Let’s delve into pre-menstrual syndrome or PMS.
PMS can manifest as both physical and psychological symptoms and can begin as early as 14 days before your menses. Like I said in the first episode whilst PMS is common it is not normal. Your period is actually just meant to arrive without all the commotion beforehand.
The Types of PMS
PMS can be broken into 4 categories – and you can experience more than one
PMS-A displays as feelings of anxiousness, irritability, nervous tension and mood swings and is the most common. This is often linked to high oestrogen and low progesterone. If you head back to ‘The Female Cycle 101‘ you will learn progesterone is an anti-anxiety hormone. Have a look at your consumption of dairy and refined sugar, making sure that you aren’t having excessive amounts of these. Vitamin B6 found in pork, chicken, fish, wholegrain, eggs and vegetables, can also be helpful here to reduce oestrogen and increase progesterone.
PMS-C is what drives those cravings, the increased appetite, premenstrual headaches and fatigue. This is generally the result of a magnesium deficiency in our red-blood cells. Correcting this can help improve symptoms – again those lovely green leafy vegetables such as spinach are a great source of magnesium along with nuts (Brazil nuts, almonds, cashews and pine nuts), brown rice, wholegrain and fish
PMS-D symptoms include depression, crying, insomnia and forgetfulness, luckily this is the least common but can severely alter moods. Progesterone is often higher than normal with elevated adrenal androgens – androgens are the name for the group of hormones that the adrenals make – these can be converted to a number of our sex or stress hormones depending on signals from our body. Lead toxicity can also be a driver.
And lucky last PMS-H this manifests as bloating, fluid retention, breast tenderness and weight gain a close second to PMS-A. This is linked to increased aldosterone (a hormone) which causes our body to retain water. Again Vitamin B6 is helpful here in high doses so see a practitioner. Vitamin E found in olive oil, nuts and seeds particularly almonds, hazelnuts, pine nuts and sunflower seeds helps with the breast tenderness. Nicotine and salt will make symptoms worse. This isn’t the lovely mineral rich salt’s such as Himalayan Pink Salt or Rock Sea Salt, this is the processed salts found in abundance (and not in a good way) in our processed foods.
What causes PMS?
There are many theories as to what causes PMS including hormone levels out of whack, nutrient deficiencies or a poor diet or abnormal neurotransmitters or prostaglandins. And despite all the research there are no answers to explain all the changes that women can experience premenstrually. As I have just explained there are a vast range of presenting symptoms so this is actually a very complex condition which as a number of interrelated causes and therefore needs a treatment that is as multi-factorial as the condition.
The Oestrogen – Progesterone Balance
Oestrogen and progesterone have this nice inverse relationship where oestrogen is higher in the beginning of our cycle with progesterone dominant in the second half. (Jump back to “The female cycle 101” for more information on this). This balance can be thrown off a number of different ways
– One of these hormones is in excess
– One of the hormones being under produced
– A combination of both
In “Period Irregularities” we had the HPATO axis and I explained a little as to how a dysregulation in this axis could cause oestrogen or progesterone to be affected – eg: hypothyroidism can cause oestrogen to increase and high demands on the adrenals can cause progesterone production to decrease.
It is often thought that high oestrogen – either oestrogen in excess or out of ratio with progesterone is a driver for PMS.
Progesterone insufficiency is thought to be a driver behind the fuild retention – yep that bloated puffy feeling you can sometimes get before your period. This is because progesterone stops aldosterone – another hormone released from our adrenal glands (this is one important and busy gland) that encourages the retention of sodium and water. So if progesterone is low aldosterone isn’t kept in check cue fluid retention. Stress also affects aldosterone, it triggers the release of renin an enzyme in the kidneys that sets off a chain of events that leads to increased production of aldosterone making us retain fluid. Like I spoke about last week we have these inbuilt survival mechanisms in us that allowed us to survive, floods, famine, animal attacks – This again is one of those survival mechanisms. Remember to our body stress is stress – it could be real your life is under threat stress or coming from your day to day life. This double whammy of low progesterone with increased stress can make for some uncomfortable PMS symptoms.
Our adrenals also secrete cortisol when we are stressed which I spoke about last week and this is often elevated in some of the PMS symptoms such as depression.
