoori, S., & Malakouti, S. (2013). Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: “A pilot trial”. Complementary Therapies In Medicine, 21(3), 141-146. doi: 10.1016/j.ctim.2012.12.008