I really want to challenge a common held belief around Pre-Menstrual Syndrome (PMS), that is that if you are unlucky enough to suffer debilitating PMS symptoms then you just have to put up with it. No, I want to let you know that if you are suffering with PMS, no matter what your symptoms, then help is at hand to naturally rebalance your hormones and make it a thing of the past. Hormone shifts prior to menstruation are normal, yes, but ongoing debilitating symptoms are not. In fact, some women suffer so badly that they develop whats known as PMDD or Premenstrual Dysphoric Disorder – In PMDD, the main symptoms are mood disorders such as depression, anxiety, tension, and persistent anger or irritability. Help is at hand naturally for both PMS and PMDD and I have successfully treated both in my clinic countless times.
Firstly to give some background on the menstrual cycle, the average menstrual cycle lasts 28 days. It begins on the first day of your period, this ia Day 1. A regular, functional cycle then goes like this: For the first 14 days of the cycle, estrogen levels rise. This helps the endometrium (one of the layers of the uterus walls) fill with blood to prepare for possible fertilization. Estrogen levels are at their highest on day 14, when ovulation begins. After day 14, estrogen levels begin to drop and progesterone levels increase. As those levels go up, the body sends nutrients to the uterus in case an embryo implants. About a week before a period begins, progesterone starts to decline again. It reaches its lowest point on day 28, and a new period begins, with a period bleed. So generally speaking PMS (pre-menstrual syndrome) refers to a group of symptoms (mild, moderate or severe) which women can experience in the week or so leading up to the beginning of her menstrual cycle (when she starts menstrual bleeding again) from day 21 and progesterone and estrogen levels are both falling.
So what causes PMS or PMDD ?
Changes in levels of progesterone, oestrogen and their metabolites (what they convert into) causes PMS. Progesterone is like valium to the female brain, calming, positive, balancing and relaxing, so if our levels decline we feel negative affects. Decreased levels of the positive neurotransmitter (brain chemical) serotonin may also influence mood symptoms, this is important to remember as low neurotransmitters can be at play just as much as hormone levels when it comes to PMS causes.
The symptoms of PMS are wide ranging from mood swings, depression, anxiety, physical symptoms, fatigue, headaches, insomnia, digestive issues, sore breasts and bloating.
How ‘bad’ your PMS is depends on
(1) how quickly estrogen and progesterone are falling from day 21 of your cycle and
(2) if progesterone is falling more rapidly than estrogen
(3) other factors such as levels of inflammation, blood sugar levels, levels of neurotransmitters
Generally speaking levels of progesterone in the body protect us from feeling symptoms of “estrogen dominance”. These symptoms of estogen dominance include the puffiness, bloating, mood swings, breast tenderness, weepiness, and weight gain we associate with PMS. Oestrogen dominance can also contribute to heavy period bleeds.
There are three typical imbalances involved and at play here – and the common element in each of the three imbalances is this: temporary (or ongoing) estrogen dominance yields what we call “PMS” symptoms.
So how does this unfold in the body? There are three common ways –
(1) PMS may be severe because a woman has relatively high estrogen levels all the time, so as progesterone falls, estrogen continues to dominate (this often has environmental roots).
(2) Or PMS may be severe because a woman’s baseline estrogen levels are normal but her progesterone levels are on the lower side; thus, as progesterone falls, it drops lower than what is needed to “buffer” her body from estrogen and the resulting oestogen dominant affects.
(3) PMS may also be severe because a woman’s body is poor at detoxifying and ridding itself of estrogen in the liver (often due to poor methylation cycles or clearance cycles in the liver or issues in the GI tract such as estrogen binding and/or reabsorption due to constipation or a low fibre diet). It is therefore vital to address gut and liver detoxification pathways when working to reduce PMS as both PMS/PMDD have a link with oestrogen dominance, toxicity and inflammation in both the gut and the liver. Female hormonal health is highly dependent on effective liver and bowel clearance of oestrogens (and other steroid hormones), as well as effective detoxification of environmental toxins.
Indeed gut bacteria itself can effect hormone levels in the two major ways.
First, an overgrowth of certain anaerobic bacteria can produce high levels of an enzyme called beta-glucuronidase, which effects estrogen metabolism. High levels of this enzyme prevents proper excretion of estrogen, which can cause it to build up and recirculate in our bodies, causing worse symptoms.