Progesterone receptors could also play a part in PMS. We may be making healthy levels of both progesterone and oestrogen, nicely in the ratios we want but our receptors may be faulty meaning that the progesterone cannot get to where it is supposed to be. A couple of our adrenal hormones norepinephrine and epinephrine which are elevated during stress actually block progesterone receptors therefore they are unresponsive. These progesterone receptors are located in all the areas we experience PMS symptoms – in our brains, uterus, skin, breasts and respiratory passages. These little receptors to need to be primed by oestrogen first – that is the oestrogen gets the receptors excited, open and ready to grab hold of the progesterone when it increases during the second half of our cycle. This is also why PMS is generally worse around times of hormonal change – puberty, menopause, post pregnancy – oestrogen activating the receptors may be inadequate.
Prolactin another hormone secreted from our pituitary – see last weeks video for an explanation on this hormone – has been linked to breast soreness and swelling.
What do we need to do?
Stress management: this is mainly lifestyle. It is the way we perceive stress and urgency. Simple things such as changing I have to’s to I get to’s can go a long way to helping reduce the stress. For example change I have to get up and go to work to I get to get up and go to work.
Sleep is also key. Get a good bedtime routine, this cannot be underestimated.
Spend moments of time during the day doing some deep belly breaths and also appropriate exercise. I will do a post on this topic later or you can jump back to “Period Irregularities” to understand a little how stress effect on the body.
Oestrogen detox: Get that liver working. I did explain this last week but for a quick recap all the green leafy vegetables – brocolli, caulifower, Brussel sprouts, Kale and cabbage. These vegetables contain idole-3 carbinol which is key to support liver detoxification and actually promotes the metabolism of oestrogen and helps remove excess from the body. This can be supplemented if required. Also your liver loves beetroot, onion, garlic. To stimulate the liver bitter foods like rocket, fennel, lemon and apple cider vinegar and spices such as ginger, turmeric, cardamon and cumin work wonders. Zinc selenium, all the B vitamins and n-acetyl-cistene are great supplements to use if your liver needs support.
Blood sugar level control. Many of the symptoms of PMS are associated with sugar cravings, carb craving, faintness and irritability when we haven’t eaten. Controlling your blood sugar levels is crucial to helping reduce symptoms. The best way to do this is through a whole food diet, lots of plants, lots of colour, lots of variety, good quality proteins and fats.
Vitamin B6 is often used to help relieve the symptoms of PMS and the underlying hormonal imbalances. B6 is found in pork, chicken, fish, wholegrain, eggs and vegetables,. The Pill will often deplete many of the B-vitamins, in particular this B vitamin. Vitamin B6 helps improve the depression and anxiety symptoms as vitamin B6 is needed to make serotonin our happy hormone and dopamine the hormone that allows us to be alert and relaxed. It reduces prolactin and aldosterone which as I said earlier can make our breasts sore leading into our period and increase fluid retention.
We also need vitamin B6 to help regulate magnesium, produce our essential fatty acids and increase our oestrogen-sensitive tissue responsiveness helping make them more sensitive to the benefits of oestrogen.
Magnesium is the nutrient that helps all the switches in our bodies turn off. With the heightened world we live in, those switches are always on. When we are deficient in Mg we can experience increased symptoms of depression and deplete dopamine, leading to tension and irritability. Mg deficiency causes aldosterone to increase – cue fluid retention. But in one of those horrible spirals our bodies can do, increased aldosterone makes our body excrete magnesium perpetuating the problem. Mg deficiency also causes increased insulin secretion, which has further problems for insulin sensitive. This I will talk about more during the PCOS episode coming up.
Mg can be low through inadequate intake in the diet; absorption is affected through excessive diary intake and excretion is increased with increased refined sugar intake. Magnesium is one of the true unsung heroes of PMS reduction.
We need to take a honest look at toxins in your life. These can come from our foods, what we put onto our bodies and I’m sure I will become unpopular here but drinks such as coffee and alcohol. These can effect our liver and our kidneys both which add to our PMS symptoms. Our liver detoxes our hormones and our kidneys are sensitive to aldosterone making us retain fluid and feel puffy.
The Wrap UP
As there are many different types of PMS the treatment will differ from person to person. A treatment should be tailored to reduce the symptoms that you are experiencing. I have created a checklist so you can identify which PMS type you are. You will find the link for this below.
I hope you have learnt something new about PMS today and if you are experiencing PMS symptoms you have a few tools you can now use to help reduce those symptoms.
As with all these blogs they are not prescriptive and are not to be taken as a replacement for actual advice. If you feel you need support in any area please book in for a consult with me or seek the advice of another qualified natural health practitioner.