The PMS Protocol: 8 Strategies to Send Period Pain Packing!
Updated: Jul 25, 2018
Ask any woman and she'd be liable to tell you that life would be sunshine and roses indeed if her uterus didn't go on a sadomasochistic rampage each month. Whether you equate premenstrual syndrome (PMS) with 'Pissy Mood Swings' or 'Pardon My Sobbing', most of us who belong to the Sisterhood of the Vicious Vagina are acquainted with usual rigmarole of anxiety, food cravings, bloating, acne, and the unrelenting desire to punch someone in the face as that-time-of-the-month approaches.
PMS affects 70 to 90 percent of menstruating women worldwide, with an estimated 40 percent experiencing symptoms so debilitating that they negatively impact quality of life (Trickey, 2013). While the most common symptoms associated with PMS include headaches, bloating, breast tenderness, food cravings, lowered libido, sleep disturbances, and mood changes such as irritability, anger, anxiety and depression (Pizzorno, Murray & Joiner-Bey, 2016), not all women will experience the same symptoms. Depending on dietary changes and lifestyle factors that vary from month-to-month, your experience of pre-period melodrama may well differ in terms of severity and symptom frequency.
What Causes PMS?
The exact causes of PMS are not well understood, but studies acknowledge a strong family influence in those who are affected, suggesting that your likelihood of experiencing PMS is higher if your mother, aunt, sister or grandmother did as well (Hechtman, 2012). Other theories suggest that PMS stems from an imbalance of serotonin triggered by fluctuating levels of oestrogen and progesterone. As a feel-good hormone tasked with regulating mood, arousal and cognition, imbalanced serotonin manifests as increased pain perception, disrupted sleep, and mood disorders such as anxiety and depression (Jenkins, Nguyen, Polglaze & Bertrand, 2016).
From a nutritional standpoint, PMS is attributed to deficiencies in calcium, magnesium and vitamin B6, as well as an intolerance to carbohydrates that triggers hypoglycaemia (Hechtman, 2012). Poor liver function is also implicated in PMS due to the liver's role in hormone metabolism, wherein poor regulation of oestrogen results in oestrogen dominance and associated risks for endometriosis and other uterine diseases (Hechtman, 2012). Given the liver's role in hormone maintenance, substances that impair liver function such as alcohol should be avoided, as even moderate drinking can increase your risk of PMS (Del Mar Fernandez, Saulyte, Inskip & Takkouche, 2018).
PMS and the Menstrual Cycle
Despite massive advances in technology that have made information more accessible, a staggering number of women remain unaware of their reproductive health intricacies. A large-scale American study reveals that 70 percent of women don't keep track of their menstrual flow, and 47 percent do not understand what ovulation is (Ayoola, Zandee & Adams, 2016). Even worse, 53 percent of women surveyed reported not knowing when their next menstrual period would be, while 50 percent were unaware of how many days constituted an actual menstrual cycle (Ayoola et al., 2016).
Despite variations in cycle length, a woman's menstrual cycle is divided into two phases: the follicular phase and the luteal phase. The follicular phase kicks in at the start of menstruation, spans days 1 to 14, and sees oestrogen playing a prominent role in the maturation of ovarian follicles. Ovulation typically occurs between days 14 and 15, after which time the luteal phase takes over. Progesterone is the dominant hormone in the luteal phase and helps thicken the endometrial lining to support possible conception. If conception does not occur, both oestrogen and progesterone levels begin to decline after day 21, and menstruation occurs approximately a week to 10 days later.
PMS is considered a disorder of the luteal phase given that symptoms typically set in around the time of ovulation or soon after, and disappear once menstruation begins. PMS is believed to stem from an imbalance of ovarian hormones, as affected women tend to have higher levels of oestrogen relative to progesterone. This is known as oestrogen dominance, and is a chief mechanism in reproductive health disorders such as PMS, endometriosis, uterine fibroids, and cancers of the breast and uterus. More information about oestrogen dominance can be found here.
Liver Qi Stagnation and Detoxification Mechanisms
From a traditional Chinese medicine perspective, an imbalanced oestrogen-progesterone ratio points to liver qi stagnation, given that the liver regulates female hormonal health via its interaction with the body's endocrine-immune network (Qiao et al., 2008). The liver's roles include maintaining the flow of blood and qi to all organs in the body, regulating water balance, and ensuring mental and emotional harmony (Liu, Shu, Tu, Zhang & Hong, 2017).
