PMS (premenstrual syndrome) has many symptoms - and each of these comes with its own potential causes! Although this makes it hard to pinpoint a singular reason behind why women get PMS in the first place, the good news is that scientific research does tell us how we can manage these symptoms.
Read on to understand what happens during PMS, its potential causes and tips for how to make it better.
What is PMS or Premenstrual Syndrome?
It is a set of symptoms experienced by women, beginning approximately five days (or even 1-2 weeks, for some) before menstruation, and lasting for a few days after it starts [1, 2]. These symptoms mainly fall into two general categories, viz. physical and psychological, and can range from mild symptoms (like acne or bloating) to severe ones (such as mood swings and painful uterine cramps) .
According to worldwide research, about 47.8% of women suffer from PMS . A study also reported that women in their 30s are more likely to get PMS - for reasons as elusive as its cause !
Speaking of which:
What causes these menstrual symptoms?
Although researchers haven’t been able to zero in on the exact cause of PMS, changes in certain hormones’ levels may play a role because of how they impact our body functions.
There are two hormones that generally tend to fluctuate throughout a woman's menstrual cycle: (i) oestrogen, which dips in its levels, and (ii) progesterone, which increases [6, 7].
Women with PMS or PMDD (a more serious form of PMS) tend to be more sensitive to these changes, which may influence other hormones and neurotransmitters (chemical messengers in the brain), as they all work in a concerted fashion. These collective hormonal changes seem to lead to the characteristic psychological as well as physical symptoms of PMS [8, 9].
Let’s dive a little further into what these changes involve.
What happens when oestrogen levels drop
A drop in oestrogen levels leads to a decrease in our levels of serotonin (also known as the ‘happy hormone’) [10, 11].
Serotonin positively influences our mood and makes us feel good about ourselves. A decrease in its levels is believed to contribute to premenstrual depression, as well as cause fatigue, impulsive behaviour, irritability, crying spells and intense craving for food (especially carbohydrates) [12, 13, 14, 15].
The oestrogen decrease also causes the endometrium (the lining of the uterus) to produce large amounts of hormone-like compounds called prostaglandins, which triggers contractions in the uterine muscles, causing abdominal pain [7, 16, 17, 18]. High levels of prostaglandins are also associated with headaches .
Oestrogen also influences a region in our brain called the hippocampus, which plays a major role in our learning, cognition and memory . Low estrogen levels may cause forgetfulness and are also thought to be the trigger for the headaches that arise during PMS [21, 22].
What happens when progesterone levels rise
- Water retention: The high levels of progesterone during PMS are believed to cause water retention, ultimately leading to physical symptoms like weight gain, swelling (of the abdomen, feet and ankles), bloating and breast tenderness .
- Poor sleep: An increase in progesterone leads to a rise in our body temperature and cortisol (our primary stress hormone) levels as well, both of which are associated with decreased sleep quality - one of the primary physical symptoms of PMS [24, 25, 26].
- Acne: high progesterone, boosts the production and build-up of sebum - an oily substance found in the glands of our skin, which, when in excess, can clog pores and result in acne [27, 28].
- Psychological symptoms: Gamma-Aminobutyric acid or GABA) is a neurotransmitter that produces a calming effect. Higher progesterone levels hinder GABA’s function and may lead to feelings of anxiety, depressive mood and aggression [2, 29, 30, 31].
PMS and our diet and lifestyle
Certain lifestyle and dietary factors are often associated with PMS; examples include consuming a lot of sugary food and drinks, junk and fried food with not enough vegetables or fruits, exercising less and following poor sleeping patterns [32, 33].
While these behaviours are observed in women with PMS (and can worsen its symptoms), they do not cause PMS; they’re just complicatedly interrelated. For example, it is more likely that PMS causes stress, and if one is stressed during this time, it may worsen symptoms of PMS such as anxiety or food cravings [34, 35, 36].
Another example is our body fat and its relationship with food. Studies show that women who have a BMI above 27.5 kg/m2 are at a significantly higher risk of developing PMS, while, on the other hand, PMS causes mood swings and cravings that affect our dietary patterns [37, 38].
Given the many factors that may cause (or, at least, contribute to) PMS, it seems like the best way to try and manage its symptoms is to work towards our overall fitness and adopt a healthy lifestyle.
Evidence-based tips to relieve PMS symptoms
According to research, 30 min of daily aerobic exercise (through the month) can help with symptoms such as depression, difficulty concentrating and fatigue [39, 40, 41]. Including exercise in your routine can also help you sleep better and regulate the hormones associated with water retention, mood swings and abdominal cramps, amongst other PMS symptoms [42, 43, 44, 45].
2. Getting sufficient sleep
Lack of sleep is also linked to depression and anxiety, which can aggravate PMS. That’s because sleep allows our brain to evaluate our memories and thoughts, helping us process emotional information. Disrupting this can impair our mood and emotional reactivity. (Here’s a deeper look at the effects of lack of sleep on our health, if you’re interested.)
