An Holistic Approach To PMS & PMDD
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Beyond the “nurse talk” back in high school, women don’t get enough education about their bodies. How to know when things are going well? And what are the signs and symptoms when something needs addressing?
In November, I plan to focus on Women’s reproductive health:
🪆Week 1: Estrogen, Progesterone & Reproductive Health
🪆Week 2: Natural Care PMS & PMDD
🪆Week 3: Holistic Approach To Uterine Fibroid
🪆Week 4: Herbal Support For Reproductive Health
We tend to keep reproductive health out of the conversation because we feel shy about our bodies. Silence keeps us uninformed, which might lead to living with debilitating symptoms for years or even worse, not being able to hear the alarm bells sounding when something is wrong.
Most of my fertile years, I struggled with PMS or Premenstrual Syndrome. My symptoms were both physical (water retention, bloating, and breast tenderness) and emotional.
When I lose my mind and become irritable and let’s be honest bitchy, I would call my friend and rant to her about my mood swings and my bitchy behavior. She always said, “Oh, Lior, you are getting your period soon, right? which was always the case.
At the time, nobody talked to me about PMS. I always thought that something was broken with me for having these symptoms. However, at the same time, I thought it was a regular part of menstruation, like a force of nature that you had to endure but could never change.
Today, I know better. PMS is a story that your body tells you about its well-being. The following statement from the ACOG (American College of Obstetricians and Gynecologists) committee emphasizes the importance of monitoring your body and identifying PMS symptoms that require attention.
“Identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood. It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient. By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers.”
What is PMS?
PMS is a cluster of symptoms that begin about a week to ten days before menstruation and end once you start menstruation. If these symptoms don’t magically disappear once you begin to bleed, then they are not a manifestation of PMS.
For some women, PMS manifests only as emotional symptoms:
Brain fog and a hard time focusing
Mood swings
Sensitivity to rejection
Self critical thoughts
Depression or sadness
Anxiety
Irritable, short fuse
Low motivation
Some physical symptoms associated with PMS are:
Food cravings
Fatigue
Breast tenderness
Bloating
Fluid retention
Sleep disorder (either too much or too little)
Acne
Headaches
While PMS is common, a smaller number of women experience PMDD. In PMDD, the symptoms are similar, but their manifestation is much more intense and debilitating.
If you are struggling with these symptoms, please know that it is NOT in your head.
Understanding the symptoms of PMS
The primary energetic patterns of PMS are excessive heat excitation and congestion.
Signs that point toward a heat pattern:
Irritability and anger - classic heat emotions
Breast tenderness and swelling - heat creates inflammation and congestion
Headaches - often tension-type from heat rising
Food cravings (especially sweet/salty) - heat driving excessive appetite
Bloating with distension - heat creating expansion
Signs of congestion pattern in PMS:
Fluid retention - circulation becomes sluggish
Breast engorgement - lymphatic congestion
Digestive sluggishness - liver congestion affecting hormone metabolism
Mental/emotional stagnation - thoughts become “stuck” in negative patterns.
Root cause of PMS
Although PMS is a reflection of a hormonal imbalance, if you look under the hormones, you will find that the root causes are much more complex.
The hormonal imbalance
PMS typically occurs in the second half of the cycle, known as the luteal phase, when progesterone is dominant and estrogen levels are low.
In the brain, progesterone becomes allopregnanolone, a neuro-steroid that affect GABA receptors.
During the luteal phase, progesterone levels rise, along with those of allopregnanolone. Aallopregnanolone is calming, with an anti-anxiety effect on the brain.
If pregnancy didn’t happen, progesterone levels begin to decline about a week after ovulation, which is about a week before menstruation, precisely the time when most women will start experiencing PMS symptoms. A much more dramatic fall in progesterone about 48 hours before you start bleeding coincides with the worsening of symptoms.
PMS is a withdrawal-like symptom from allopregnanolone that is experienced by women with heightened sensitivity to the fluctuation in progesterone and allopregnanolone.
A couple of key factors affect your response to the decline in progesterone and allopregnanolone:
How efficiently your body converts progesterone into metabolites, such as allopregnanolone.
How sensitively your brain responds to these fluctuations.
Metabolic health in PMS
When your metabolic health is compromised, your insulin levels will increase significantly before you experience high blood sugar or insulin resistance, leading to an increase in sex hormone binding globulins (SHBG). These proteins bind to your hormones and prevent them from performing their job. Even though your blood test may show normal levels of estrogen and progesterone, the amount available for your cells is lower than normal.
Stress and PMS
It all starts in the hypothalamus and cascades down through the pituitary gland. By all, I mean both reproductive hormones and stress hormones are managed by the hypothalamus.
In acute stress, the hypothalamic cascade will lead to cortisol release in your adrenal gland. Cortisol increases alertness, blood sugar, and cardiovascular output. Short term increased cortisol is an adaptive survival response.
However, the same response when it becomes chronic leads to high blood sugar and insulin, reducing your available reproductive hormones.
Pregnenolone, a steroid hormone, serves as a precursor for reproductive hormones and cortisol. In chronic stress, your body will prioritize cortisol production, leaving less available for sex hormone synthesis.