Second, overgrowths of bad bacteria can produce high levels of endotoxins called lipopolysaccharides that produce inflammation in the body. This inflammation causes a host of problems in the body one of which is hormone dysfunction. Higher levels of inflammation have been found in women with PMS compared to controls. Inflammation in the body can be cause by diet, physical or emotional stress, autoimmune conditions or gut infections.
It s also really important to realise that High and/or ongoing stress will also exacerbate PMS and could be your core driver as to why you are experiencing it – so many women are under chronic stress. When we are stressed, our adrenal glands secrete large amounts of a stress hormone called cortisol (to protect the body from the affects of short-term stress). Cortisol, however, competes with progesterone for receptor sites in our cells. So even with normal progesterone production, high levels of cortisol can prevent a women from benefiting or “feeling” the benefits of having healthy progesterone levels (and estrogen dominance will then also occur). It is vital to support the adrenals if stress is an issue in your life, to help in balancing your homrones as stress can cause and maintain estrogen dominance. It is always vital to ensure the thyroid is balanced too when addressing root causes of PMS as a low thyroid function is also associated with sex hormone imbalances and PMS.
Realize too that our “fat cells” generate their own estrogen. Thus women with excessive amounts of body fat often struggle with estrogen dominance and worse PMS (keep in mind that even individual with normal weight may still have an excessive percentage of body fat) . Obesity and insulin resistance increase oestrogen production and may impair fertility, increase systemic inflammation, up-regulate stress hormone production and drive oestrogen dominant conditions like PMS / PMDD. Changes in insulin sensitivity throughout the ovarian cycle can also present as PMS problems. During the luteal phase of your cycle before your period starts, insulin sensitivity is usually lower than the follicular phase of your cycle. Symptoms of blood sugar instability are strikingly similar to PMS symptoms like brain fog, irritability, fatigue, insomnia and increased appetite and could be a core driver for you.
How can we naturally reduce PMS symptoms?
Certain foods do make PMS worse. In particular, reduce
Inflammatory foods – this includes sugar, gluten, processed deep fried foods. Increased levels of inflammation in the body cause issues with the GABA (neurotransmitter) receptors which can exacerbate symptoms such as anxiety, moodiness and irritability.
Salt- this increases fluid retention and puffiness
Alcohol- also dehydrates, causing bloating and puffiness, plus poor sleep patterns then increasing irritability
Eat less from a packet and more from the Earth to get the nutrients we need. Focus on an anti-inflammatory diet, high in fibre, with moderate levels of protein – think lots of green leafy vegetables, nuts and seeds, other good fats such as avocado and olive oil, protein such as fish, eggs, pasture raised meats, to help to balance blood sugar and maintain gut health Cruciferous foods such as broccoli, cauliflower and cabbage include glutathione which help us to detoxify hormones, and liver detoxifying foods such as lemons, garlic, leafy greens, beetroots and carrots can also be really helpful.
Warming, cooked foods can really increase comfort levels and reduce stress.
Reducing stress and employing good stress management practices will help to reduce cortisol interfering with your progesterone levels – daily movement, mediation, breathing exercises, yoga are all ideal.
Eating or supplementing sources of nutrients such as magnesium, B6 will assist PMS as they support the calming GABA pathways, the feel good brain chemical which relaxes us.
Once of my favourite herbs for balancing progesterone and reducing PMS is chaste tree, or vitex agnus castus, which works through pathways in the brain and the body to reduce symptoms of PMS and has a mild opiate effect. I use herbs such as Angelica, ginger and cinnamon to relieve heavy, painful periods. For oestrogen clearance or detoxification, as well as liver support and Methylating nutrients such as B12, soy isoflavones and broccoli sprout powder, turmeric, I use calcium d glucarate, a systemic inhibitor of beta- glucoronidase enzyme thay I spoke of earlier, to prevent the reabsorption of detoxified oestrogen. are all wonderful with oestrogen detoxification. For poor sleep or depression or PMDD St Johns Wort, samE, adrenal support and magnesium are fantastic
There are so many effective herbal treatments for PMS, but I would urge you to seek the services of myself or another trained herbalist, as some of these herbs can interfere with prescription medications and need close supervision and are most effective when tailored to the individual needs of the person.
There can be so many influencing factors and root causes for PMS, its vital to not just treat the symptoms but look to what imbalance is causing it in each individual. I work with partnering GPs to run full blood testing so that I can assess all factors influencing the cycle, and support your hormones to rebalance, naturally. Please get in touch or book in with me to discuss more
Victoria x
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