Premenstrual syndrome is physical, mental, and emotional changes that you experience in the second half of your cycle (from ovulation to the onset of menses). While this is incredibly common (up to 80% of women report symptoms), it does not mean that it is normal or inevitable.
- sleep disturbance
- fluid retention
- abdominal bloating
- joint pain
- brain fog
- food cravings
- breast pain
For these symptoms to be considered PMS, they must during the 10 days before your period and resolve during or shortly after your menses.
Causes of PMS
Here are some of the mechanisms that produce symptoms of PMS:
- estrogen excess causing breast pain, fluid retention, irritability, headaches
- estrogen withdrawal causing fatigue, night sweats, and migraines
- progesterone deficiency causing anxiety and insomnia
- issues with the hormone receptors responding appropriately to hormones
- combination of the above
Now that we now a little more about the biochemistry, the next step is to ask why are there hormonal imbalances? Many people stop at progesterone deficiency and think the solution is to supplement with progesterone. While that may improve your symptoms, is does not fix the real problem. So what is the real problem?
Understanding estrogen excess
For most women, estrogen excess is not caused by the ovaries producing too much estrogen. The real issue is your body's ability to detoxify estrogen. Estrogen is detoxified in the liver and due the genetic mutations, environmental toxins, alcohol use and other factors, your liver may not efficiently metabolize estrogen. So this creates a build up of estrogen in your system or a build up of estrogen metabolites that can also bind the estrogen receptors. Some of these metabolites can be very damaging to cells and may increase your risk of reproductive cancers.
Once your liver metabolizes estrogen, it dumps it in your digestive tract through the bile where it should end up in the toilet. But, if you have high amounts of bacteria that produce an enzyme called beta-glucuronidase, your estrogen will be reactivated and absorbed back into your body.
Understanding progesterone deficiency
The most common cause of low progesterone is your ovaries not ovulating. In order for your ovaries to make progesterone, you first need to ovulate. Which can be difficult. What may be interfering with ovulation? Inflammation, nutrient deficiencies, stress, lack of sleep, low thyroid function, or polycystic ovaries. Also, as you get into your 40s, your ovaries do begin shutting down, which is a natural biologic process that results in a lot of anovulatory cycles with low progesterone.
PMS responds beautifully to natural treatments. But it is important to note that you may notice any changes in symptoms until after 100 days of treatment. This has to do with normal ovarian function and maturation of ovarian follicles. So be patient with your treatment and don't expect drastic results during your next cycle.
The key to successful natural treatment is to accurately assess your hormones and to identify the root cause of any imbalances. See this blog post to learn more about how to test your hormones. Once you understand your hormones, you can then choose the appropriate treatment.
Treatment may include dietary changes, targeted nutrients, and specific herbs during certain phases of your cycle. For many women, the above therapies can drastically reduce their symptoms in 2-3 months. For other women, bio-identical hormone therapy may be necessary if ovarian function is impaired.
I do not recommend self-prescribing herbs or over the counter hormone products. You need to do the testing so you understand the imbalances. Otherwise, you may actually exacerbate imbalances using herbs and hormones. Timing and dose are also extremely important when it comes to herbs and hormones. And symptoms are not always the best indicator of hormone imbalances.
A good place to start is with your diet. Focus on a whole foods diet to reduce inflammation. Reduce added sugar and consider avoiding gluten and dairy, though I do recommend consulting with a doctor before eliminating foods from your diet. It isn't always necessarily and eliminating foods can cause stress and impair our relationship with food.
A simple, safe, and often incredibly effective dietary tool is seed cycling. See this blog post for details.
I'm Dr. Carly and my mission is to create a health revolution. I believe that another prescription is not the answer. I believe in using natural therapies that go beyond the symptoms. And I believe that doctors should spend way more than 7 minutes with a patient.