Most women of reproductive age say they experience some emotional or physical symptoms around the time of their period. These can include feelings of irritability or bursting into tears with minor triggers. Some women report they feel more tired around this time or they crave carbohydrate rich foods like pasta or bread. Physical symptoms often manifest during the first day of menstruation with abdominal cramps, headaches and nausea being common. Often by the second day of their period, most of these symptoms have settled down but wouldn't it be great if you didn't experience them at all!
The reason that these symptoms occur is due to an increased production of inflammatory chemicals called Prostaglandins. They are triggered by endometrial tissue, otherwise known as the lining of your uterus, as it begins to break down at the end of your cycle. These inflammatory chemicals trigger a response that includes pain, heat and swelling that you experience as those uncomfortable symptoms at the beginning of your period. The reason that emotional symptoms are part of the picture is that these inflammatory chemicals can also have an effect in your brain.
The thickness of the endometrium (uterine lining) plays a role in the severity of the symptoms and a dysregulation between estrogen and progesterone can lead to unopposed estrogen causing increased proliferation of the lining and more prostaglandin production. There are other factors that are involved in the way women experience pain around the time of the period including deficiencies in neurotransmitters such as serotonin.
The inflammatory response causes by prostaglandin production can also be exacerbated by other stimulus that triggers the HPA axis and leads to the release in cortisol. Diet is a major contributor to this with the common western diet that is high in refined carbohydrates leading to increased cortisol production. Simple sugars cause almost instantaneous spikes in blood glucose that must be dealt with by the body through the release of insulin. Long term high blood glucose can lead to insulin resistance and increased body fat. Fat cells are very metabolically active and can produce estrogen that increases the systemic levels of hormone and exacerbates the dysregulation that already exists.
The body’s fight or flight response is also triggered by disruption to sleep. This inability for the parasympathetic nervous system to be dominant overnight can also lead to high estrogen levels. High intensity exercise can also have the same effect as well as triggering increased testosterone production, and this can also interfere with normal menstruation as well as being associated with acne and hirsutism (hair growth).
Estrogen is metabolised by your liver and then excreted by your bowels, and dysfunction with any of these processes can also lead to an increased estrogen pool and more severe PMS symptoms. Liver metabolism relies on the availability of many nutrients including amino acids, magnesium and vitamins. When these are deficient the process can be slowed, and it can become like a log jam in the river. Once estrogen reaches the large intestine, the process relies on a beneficial microbiome otherwise estrogen can be reabsorbed, and the systemic pool increased. Diet and stress are important here too as they impact the type of species that reside in the colon.
The Oral Contraceptive Pill or OCP is often prescribed to manage PMS symptoms. Often this is achieved with both synthetic estrogen and progesterone that inhibit ovulation and thin the endometrium. Although some women do find that their symptoms can be reduced in the short term, the side effects can include deficiencies in some nutrients that are needed for estrogen metabolism and alterations in the gastrointestinal microbiome. There are now more concerns with the long term use of these synthetic hormones due to the increased risk of some cancers due to increased exposure to estrogen during a woman’s lifetime. There is also research that indicates that progesterone, produced following ovulation, is crucial for health, especially for our brain and cardiovascular system. Although synthetic progesterone is often prescribed in both oral and intrauterine forms, this does not convey the same benefits as the progesterone that your body produces and, may actually mimic testosterone.
Naturopathic treatment for PMS focuses on reducing the inflammatory response and improving estrogen metabolism and excretion. Removing processed foods from the diet and replacing them with fresh vegetables, sources of omega 3 fatty acids including oily fish, walnuts and flaxseeds is very important. Stress management and promoting activities such as meditation and yoga are also important to reduce cortisol production.
Nutrients that support healthy estrogen metabolism include magnesium and zinc, and compounds found in brassica vegetables are also found to improve liver detoxification pathways. Prebiotics found in fibre and fermented foods help to improve the microbial diversity required for estrogen excretion.
There are a group of women who experience much more severe psychological symptoms prior to menstruation with many reporting that they interfere with their relationships, work/study and social lives. Premenstrual Dysphoric Disorder (PMDD) can include extreme anxiety and/or depression, insomnia and reduced energy as well as gastrointestinal bloating, constipation and breast tenderness. These symptoms are thought to be caused by the fluctuations of hormones in the lead up to menstruation, particularly progesterone with reduced sensitivity to the changing levels. It is thought there is also a reduction in GABA, a neurotransmitter that reduces cortisol and promotes sleep and calmness, and serotonin that is associated with mood and perception of pain. Allopathic treatment often includes prescription of antidepressants as well as the OCP to reduce the fluctuations in hormones over the cycle.
Naturopathic treatment focuses on improving GABA sensitivity as well as regulating hormone levels through the same processes mentioned for PMS. There is also a focus on regulating the production of histamine that is part of the inflammatory response by the immune system. Histamine is released by mast cells and these can be found in great numbers in uterine tissue and are responsive to increased estrogen levels.
As well as reducing inflammatory foods in the diet, nutrients such as magnesium and B6 have been found to reduce symptoms.
If you would like more information about PMS or PMDD please head over to my website to book a consultation. None of these symptoms are part of normal menstruation and you should not feel that you have to live with them.