No jokes about “that time of the month” and chocolate here — premenstrual syndrome (PMS) is a legitimate issue, as any woman who has struggled with it will attest. In fact, it’s estimated that roughly 3 out of every 4 women have experienced some form of premenstrual syndrome. But what, exactly, is PMS? One of the reasons it’s so hard to pin down is that a huge range of symptoms — by some estimates, more than 150 — have been linked to PMS. In this post, we’ll demystify premenstrual syndrome, looking at the common symptoms, causes, and what you can do to get it under control and keep a handle on your health.
What is PMS?
Premenstrual syndrome is a hormonal disorder characterized by the monthly recurrence of certain physical and psychological issues. These commonly begin the 2 weeks before your period starts and subside when the flow begins. The symptoms (both physical and mood-related) tend to occur in a cyclical, predictable pattern, but can vary in intensity from just enough that you notice them to severely disrupting your everyday routine. Symptoms of PMS can also change with time — shifting as you age — but also with circumstance. If you’re already under considerable stress, for example, the symptoms of PMS can be exacerbated.
What Causes PMS?
Despite the fact that premenstrual syndrome is incredibly common, there is no definitive explanation of what actually causes it. There are a number of theories out there, and it is likely to be multifactorial. For any one woman, there may be different factors that affect her but are specific to her physiology and lifestyle, so therefore there is no consistent single rationale that is understood as the primary cause.
One of the biggest theories of what causes PMS is hormonal imbalance, focusing on the concept of estrogen dominance. Estrogen dominance can happen when a woman has too much estrogen or when levels of progesterone fall, either during the natural fluctuation of the menstrual cycle or during peri-menopause/menopause (though sex hormone levels fall at this point in the life cycle, levels of progesterone drop more quickly than estrogen). In younger women, high levels of estrogen could be genetic, but estrogen levels can also be abnormally raised due to various environmental factors such as poor diet, obesity due to blood sugar dysregulation, or environmental toxins that affect the liver or act like xenoestrogens, which increase the estrogenic effect. Additionally, when women reach their 30’s and 40’s, it is common to lose some of their natural progesterone, which acts to counterbalance the effects of estrogen. In this scenario, PMS symptoms would worsen as one reaches menopause but eventually cease when menopause arrives, since the estrogen eventually becomes nonexistent.
There are other theories about the causes of PMS that look at factors like altered prostaglandin levels (fat molecules that have hormone-like effects, impacting areas including blood flow and inflammation), lower circulating endogenous opiates (pain mediators), and imbalanced neurotransmitters such as serotonin and norepinephrine, which play a major role in regulating mood. Many possible vitamin and mineral deficiencies could also play a role, such as deficiencies in Vitamin A, Vitamin B6, Vitamin E, calcium, magnesium, and potassium. Other factors that can influence PMS symptoms are psychosocial, cultural, and stress from home or work.
What are the Symptoms of PMS?
One reason why the exact cause (or causes) of PMS is so difficult to identify is because the symptoms are extremely varied and inconsistent. Symptoms of PMS vary considerably from woman to woman, and again, can change even for one person from year to year (or even month to month). Some common physical symptoms include bloating or temporary weight gain, fatigue, headaches, muscle and joint aches, menstrual or abdominal cramps, constipation or diarrhea, decreased libido, acne or other skin issues, finger swelling, sensitivity to light or noise, and a disrupted sleep schedule (which can mean sleeping too little or too much). Interestingly, some physical symptoms of PMS are similar to those pregnant women experience, including breast tenderness, lower back pain, and cravings for salty or sweet foods.
PMS also can have emotional or behavioral symptoms. The mood swings that can accompany PMS are often made light of, but they’re no joke when you’re going through them. Other emotional symptoms can include feeling sad or depressed, irritability, anxiety, anger outbursts, crying jags, suspiciousness, and difficulty concentrating. For some, this can lead to withdrawal from social situations.
The symptoms of PMS are extensive, and include many more than are listed here. Most women only experience a few, and in many cases, the symptoms may only be just strong enough to make note of but not sufficient to cause concern. For others though, the physical pain and emotional stress can be intense enough to impact their daily lives. Whether your symptoms are mild or severe, PMS generally goes away within four days of the start of your period.
How Do You Diagnose PMS?
There is no definite diagnostic test or blood test that confirms PMS. The diagnosis is made by the clinical presentation.
What is the Difference between PMS and PMDD?
You might have heard of PMDD, which is an abbreviation for Premenstrual Dysphoric Disorder. It’s basically a severe form of PMS, characterized by experiencing intense, disabling emotional symptoms every month. Women with PMDD have severe mood swings, excessive difficulty with concentration, and intense depression, irritability, and anxiety. PMDD may or may not be accompanied by physical symptoms. (If you regularly experience disabling physical symptoms, like intense cramps, it’s important to see a doctor to rule out other causes such as endometriosis.) The symptoms of PMDD may last longer than PMS, but still usually go away within the first 3 days of your period.