Disruptions to liver qi deranges all of these functions, and gives rise to classic PMS symptoms such as fatigue, bloating and mood changes (Liu et al., 2017). Anger and irritability are characteristic of PMS and liver dysfunction, given the liver's reputation as a modulator of 'hot' emotions. Furthermore, due to its endocrine affiliations, any imbalance in liver qi obstructs hormonal metabolism and increases the likelihood of oestrogen-progesterone imbalance.
Western medicine holds a similar view regarding the liver's importance in hormone metabolism vis-a-vis phase 1 and phase 2 detoxification mechanisms. All hormones including oestrogen and progesterone are metabolised by the liver, and are 'reduced' in phase 1 by cytochrome P450 enzymes. The main function of this group of enzymes is to transform hormones, chemicals and other endogenous and exogenous matter via chemical processes such as hydroxylation, oxidation and hydrolysis to make them less toxic (Hodges & Minich, 2014).
Phase 2 employs processes such as sulphation, glucuronidation and methylation to make the aforementioned metabolites more water-soluble so they can be excreted as faeces and urine (Hodges & Minich, 2014). This process is known as conjugation, and is an important mechanism in modulating the oestrogen-progesterone ratio by deactivating excess oestrogen and supporting its removal from the body. Phase 2 mechanisms are dependent on adequate sulphur, glutamine, choline, taurine and inositol, as these nutrients are required before conjugation can occur.
8 Strategies for PMS Relief
When you're tired of feeling like you've been sucker-punched in the vagina, give these holistic solutions a go!
(1) Balance Your Vata
In Ayurveda, a trinity of elements known as Vata (air), Pitta (fire) and Kapha (water) regulate all manner of health and disease. While female reproductive health is governed by all three elements to a degree, PMS is regarded as Vata disorder due to the fact that Vata's natural 'home' is situated within the lower abdomen where the ovaries and uterus are housed (Svoboda, 2004). Because Vata energy is akin to the wind and is characterised by a rough, irregular quality, symptoms of Vata aggravation typically include mood swings, insomnia, bloating, enhanced perception of pain, constipation and fatigue.
Vata is finicky and fragile, and needs plenty of coddling in the form of warm, grounding foods such as root vegetables cooked in mild curries and stews. Carrot, pumpkin, sweet potato and turnip are excellent foods for calming aggravated Vata. Additionally, the element's dry and cold qualities are soothed by plenty of healthy fat such as olive oil and ghee, which provide natural lubrication to joints, nourish the digestive tract, and reduce mental agitation. Vata also thrives on routine, benefits from a regular bedtime, and loves regular spa trips to indulge in touch-based therapies such as massage.
(2) Support Liver Qi
Bloating and PMS go together like peaches and cream, albeit in a less delightful manner. Because the liver directs the flow of qi to all parts of the body, liver stagnation results in accumulation of qi in certain parts of the body, leading to facial puffiness, swelling of the abdomen and breasts, as well as a feeling of heaviness in the calves and ankles (Pitchford, 2002).
Liver qi is disrupted by excess consumption of fatty food, meat, cheese and eggs, and is nourished by raw foods and those with sour or bitter properties (Pitchford, 2002). Alfalfa, arugula, bitter melon, leafy green vegetables and Brussels sprouts are excellent foods for relieving liver stagnation due to their cooling, bitter properties, which soothe and calm a grumpy, over-heated liver. These foods also contain sulphur which enhances liver detoxification mechanisms by improving bile flow and supporting more efficient oestrogen metabolism. For an added boost to hormonal health, check out my top 11 liver-supportive foods here.
(3) Eat More Low-Glycaemic Carbs
Though your natural impulse might be to gravitate towards a cupcake when PMS has you in its hot, sweaty little grip, choosing more blood-sugar friendly alternatives is a better idea. Though sugary foods may temporarily relieve changes in appetite, anxiety and other hormonal-driven symptoms, these foods are associated with increased PMS severity in the long run (Hechtman, 2012). Excess consumption of sugar-laden snacks may also prompt an exaggerated insulin response, resulting in continuous uptake of glucose into the liver, muscle tissue and fat cells, leaving insufficient glucose remaining in the bloodstream to support brain function (Knüppel, Shipley, Llewellyn & Bruner, 2017). This resulting brain-glucose deficit is key factor in lowered mood, and is correlated with heightened states of anxiety and depression.
