Premenstrual tension (PMT)

What is premenstrual tension?

Premenstrual tension refers to the symptoms that typically occur before a monthly period. It is thought to affect as many as three in every four people with female reproductive organs. Whilst the exact cause still remains unclear, it is likely due to changing hormonal levels in the middle and end of the menstrual cycle. Sometimes, people can find that long-term conditions such as asthma or migraines may also get worse during this time.

It's important to note that every person tends to have a slightly different experience of PMS, and there are many different symptoms. These symptoms fall into two categories: physical, and psychological/behavioural. They can change with age but, generally, premenstrual syndrome/tension affects those in their twenties to early forties. 

Symptoms of PMT

Common symptoms of PMS/PMT include:

• bloating
• breast pain
• mood swings
• food cravings
• tiredness

Certain lifestyle factors are thought to worsen symptoms, such as lack of exercise, poor diet and stress. Luckily, there are some habits you can incorporate into your daily routine to reduce the symptoms of premenstrual syndrome/tension, ranging from diet changes, vitamins and minerals, to natural remedies such as exercise and holistic therapy. 

What is the best diet for PMT?

Whilst dietary and lifestyle changes won’t make PMT disappear, they can help ease symptoms, making the days and weeks before the monthly cycle more manageable.

In this video, we speak to nutritional therapist Julia Young on how to ease unpleasant symptoms of PMT through the power of nutritional therapy.

Below are a few pointers 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 keep 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). These 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, which are thought to ease PMS symptoms.
6. Reduce caffeine and alcohol intake as these can affect your mood and energy levels, making PMS symptoms worse. Some people have a stronger desire for alcohol before their period starts, but PMT 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 an 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. This is helpful if you experience significant mood swings in the lead-up to your period.
• If you struggle with cramps, you could consider supplementing magnesium as it’s a muscle relaxant – helping calm the uterine muscles, the cause of painful cramps. 
• Calcium is thought to ease mood swings, bloating, and headaches. 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.

- Nutritionist Rosie Letts (BSc Hons, MBANT, CNHC) 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/PMT symptoms. Most women do not get enough calcium throughout the month."

What foods to eat during your menstrual cycle

There are four phases of the complete monthly cycle: menstruation, the follicular phase, ovulation, and the luteal phase. Each phase can benefit from slight tweaks in your diet (known as 'cycle foods'), 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 (glycemic index) 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 phase

Your estrogen levels begin to rise as an egg prepares to be released, so you may feel you have more energy and 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

Phase 3: Ovulation

Once the egg has matured, you enter the ovulation phase (roughly 14 days after your period first starts). 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 avoiding 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)

Phase 4: Luteal phase

This is the final stage before menstruation – hormone levels have peaked, and this is when many people start to experience PMT, 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. 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. 

- Registered Nutritional Therapist and Certified Fertility Specialist, Julia Young, explains. 

What is seed cycling?

Seed cycling has been gaining traction in the female hormone health space as a natural alternative to managing PMS/PMT. 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.

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 PMT 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. 

How do you relieve premenstrual tension?

It can be easy for us to reach for over-the-counter pain relief to deal with PMT symptoms, such as bloating and cramping, but here are some natural approaches to help ease the symptoms:

Exercise

Of course, regular physical activity is essential for 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. 

Holistic therapy

Alternative treatments and supplements have been said to help ease symptoms of PMS. However, there is no evidence as yet that these are effective treatments. If you’re interested in alternative treatment, 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.

When to seek further help for PMT

Most people will experience some form of PMT 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.

Medical treatment

If you are experiencing particularly severe symptoms of PMT, 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, estrogen-only patches, and implants. Your healthcare team will be able to give you more guidance. 

Finding a professional 

If you want to try to reduce your PMT symptoms naturally before seeking help from a GP, you may benefit from speaking to a nutritional professional. They will help you to identify what triggers your symptoms and can work with you to make your period a better experience.

Further reading

• Women’s nutrition