The PMS-Hormone Connection
Foula Tourikis
According to the American Academy of Family Physicians, pre-menstrual syndrome (PMS) is defined as, “...recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation” (2011).
The majority of reproductive aged women experience PMS to some degree however, for most, symptoms are considered tolerable. Just because PMS is common, doesn’t mean it is normal!
In fact, up to 95% of women experience symptoms (Kwan & Onwude, 2015). In 5% of those women, symptoms can be severe (Kwan & Onwude, 2015).
About 20 to 32% of women experience symptoms when they are premenopausal, and about 3 to 8% of those who are premenopausal experience a more severe form known as PMDD (Kwan & Onwude, 2015).
The expression of symptoms varies among women however, symptoms commonly manifest two weeks prior with peak discomfort occurring two days before menstruation begins.
Periods 101
Each month our hormones prepare our body for pregnancy and of course, without fertilization of an egg, there is menstruation.
Complete cycles are typically 28-32 days long, with 4-7 of those days including a period, or when you bleed. Menstruation is the first phase where the lining of your uterus is shed, your period.
The second phase is the follicular phase. Lastings approximately 11-27 days, follicle stimulating hormone (FSH) is produced telling your body to prepare an egg for ovulation.
There are multiple eggs that are inside each of the ovaries but the largest and most dominant is the egg that is released and prepared.
During the follicular phase, also known as the proliferative phase, the lining of the uterus becomes thick. While your ovaries are busy preparing egg-containing follicles, the uterus builds its lining preparing for a potential fertilized egg to implant and take residence.
The ovulation phase (6 days) divides the follicular and luteal phase. Ovulation is when an egg is released from the ovary into the fallopian tube. The egg that is released is considered to be dominant or the strongest egg.
This leads us to the luteal phase. The sac that the egg was previously located, now called the corpus luteum, produces progesterone and estrogen. Unless a pregnancy occurs, the corpus luteum will breakdown causing a significant drop in estrogen and progesterone initiating a period.
And the cycle restarts!
What hormones affect PMS symptoms?
It all starts in the follicular phase when FSH peaks triggering growth of eggs. When the most dominant egg is released, the follicles that are maturing begin to produce increased levels of estrogen. High levels of estrogen can cause mood disturbances, headaches, bloating, fatigue, among other PMS-related symptoms.
UNFORTUNATELY, the exact cause of pms remains unclear however, WHAT WE do KNOW IS THAT WHEN ESTROGEN LEVELS DROP, SEROTONIN (YOUR HAPPY neurotransmitter) CAN ALSO DROP LEADing TO MOOD SWINGS.
Progesterone, estrogens counter, has a calming effect, but if estrogen levels are too high, progesterone will not balance estrogen leading to symptoms typical of PMS.
What are symptoms of PMS?
bloating
breast tenderness
lower back pain
breakouts (typically around the jawline)
food cravings
mood swings
irritability
fatigue
anxiety
insomnia
Keep in mind you may not experience every symptom.
What are some treatment options?
You have options! Conventional practitioners will typically recommend hormonal birth control and non-steroidal anti-inflammatory drugs such as ibuprofen.
Holistic Health Code encourages women to work with providers who will spend time searching for root cause. Typical treatment options include dietary interventions focused on reducing inflammatory foods, magnesium glycinate, B vitamins and omega-3 fatty acids.
Be sure to talk to your provider before starting supplementation.
References
El-Lithy, A., El-Mazny, A., Sabbour, A., & El-Deeb, A. (2015, May). Effect of aerobic exercise on premenstrual symptoms, hematological and hormonal parameters in young women. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25279689/
Kim, S.-Y., Park, H.-J., Lee, H., & Lee, H. (2011, July). Acupuncture for premenstrual syndrome: a systematic review and meta-analysis of randomized controlled trials. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21609380/
Kwan, I., & Onwude, J. L. (2015, August 25). Premenstrual syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26303988/
Ray, L. (2019, November 12). The menstrual cycle, explained. Retrieved from https://helloclue.com/articles/cycle-a-z/the-menstrual-cycle-more-than-just-the-period
Yonkers, K. A., O'Brien, P. M. S., & Eriksson, E. (2008, April 5). Premenstrual syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18395582/
Foula Tourikis is a health educator and enthusiast with a keen interest in Naturopathic Medicine. She is currently pursuing a B.A. in Exercise and Sports Science.