In contrast to sugary foods which have a low glycaemic index and are more rapidly converted to sugar in the bloodstream, whole-grains such as quinoa, millet, amaranth and kamut are more gradually catabolised in the digestive tract and don't cause dramatic fluctuations in blood sugar. What's more, given that constipation tends to be a common symptom of PMS, the fibre content in whole-grains eases bowel movements while supporting better oestrogen elimination via faeces (Hechtman, 2012).
(4) Take a Rain-check on Caffeine
Though coffee might seem like a life-saver when your hormones are driving you up the wall, research suggests that caffeine may actually worsen PMS symptoms. In support, an Egyptian study reports increased PMS severity in college-aged women with a caffeine habit, and surmises that a worsening of symptoms may be due to caffeine's stimulation of neurotransmitters in the brain that enhance pain perception and trigger anxiety (Seedhom, Mohammed & Mahfouz, 2013). And if that's not bad enough, caffeine also aggravates liver qi stagnation, and leads to bloating and puffiness of the face and lower body.
In addition to giving coffee a wide berth, black, green, white and oolong tea should be avoided as well as they contain caffeine and tannins which deplete the body of its natural calcium reserves (Hechtman, 2012). This loss of calcium is significant given's calcium's synergistic role alongside magnesium in supporting pain relief, as well as its ability to reduce psychological symptoms such as agitation and irritability (Hechtman, 2012).
(5) Invest in a Period-Tracking App
With a wealth of period-tracking apps on the market, it makes sense to let technology help you track your menstrual cycle and symptoms. Research reports that in addition to charting ovulation to maximise fertility outcomes, such apps also helps users determine at which point during their menstrual cycle PMS symptoms are most likely to occur (Duane, Contreras, Jensen & White, 2015), thereby enabling correct lifestyle and dietary intervention to better manage symptoms.
Most apps are free to download, and my personal favourite iPeriod Period Tracker allows you to categorise symptoms on a day-to-day basis and rate them in terms of severity while simultaneously providing a baseline reference for cycle length each month. Other fun apps include Eve, which boasts a colourful array of emoticons that will appeal to more visual-centric users, and Pink Pad, which has a great social media vibe and allows users to access community-linked wellness resources.
(6) Increase Your Omega-3 Consumption
Oily cold-water fish, flaxseed oil and chia seeds rank as among the world's most potent sources of omega-3, an essential fatty acid that has proven useful in PMS management due to its anti-inflammatory properties. In support, research examining omega-3's effects on women with PMS reported significant improvement in the severity and duration of symptoms such as breast tenderness, bloating, headaches, depression and lack of concentration (Sohrabi, Kashanian, Ghafoori & Malakouti, 2013). Omega-3 also functions as a powerful pain-relief agent due to its prostaglandin-regulating abilities, thereby reducing muscle spasm activity within the uterine lining that causes cramping (Hechtman, 2012).
(7) Fit Yoga into Your Schedule
The benefits of yoga for PMS management are manifold due to improved regulation of stress hormones such as cortisol and epinephrine alongside inflammatory markers that trigger pain-enhancing prostaglandin activity (Kamalifard et al., 2017). In testament to yoga's benefits, Taiwanese research reports that 91 percent of study participants with PMS who took up 50 minutes of yoga twice weekly experienced reduced menstrual pain, breast tenderness, abdominal cramps and cold sweats (Tsai, 2016).
Other supporting research reveals that women who practiced yoga for an hour at least three times a week over a duration of 10 weeks experienced significantly less anger, irritability and anxiety compared to women who did not practice yoga (Kamalifard et al., 2017). Yoga's benefits don't stop there, as further rewards include increased mental concentration, workplace productivity and interest in social activities alongside all-round improved PMS symptom control (Kamalifard et al., 2017). What more convincing do you need?
(8) Consider B-Vitamin Supplementation
All B vitamins are important for endocrine health and mental well-being, and a high-quality supplement featuring the entire spectrum of activated B vitamins is a crucial intervention in PMS support. Vitamin B6, in particular, plays a pivotal role in PMS management due to its ability to modulate gamma-aminobutyric acid (GABA) pathways in the brain to elicit a relaxation response (Hechtman, 2012). Vitamin B6 also supports serotonin levels which, alongside GABA neurotransmitters, assists in relieving fluid retention, pain, anxiety and depression (Kaewrudee, Kietpeerakool, Pattanittum & Lumbiganon, 2018).
Other supplementation to consider in extremely severe cases of PMS includes magnesium, calcium and 5-hydroxy-tryptophan (5HTP) for collective neuromuscular, mental and energy support.
