Understanding PMS (Premenstrual Syndrome) and Its Impact on Women's Health

Premenstrual syndrome (PMS), also known as premenstrual tension (PMT), affects millions of women worldwide. Characterised by a range of physical and emotional symptoms, PMS typically occurs one to two weeks before menstruation. Although the severity of symptoms varies from person to person, it can significantly impact a woman's overall well-being, often influencing her daily activities and mental health.

In this blog, we'll delve into the symptoms, causes, and potential management strategies for PMS, while exploring the role of hormones, contraception, and lifestyle in managing the condition.

What is PMS?

Premenstrual Syndrome (PMS) is a syndrome of sorts because many women have a number of symptoms in common that begin a week or two before the period and then often dissipate completely once the period ( menstruation ) begins- thank goodness, I hear you say!

The change in hormones which causes this syndrome can be more pronounced when our periods start in our teenage years and also when we see these same hormonal fluctuations again around the perimenopause.

These fluctuations in hormones can affect mood, cause a bloating, headaches, reduce physical well-being, and overall quality of life for many women. If you have always exercised you may have some immunity to PMS.

However, whether you exercise or not a well-balanced diet can play a crucial role in alleviating or reducing many of these symptoms.

PMS encompasses a broad array of symptoms that typically manifest during the luteal phase of the menstrual cycle, which is the period following ovulation and before you bleed (menstruation). These symptoms usually subside once menstruation begins, although for some women the cycle of symptoms can begin again quite soon after their period finishes.

Women often report experiencing a mix of physical and emotional symptoms, which may include:

• Bloating and water retention

• Tender or swollen breasts

• Fatigue

• Headaches

• Mood swings, irritability, and low mood

• Changes in appetite or food cravings

• Difficulty concentrating

• Sleep disturbances

The extent to which these symptoms interfere with daily life varies widely. For some women, the effects are mild, while others may find themselves struggling with severe physical discomfort or emotional distress that can disrupt their routines.

The Hormonal Connection

At the core of PMS lies the fluctuation of hormones during the menstrual cycle, particularly estrogen and progesterone. These hormones, which regulate the reproductive system, naturally rise and fall throughout the cycle. In the second half of the cycle, after ovulation, progesterone levels increase to prepare the uterus for a potential pregnancy. When pregnancy does not occur, both oestrogen and progesterone levels drop, triggering menstruation.

For many women, this hormonal shift can lead to physical symptoms like bloating and tender breasts, as well as emotional effects like irritability and low mood. The precise reason some women are more sensitive to these hormonal changes than others remains unclear, though genetic, nutritional, and lifestyle factors likely play a role.

Emotional Symptoms: Low Mood and Mental Health

One of the most challenging aspects of PMS can be the emotional symptoms. Many women report feeling down, anxious, or excessively irritable in the days leading up to their period. In some cases, PMS can even be linked to premenstrual dysphoric disorder (PMDD), a more severe form of the condition that primarily impacts mental health. PMDD is characterised by extreme mood swings, depression, and anxiety that can interfere with work, relationships, and day-to-day life.

The link between low mood and PMS underscores the importance of understanding hormonal health in relation to mental well-being. Oestrogen influences serotonin, the "feel-good" neurotransmitter in the brain, and when oestrogen levels drop in the days leading up to menstruation, some women may experience mood disturbances.

The Role of Contraception and the Pill

For women struggling with PMS, contraceptive methods, particularly hormonal contraception like the pill, are often suggested as a management tool. The pill works by regulating hormone levels, and in many cases, it can stabilise the hormonal fluctuations that lead to PMS symptoms.

Birth control pills that contain both oestrogen and progesterone can be especially effective in reducing bloating, improving low mood, and relieving physical discomfort associated with PMS. In some cases, doctors may recommend skipping the placebo week in birth control packs, which eliminates the menstrual cycle altogether and provides continuous hormonal support.

However, contraception is not a one-size-fits-all solution. Some women may experience side effects like nausea or weight gain, while others may find that certain types of birth control exacerbate their symptoms. It’s essential to consult a healthcare provider to determine the best option based on individual health needs.

Managing PMS Symptoms Naturally

While hormonal contraception can be helpful, some women prefer to manage PMS symptoms through natural or lifestyle changes. Here are some practical strategies:

• Dietary adjustments: Eating a balanced diet rich in whole grains, fruits, and vegetables can help manage symptoms. Reducing sodium intake may help with bloating, while avoiding sugar and caffeine may lessen mood swings and irritability.

