Premenstrual syndrome (PMS or PMT)

Premenstrual syndrome (PMS) is the physical, psychological and behavioural symptoms that typically occur in the two weeks before your monthly period. While nearly all those of reproductive age who menstruate will experience some symptoms of PMS - also known as premenstrual tension (PMT) - some will experience symptoms which are particularly severe.

With common symptoms including bloating, breast pain, mood swings, food cravings and tiredness, certain lifestyle factors are thought to worsen symptoms, such as lack of exercise, poor diet and stress. Let’s take a closer look at the link between PMS, lifestyle and diet.

Every person tends to have a slightly different experience of PMS, and the many different symptoms - generally falling into two categories: physical, and psychological and behavioural - can change with age.

Premenstrual syndrome is thought to affect as many as 30% of people with female reproductive organs and, whilst the exact cause still remains unclear, it is thought to be due to changing hormonal levels in the middle and end of the menstrual cycle. Any long-term conditions such as asthma or migraines may also get worse during that time. 

PMS and diet

Whilst dietary and lifestyle changes won’t make PMS disappear, they can help to ease symptoms, making the days and weeks before the monthly cycle more manageable. There are a few golden rules to follow that could help you maintain a healthy lifestyle, and ease your symptoms.

1. Ensure you eat a balanced diet to maintain adequate levels of both macro and micronutrients and keeping your blood sugar levels balanced.

2. Eat little and often to help reduce bloating during this time of the month. Try to avoid particularly salty foods as they can make bloating worse.

3. Drink plenty of water throughout the day to keep you hydrated. Dehydration can make headaches and tiredness worse, exacerbating symptoms.

4. Choose complex carbohydrates found in fruit, green vegetables, starchy carbohydrates (potatoes and sweet potatoes) and whole grains (oats, whole grain pasta and bread), which are higher in vitamins and minerals than simple carbohydrates. They provide a slow-release of energy and are rich in fibre, keeping you fuller for longer.

5. Eat your five a day as fruit and vegetables are rich in vitamins and minerals, thought to ease PMS symptoms.

6. Reduce caffeine and alcohol intake as these can affect your mood and energy levels, making PMS symptoms worse. It’s thought that some people have a stronger desire for alcohol before their period starts, but PMS can affect the body’s ability to break it down. If you can’t avoid alcohol completely, try to limit your consumption.

Vitamins and minerals

Supplementation of vitamins can be helpful - particularly in relation to hormonal changes - if you struggle to get the adequate amount from your diet. You could try including the following supplements to support your cycle:

B vitamins have a direct impact on your energy levels and brain health, they keep the nervous system healthy and can aid mood regulation: helpful if you experience significant mood swings in the lead up to your period.

If you particularly struggle with cramps, you could consider supplementing magnesium as it’s a muscle relaxant and will help calm the uterine muscles, the cause of painful cramps. 

Calcium is thought to ease mood swings, bloating and headaches and you could consider including a vitamin D supplement, which works alongside the calcium to help your body absorb it sufficiently. 

Calcium plays an important role in hormone secretion. In the week leading up to the period, many women appear to have abnormally high levels of a substance called secondary parathyroid hormone in their body.

- Rosie Letts on easing PMT with nutritional therapy.

Rosie says, "This hormone [parathyroid] can cause a long-term imbalance in the body's calcium levels and lead to an increase in PMS symptoms. Most women do not get enough calcium throughout the month."

Breakfast bowl with yoghurt and seeds

Cycle foods 

There are four phases of the complete monthly cycle: menstruation, the follicular phase, ovulation and the luteal phase, and each phase can benefit from slight tweaks in your diet, to support hormone harmony.

Phase 1: Menstruation

This is the shedding of the uterine lining known as the period - day one of bleeding - where your estrogen and progesterone hormone levels are at their lowest. In this stage, focus on iron-rich, nutrient-dense foods to balance blood sugar levels and keep your energy stable. Choose low GI complex carbs, lean proteins and healthy fats which could include:

  • whole grains
  • legumes
  • seeds, in particular, pumpkin seeds
  • fermented foods such as kimchi, and sauerkraut
  • root vegetables 

Phase 2: Follicular

Your estrogen levels are beginning to rise as an egg prepares to be released, so you may feel you have more energy, are more alert and motivated. This is the optimum time to focus on fresh, antioxidant and phytoestrogen foods that promote good gut health and detoxification (to remove excess estrogen). These include:

  • cruciferous vegetables such as cauliflower and cabbage
  • dark, leafy green vegetables 
  • protein such as tempeh or eggs

Leafy vegetables also contain compounds called indole-3-carbinol which support liver function, important for helping to eliminate 'old' hormones and keep hormone levels balanced

- Nutritional therapist Julia Young on what to eat for your period.