Like most disorders of the female reproductive tract, PMS benefits from a long-term approach emphasising supportive dietary and lifestyle changes. Book a consultation with me to discuss the best nutritional support and functional foods for your PMS needs, and to discover lifestyle solutions to correct underlying imbalances that may be contributing to menstrual discomfort. For more information about women's health, please visit www.applesandunicorns.com and follow me on Facebook for weekly updates!
Ayoola, A. B., Zandee, G. L., & Adams, Y. J. (2016). Women's knowledge of ovulation, the menstrual cycle, and its associated reproductive changes. Birth, 43(3), 255-262. doi:10.1111/birt.12237
Del Mar Fernandez, M., Saulyte, J., Inskip, H. M., & Takkouche, B. (2018). Premenstrual syndrome and alcohol consumption: A systematic review and meta-analysis. BMJ Open, 8, e019490. doi:10.1136/bmjopen-2017-019490
Duane, M., Contreras, A., Jensen, E. T., & White, A. (2015). The performance of fertility awareness-based method apps marketed to avoid pregnancy. Journal of the American Board of Family Medicine, 29(4), 508-511. doi:10.5122/jabfm.2016.04.160022
Hechtman, L. (2012). The female reproductive system. In L. Hechtman (Ed.), Clinical naturopathic medicine, pp. 734-871. Chatswood, New South Wales: Elsevier Australia.
Hodges, R. E., & Minich, D. M. (2015). Modulation of metabolic detoxification pathways using foods and food-derived components: A scientific review with clinical application. Journal of Nutrition and Metabolism, 2015 (Article ID 760689), 1-23. doi:10.1155/2015/760689
Jenkins, T. A., Nguyen, J. C. D., Polglaze, K. E., & Bertrand, P. P. (2016). Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis. Nutrients, 8, 56-71. doi:10.3390/nu8010056
Kaewrudee, S., Kietpeerakool, C., Pattanittum, P., & Lumbiganon, P. (2018). Vitamin or mineral supplements for premenstrual syndrome. Cochrane Database of Systematic Reviews, 1, 1-23. doi:10.1002/14651858.CD012933
Kamalifard, M., Yavari, A., Asghari-Jafarabadi, M., Ghaffarilaleh, G., & Kasb-Khah, A. (2017). The effect of yoga on women's premenstrual syndrome: A randomised controlled clinical trial. International Journal of Women's Health and Reproductive Sciences, 5(3), 205-211. doi:10.15296/ijwhr.2017.37
Knüppel, A., Shipley, M. J., Llewellyn, C. H., & Brunner, E. J. (2017). Sugar intake from sweet food and beverages, common mental disorders and depression: Prospective findings from the Whitehall II study. Scientific Reports, 7, 6287. doi:10.1038/s41598-017-05649-7
Liu, Z.-W., Shu, J., Tu, J.-Y., Zhang, C.-H., & Hong, J. (2017). Liver in Chinese and Western medicine. Integrative Medicine International, 4, 39-45. doi:10.1159/000466694
Pitchford, P. (2002). Healing with whole foods: Asian traditions and modern nutrition (3rd ed.). Berkeley, CA: North Atlantic Books.
Pizzorno, J. E., Murray, M. T., & Joiner-Bey, H. (2015). The clinician's handbook of natural medicine (3rd ed.). St Louis, MI: Elsevier.
Qiao, M., Zhang, H., Yu, Y., Ci, Y., Xu, X., Qiao, Y., & Chen, Y. (2008). Dynamic changes in serum estradiol and progesterone levels in patients with premenstrual syndrome with adverse flow of liver-qi. Journal of Traditional Chinese Medicine, 28(2), 106-109. doi:10.1016/S0254-6272(08)60026-6
Seedhom, A. E., Mahommed, E. S., & Mahfouz, E. M. (2013). Lifestyle factors associated with PMS among El-Minia University students, Egypt. ISRN Public Health, 2013 (Article ID 617123), 1-16. doi:10.1155/2013/617123
Sohrabi, N., Kashanian, M., Ghafoori, S. S., & Malakouti, S. K. (2013). Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: A pilot trial. Complementary Therapies in Medicine, 21(3), 141-146. doi:10.1016/j.ctim.2012.12.008
Trickey, R. (2013). Women, hormones and the menstrual cycle (3rd ed.). Victoria, Australia: Melbourne Holistic Health Group.
Tsai, S.-Y. (2016). Effect of yoga exercise on premenstrual symptoms among female employees in Taiwan. International Journal of Environmental Research and Public Health, 13(7), 721. doi:10.3390/ijerph1307072