PMDD is relatively uncommon, and if you believe you may be experiencing it, you should see a doctor to confirm your suspicions — it may be that you have anxiety or depression that is being exacerbated by PMS. Depression alone will not cause all of the symptoms of PMS, but if you are experiencing severe emotional symptoms undiagnosed depression could be an underlying cause.
Can PMS Impact Other Conditions?
Anxiety, depression, and other mental health issues can definitely be intensified by PMS, but there are also other conditions that premenstrual syndrome may make worse. If you’re already prone to migraines, PMS can be a trigger. It can also worsen allergies, asthma, irritable bowel syndrome (IBS), chronic fatigue syndrome, and seizure disorders.
How Can PMS Be Treated?
In order to get a handle on premenstrual syndrome, it’s important first to know exactly what you’re dealing with so that you’re attacking the symptoms that truly affect you, and so that you know that what you’re battling is PMS and not another condition. The best way to do this is to keep a menstrual diary for at least 2 to 3 months in order to establish a pattern. You’ll want to track what symptoms you experience, their intensity, when they occur (and when they stop), and the dates that your period begins and ends. It sounds like a hassle, but — no surprise here — there are actually a large number of free apps that you can use on your smartphone or tablet to simplify tracking your symptoms. Once you’ve got some data, a healthcare pro like Dr. Tang can help you sort out the best approach for managing your symptoms.
Here are some common ways to head off symptoms of PMS:
Eat Right
There are certain foods that may cause or worsen PMS, though studies have varied in their findings. One study found dairy and refined sugars to be associated with worse PMS. Another study found that women who experienced more severe PMS consumed diets that were higher in carbohydrates, fat, and simple sugars and lower in protein than those with less intense symptoms. Based upon these studies, one solid approach is to avoid foods that have a high glycemic index such as refined carbohydrates, simple sugars, sugary drinks, and so on. Another way to keep your blood sugar regulated and limit any major spikes or dips is to eat 6 small meals throughout the day rather than waiting hours between each mealtime.
There are several mechanisms to explain how elevated sugars can trigger symptoms of PMS. The rapid rise in sugars causes a rise in a hormone called insulin to drive the sugar inside your cells. This causes sodium retention, which can leads to symptoms like bloating, swollen fingers, or tender breasts. (If you experience excessive bloating or swelling, avoidance of high salt foods is helpful to reduce these symptoms.) Second, elevated sugar levels also cause a depletion of magnesium. Last, sugars can cause an increase in estrogen levels because they may impair estrogen metabolism. All of these are implicated in causing symptoms of PMS.
It’s also important to identify any food intolerances or sensitivities that are unique to you as an individual. While these naturally would impact you throughout the month, an underlying dietary condition such as sensitivity to gluten, soy, or dairy could exacerbate the symptoms of PMS. If you experience gastrointestinal symptoms such as bloating, gas, abdominal cramps, heartburn, or loose bowel movements, then this may raise suspicion that it may be associated to PMS. One way to help identify whether food intolerance or sensitivity may be an issue is to keep a food diary for three to seven days, noting not only what you eat (and when you eat it), but also any physical responses or symptoms that you experience.
Last, limiting caffeine is also highly recommended when it comes to managing PMS. Caffeine acts as a diuretic, depleting the body not only of water but also potassium, magnesium, B vitamins, and vitamin C. Caffeine can also increase the production of prostaglandins, which are believed to cause breast tenderness, bloating, headaches, back pain, and joint pain. Keep hydrated with water instead of reaching for coffee or soda to relieve your symptoms.
Get Regular Exercise
It seems like there’s nothing that exercise can’t help with, and PMS is no exception. It’s likely that exercise helps to regulate blood sugars, lessening the rise in insulin and helping to modulate estrogen levels. Exercise can decrease levels of catecholamine, which can cause irritability, headaches, and nervousness. It also increases nitric oxide levels that act like endorphins (your “feel good” hormones). Moreover, it has been suggested that the frequency of regular physical activity is more important than the intensity of the exercise for alleviating the physical and psychological symptoms of PMS. The bottom line: Even if you don’t feel like hitting the gym when it’s that time of the month, stay active. Take a walk, use the stairs, even sneak in some squats while you’re loading the dishwasher. Just make sure you keep your blood pumping!
Keep Stress in Check
Stress can intensify the symptoms of PMS, and vice versa. Though it’s a good idea to take steps to reduce stress at any time of the month, giving yourself a little extra TLC when you know your symptoms are likely to kick in can help. Relaxing exercises like yoga or tai chi can kill two birds (getting exercise and reducing stress) with one stone. Meditation, deep breathing, or progressive muscle relaxation can help with anxiety, insomnia, and headaches, too.
Need help managing your PMS symptoms? Dr. Tang can give you personalized, professional advice on how to naturally alleviate your symptoms. Call us today at 408-740-5320 to learn more!