Phase 3: Ovulation

Once the egg has matured, you enter the ovulation phase roughly 14 days after your period first started. As both estrogen and testosterone are rising, you begin this phase feeling confident and outgoing, but once your egg has released, higher levels of progesterone can leave you feeling a little more sensitive, sluggish and introverted.

It’s common to experience nausea, constipation and cramps as you move towards the end of this stage, so it can be helpful to focus on fibre-rich foods, regular eating, hydration and avoid salty foods and chewing gum. Foods to support your liver in the process of detoxification at this stage are also helpful.

Try to include:

  • fibre-rich vegetables
  • antioxidant fruits
  • light carbohydrates such as quinoa
  • whole grains (rich in vitamin B, helpful for mood regulation)

Woman eating watermelon

Phase 4: Luteal

The final stage before menstruation, hormone levels have peaked, and this is when many people start to experience PMS as both estrogen and serotonin (the happy hormone) begin to drop. 

At this stage, it’s best to cut down on caffeine and alcohol, as these can trigger mood swings. Try to minimise your sugar and salt intake as well as they can increase bloating, and salt is related to water retention in swollen and tender breasts. Foods to include in the luteal phase could be:

  • starchy vegetables
  • organic meat or turkey
  • proteins including chickpeas and beans
  • fish such as tuna and salmon

Drinking plenty of water can reduce menstrual headaches, bloating and water retention. Herbal teas are another good option for keeping hydrated. Fennel tea may help to reduce menstrual bloating and ginger tea has anti-inflammatory effects which can help soothe aching muscles. 

- Julia Young 

Seed cycling 

Seed cycling has been gaining traction in the female hormone health space as a natural alternative to managing PMS. Although it lacks concrete scientific evidence, many anecdotal reports have noted positive results, with a growing number of advocates for this naturopathic practice.

Seed cycling is the process of including raw, ground flaxseeds, pumpkin, sesame and sunflower seeds in your diet - at certain stages of your cycle - to manage hormonal fluctuations.

You can find out more about seed cycling in ‘Can seed cycling help with PMS?

If you are considering tailoring your diet to support hormonal health, it’s always best to consult a nutrition professional, who can work with you to make healthy transitions. The symptoms discussed here are common in PMS but, like most things, everyone is affected differently and you may have more specific symptoms. In this case, a nutrition professional can identify any potential diet triggers and lifestyle changes that can make your cycle more comfortable. 

Natural PMS remedies

Here are some other natural remedies to help manage PMS.

Exercise

Of course, regular physical activity is essential in maintaining a healthy lifestyle. If possible, aim to do at least 150 minutes of moderate-intensity activity each week (30 minutes for five days). This could be walking, swimming or cycling.

Regular exercise keeps the body healthy, and can also help alleviate tiredness and depression. Stretching-based activities, such as yoga and pilates are great ways to de-stress and help you sleep better. In some cases, stretching is also thought to help ease abdominal discomfort during your period. Be mindful of which stage in your cycle you will have the most energy to ensure you don’t overdo it. 

Person swimming

Holistic therapy

Alternative treatments and supplements have been said to help ease symptoms of PMS. However, there is as yet no evidence that these are effective treatments. If you’re interested in alternative treatment for PMS, it’s important you consult your doctor before taking any supplements.

Psychological therapy

If you’re experiencing psychological symptoms, such as anxiety and depression, seeking professional help can be beneficial. There are many talking therapies available. Cognitive behavioural therapy (CBT) in particular is a therapy designed to help people manage feelings of anxiety and depression.

To learn more about talking therapies and mental health, visit Counselling Directory.

When to seek further help

Most people will experience some form of PMS in the weeks before the start of their monthly period. This is normal. However, if symptoms are affecting your everyday life and are having a significantly negative impact on your mental health - common in premenstrual dysphoric disorder - consider speaking to your GP.

Premenstrual dysphoric disorder (PMDD)

PMDD is a more intense type of PMS, where symptoms affect the individual’s daily life and well-being. Symptoms are typically more severe and may include more psychological symptoms such as feelings of hopelessness, persistent sadness or depression, extreme anger, change in sleeping patterns, extreme tension or irritability. 

Medical treatment

If you are experiencing particularly severe symptoms of PMS or you have PMDD, you may be considering medical treatment. There are several treatments available, and no one treatment works for everyone. Options include painkillers, a combined oral contraceptive pill and oestrogen-only patches and implants.

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