Premenstrual syndrome (PMS)

Written by Katherine Nicholls
Katherine Nicholls
Nutritionist Resource Content Team

task_alt Reviewed by Uta Boellinger
Last updated 4th December 2024 | Next update due 4th December 2027

Premenstrual syndrome (PMS) describes the physical, psychological, and behavioural symptoms that typically occur before a monthly period. PMS symptoms are common but, for some people, they can be particularly severe. Here, we explore what nutrition and lifestyle changes can help ease symptoms and how a nutrition professional can support you.

What is premenstrual syndrome?

Premenstrual syndrome refers to symptoms that can be experienced before your period. It may also be referred to as premenstrual tension (PMT) but both terms describe the same set of symptoms.

It is thought to affect as many as three in every four people with female reproductive organs. Whilst the exact cause remains unclear, it is likely due to changing hormonal levels in the middle and end of the menstrual cycle. Other influences that have been linked to PMS symptoms include:

  • low levels of serotonin
  • low levels of vitamin B6
  • high stress levels
  • higher levels of inflammation
  • excess intake of caffeine, alcohol and sugar

Sometimes, those with long-term health conditions such as asthma or migraines find they get worse during this time.

It's important to note that every person tends to have a different experience of PMS, and there are many different symptoms.


Symptoms of PMS

PMS symptoms fall into two categories: physical, and psychological/behavioural. They can change with age but, generally, premenstrual syndrome affects those in their twenties to early forties.

Common physical symptoms include:

  • acne
  • bloating
  • breast pain
  • headaches
  • tiredness

Common psychological/behavioural symptoms include:

  • mood swings
  • food cravings
  • irritability
  • anxiety
  • feeling low 

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 PMDD? 

Premenstrual dysphoric disorder (PMDD) is a less common, but much more severe form of PMS (affecting up to one in 10 women and those assigned female at birth).

The symptoms of PMDD are similar to PMS but are more likely to disrupt daily life. Symptoms can include headaches, joint pain, sleeping problems, high anxiety levels, feeling depressed or even suicidal.

If you think you could have PMDD, speak to your doctor to find out what support is available to you. 


How can dietary changes help with PMS?

Whilst dietary and lifestyle changes won’t make PMS 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 PMS through the power of nutritional therapy.

Making small changes to your diet can help to reduce bloating, stabilise blood sugar levels and generally improve mood. 

What is the best diet for PMS?

Below are a few pointers to follow that could help you maintain a healthy lifestyle, and ease your symptoms.

  1. Ensure you eat plenty of fibre and protein with all of your meals (aim for 20-30 grams of protein per meal) to reduce cravings and keep blood sugar levels balanced.
  2. Drink plenty of water throughout the day to keep you hydrated. Dehydration can make headaches and tiredness worse, exacerbating symptoms.
  3. 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.
  4. Eat your five a day as fruit and vegetables are rich in vitamins and minerals, which are thought to ease PMS symptoms.
  5. 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 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 for PMS

Supplementation of vitamins can be helpful (particularly in relation to hormonal changes) if you struggle to get enough 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 PMS 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."


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 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. 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

What is 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. 


How can working with a nutrition professional help with PMS?

Nutrition professionals can help if you are struggling to manage PMS symptoms and feel changing your diet could help. Together, you can explore your current diet and symptoms to see where change may be needed.

Using their expertise and understanding, your nutrition professional can help you create a PMS eating plan. This may include certain nutrients and vitamins to support you throughout your cycle and reduce PMS symptoms. They will likely take a holistic approach, ensuring any dietary changes complement advice given to you by your doctor.

Nutrition professionals who can support PMS

Other holistic approaches to PMS

It can be easy for us to reach for over-the-counter pain relief to deal with PMS 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). Regular exercise can help alleviate tiredness and depression and can be supportive throughout your cycle. 

Studies have shown that both high and low-intensity training can reduce menstrual pain, the key is to find something you enjoy. Strength and resistance training helps you build lean muscle mass and is associated with many health benefits – so this is a great place to start.

During your cycle, you need to listen to your body but contrary to popular belief we don't necessarily perform worse during our luteal phase and menstruation. You may actually perform better during your period. 

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.


Further support for PMS

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.

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, estrogen-only patches, and implants. Your healthcare team will be able to give you more guidance. 

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.

However you're feeling, know that you're not alone and that support in all areas is available.


Further reading

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