• Exercise: Regular physical activity can improve mood by releasing endorphins, which are natural mood enhancers. Exercise can also alleviate fatigue and help manage weight fluctuations caused by bloating.

• Stress management: Stress can worsen PMS symptoms, so finding ways to relax and unwind is essential. Practices like yoga, meditation, and mindfulness can help balance emotional ups and downs and help understand more what our body and mind needs.

• Sleep: Adequate sleep is crucial for hormonal balance. Creating a consistent sleep schedule and ensuring a calm sleeping environment can improve sleep quality and reduce PMS symptoms like fatigue and irritability.

• Supplements: Some research suggests that supplements like magnesium, and vitamin B6 can help reduce the severity of PMS symptoms.

  Some women really notice an improvement with Evening Primrose oil taking 2-3 grams a day and studies support its use even just for the 2 weeks before a period.

Below is a summary of some dietary tips for managing PMS:

**Reduce Refined Carbohydrates and Sugar**: High sugar and refined carbohydrate intake cause fluctuations in blood glucose, worsening mood swings and cravings.

Opt for complex carbohydrates such as whole grain bread, red rice, and lentil and chickpeas, quinoa, instead of white bread, rice, and potatoes. For some women reducing all carbs is helpful and instead eating more protein and good fats as your main calorie sources, which are more nutritious.

**Include Healthy Fats**: Don’t be afraid of fat. Omega-3 fatty acids, found in oily fish (e.g., salmon, mackerel), help improve mood and reduce pain. Plant-based alternatives like linseeds ( Flaxseeds) and pumpkin seeds are good for those who prefer not to eat fish.

**Green vegetables**: such as spinach and broccoli, are good sources of magnesium and folic acid, which are important for hormone balance. There’s loads of leafy greens so have a nosey in your local veg shop and see what they have. I like chopping garlic into everything and adding extra virgin olive oil, sea salt and pepper. If you are bloated avoid using a lot of salt and always use sea salt. 

**B Vitamins**: These are important to help the body's neurotransmitters function properly. Diets low in these vitamins are associated with a higher occurrence of PMS. 

   - **B1 (Thiamine)**: Present in fortified cereals, legumes, and nuts.

   - **B2 (Riboflavin)**: Found in cow’s milk, soya milk, red meat, and leafy greens.

   - **B6**: Found in foods like watercress, cabbage, and bananas. 

**Calcium and Vitamin D**: Both are associated with reduced PMS symptoms. Consuming two -three servings of dairy products is recommended each day ( such as cottage cheese, ricotta, natural greek yogurt) or calcium-rich vegetables like kale and broccoli, along with adequate sunlight for vitamin D production, can help regulate hormone function. 

And get your vitamin D level checked as it is most likely low even when taking the recommended daily supplement.

**Limit Alcohol and Caffeine**: Alcohol can worsen anxiety and hormone imbalances, while high caffeine intake is linked to increased breast tenderness and may increase PMS symptoms. Moderation in both is key.

But also remember moderation does nott apply to everything. Drinking alcohol regularly increases your risk of breast cancer.

**Reduce Salt**: Excess salt causes water retention, worsening bloating and swelling. Keep intake below 6mg per day as recommended and again use natural salts.

By making these dietary adjustments, women can potentially reduce the severity of PMS symptoms and improve overall well-being.

When to Seek Help

If PMS symptoms become overwhelming or interfere with daily life, it's crucial to seek medical advice. In some cases, what seems like PMS could actually be another underlying condition, such as thyroid problems or mental health disorders. If symptoms of low mood or anxiety are severe, it may indicate PMDD, which requires medical intervention.

Doctors can recommend various treatments, ranging from hormonal contraception to antidepressants, depending on the severity of the symptoms and the patient's overall health profile.

Final Thoughts: Prioritising Women's Health

PMS is a common but often misunderstood condition that can significantly impact a woman’s life, both physically and emotionally. Understanding how hormones play a role in PMS and exploring various management options—whether through hormonal contraception like the pill or natural remedies—can help alleviate the distress associated with it.

If you're struggling with PMS, remember that you don’t have to suffer in silence. Whether you're dealing with bloating, low mood, or other symptoms, it’s important to prioritise your health and consult with a healthcare professional who can provide tailored guidance. By taking a proactive approach to managing PMS, you can regain control and improve your overall quality of life.

If you have PMS and have tried everything above then why not see Dr Rachel McKeogh or Dr Marj Quinlan who can examine you and discuss hormonal treatment if needed.

You can book online

Or

Telephone 028 9691300