In general, getting 7-9 hours of sleep is one of the small, simple steps we can take towards a healthier lifestyle .
3. Avoiding caffeine, nicotine and alcohol
Excessive caffeine can enhance PMS symptoms like irritability and jitteriness; research suggests that this could be avoided by limiting caffeine intake to 400 mg a day (which roughly equates to four cups of coffee) [47, 48].
The psychological symptoms of PMS can also be aggravated by alcohol. Its regular consumption can alter our levels of serotonin and the hormone’s interaction with other neurotransmitters that directly influence our mood . Research shows that women who drink more than one drink a day (about 150 ml of wine or 45 ml of distilled spirits) are 79% more likely to have PMS than abstainers [50, 51].
Similarly, a large-scale study showed that women who smoked reported more (and worse) PMS symptoms than women who did not smoke, indicating that reducing or avoiding smoking can definitely help manage PMS .
4. Practising stress-relieving techniques
Stress has been shown to increase the severity of PMS cramps, by significantly increasing the intensity of uterine contractions . Being stressed can also affect our healthy eating habits, which can go on to affect our general lifestyle and worsen PMS .
Talking to a friend (or generally tapping into reliable social support) has been shown to help cope with stress; it actually triggers the production of oxytocin - a hormone that lowers cortisol levels (it’s known as the ‘comfort and trust hormone’!) [55, 56, 57].
Writing a journal is also known to reduce stress, by serving as an escape or emotional release of negative thoughts and feelings [58, 59, 60]. Some women also find yoga, massages and meditation helpful, all of which, according to the evidence, can reduce the body’s levels of cortisol [61, 62, 63].
5. Eating a balanced diet
Certain nutrients are specifically helpful with PMS:
Tryptophan (an amino acid) is required for the production of serotonin. Generally, foods high in protein, iron, riboflavin (vitamin B2), and vitamin B6 all tend to contain large amounts of tryptophan. This includes foods like eggs, dairy, nuts, seeds, soy products and fish, along with healthy carbohydrates, like rice, oatmeal, or whole-grain bread .
Calcium helps with the release of neurotransmitters (including the ones that affect our mood) and can be therapeutic in the context of PMS [65, 66]. Trials with supplemental calcium, in doses as low as 500 mg daily, have shown to significantly help women who experience moderate to severe PMS symptoms . (Those choosing to supplement with calcium should consult their doctor to get the recommended dosage and duration).
Vitamin D regulates many processes in the brain (and neurotransmitters) that affect our mood and behaviour [68, 69]. It is also essential for calcium absorption, which makes it especially important in the context of PMS . The best source of vitamin D is sunlight - exposing our arms and legs to sunlight for 15-30 minutes twice a week can help avoid its deficiency . Other than that, eating fortified foods, certain fishes such as salmon and mackerel, and sun-exposed mushrooms can also provide vitamin D .
B-vitamins (especially vitamin B6 and B12) play an important role in producing neurotransmitters (including serotonin and GABA) . High intakes of vitamin B1 and B2 from food sources (whole grains, dairy, meat, fish and eggs) are also associated with a significantly lower incidence of PMS . (People who cannot consume animal-based products can go for fortified foods or supplements.)
Omega-3 fatty acids and vitamin E suppress the production of prostaglandins and help manage pain [75, 76]. Fatty fish, walnuts, chia and flax seeds are some good sources of omega-3 fats and wheat germ oil, sunflower seeds, almonds and peanuts are great sources of vitamin E .
Gamma-linoleic acid, found in evening primrose oil, has a long history of being used to alleviate PMS . It has been shown to help reduce the symptoms of premenstrual syndrome and inflammation (which can increase during PMS and worsen its symptoms) [79, 80]. One can consume the oil directly or through supplements.
Magnesium, alone as well as in combination with vitamin B6, activates certain neurotransmitters that calm our nervous system [81, 82, 83, 84]. Consuming pumpkin seeds, chia seeds, almonds, wholegrains, leafy greens, legumes, etc. can help maintain magnesium’s levels, which have been reported to fluctuate during the menstrual cycle .
It is important to understand that anyone suffering from PMS could also be deficient in some or most of these nutrients. In that case, food alone may not be able to help and you may need to supplement these nutrients under the direction of a health expert.
On a separate note, consuming less fast food and packaged foods is also found to be helpful [32, 33, 86]. These foods tend to be very high in salt; reducing salt consumption is particularly recommended for bloating, breast tenderness or swollen hands [6, 87].
Eating a healthy, balanced diet, in general, plays an important, positive role in our physical and mental health. While it may not always be possible to completely counter the effects of PMS, managing its symptoms is within our control - through a healthier lifestyle and evidence-based nutrition. Keep visiting our blog for tips on how to do just that. :)
We hope this blog helped increase your understanding of this mysterious-but-manageable syndrome. Again, if you have any further questions, please feel free to comment below. We’d love to answer them for you! :)
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