The liver and PMS
Most of the breakdown of reproductive hormones happens in the liver. These processed hormones are mixed with bile and sent through the small intestines to the colon for elimination.
A sluggish liver or insufficient bowel movements mean these hormones and their metabolites stay in your body longer, exerting their effect. The result is a messed-up hormonal system.
Inflammation and PMS
Chronic low grade inflammation means your body is super reactive to any change. The same progesterone drop that might cause mild mood changes in someone with low inflammation can trigger severe PMS symptoms in someone with chronic inflammation.
Inflammatory cytokines are chemical messengers that the immune system uses to communicate cell damage or the presence of pathogens. Inflammatory cytokines play a crucial functional role in the healing process.
However, what heals you in acute conditions becomes damaging in chronic conditions.
GnRH (gonadotropin-releasing hormone) is a hormone released in the hypothalamus and initiates the hormonal cascade that produces estrogen and progesterone. Inflammatory cytokines suppress the release of GnRH, leading to downstream suppression of the entire reproductive axis.
Even when reproductive hormones are produced, inflammatory cytokines might bind to their receptors. By competing with reproductive hormones on cell receptors, they reduce their overall effect.
Inflammation increases stress, reduces metabolic health, and disrupts liver function.
PMS symptoms are whole body symptoms because they reflect an imbalance that goes way beyond just the reproductive system.
Although PMS and PMDD have some genetic components to them, you can still reduce symptoms or avoid them altogether. A care plan for PMS will need to address all the factors contributing to your hormonal imbalance.
Care plan for PMS
When designing a care plan for a woman with PMS, you want to address the root cause and the energetic of the condition.
Addressing the root cause:
Hormonal imbalance
One way to support reproductive hormone balance is to support the liver channel that eliminates reproductive hormones after their due date.
Support bile production by eating bitter foods and using bitter herbs before meals.
Promote healthy bowel movement once or twice a day by spacing your meals, and ingesting carminative spices (fennel, cardamom, cinnamon, etc), and probiotics (fermented foods)
Support the liver cycle that conjugates reproductive hormones by eating veggies in the cruciferous family.
Metabolic condition
To increase the availability of your reproductive hormones, you want to reduce insulin and glucose in the blood.
Reduce simple carbohydrates.
Eliminate processed foods
Avoid soda and sweetened drinks.
Stress management
The first step to reducing stress is getting a good night’s sleep.
Prioritize 7-8 hours of sleep.
Practice sleep hygiene
Sun exposure for 15-30 minutes first thing in the morning.
Add movement
Add magnesium - magnesium promotes steroid hormone production, including progesterone; it reduces inflammation, relaxes muscles (for cramps), regulates stress, and enhances GABA activity.
Add vitamin B6 as P5P, which is essential for the synthesis of progesterone and GABA. It reduces inflammation and promotes estrogen detox.
Another factor that affects your stress is inflammation.
Reversing inflammation is crucial for reducing the heat pattern in PMS.
Add 1/2 lb of cold water fish, such as salmon or sardines, a week
Add 2 Brazilian nuts daily.
Add 1/2 a cup of leafy greens to every meal.
Add vitamin D/k2
Add evening primrose
Add fish oil
Avoid dairy
Herbs for PMS
Herbs that can’t support PMS can be divided into three groups:
Nervine herbs that can support the mood swings
Alterative that can reduce bloating and water retention
Bitters can support liver detox of hormones.
Nervine herbs
Some herbs to use for reducing the mood swings, increasing resilience to stress, and improving sleep are:
Milky oats
Skullcap
Lemon balm
Lavender
Blue vervain
Alterative herbs
Alterative herbs purify the blood improve fluid drainage and support liver detox. They can clear the congestion and the inflammatory waste products associated with PMS.
Alterative to consider:
Red clover
Cleavers
Dandelion leaves
Bitter herbs
Bitters are crucial for promoting hormonal balance, as they help detoxify hormones and prevent hormonal buildup.
Some bitters:
Wild yam is bitter and anti-spasmodic, which can reduce the cramps associated with PMS.
Motherwort is a bitter nervine that can support the liver and reduce anxiety.
Vitex (agnus castus)
Vitex has a long history of use for treating PMS.
Studies show that vitex stimulates dopamine receptors in the pituitary gland, thereby regulating prolactin and allowing a surge of LH, which is necessary for proper ovulation and corpus luteum formation.
While vitex doesn’t act like progesterone in the body, it creates an environment that optimizes progesterone production by supporting ovulation.
Vitex doesn’t directly affect estrogen production. However, improving progesterone levels can help balance the estrogen-to-progesterone ratio, which is often addressed in conditions such as PMS, corpus luteal insufficiency, and irregular cycles.
It was found to treat PMS emotional symptoms, including the cyclical occurrence of depressive moods, irritability, anxiety, confusion, mastalgia, fatigue, and headache, by binding to opioid receptors.
It takes 3 months of consistent use to see if vitex will help.
Maybe respecting our bodies means slowing down and being graceful with ourselves because these hormonal ups and downs that we women experience every month between puberty and menopause are not just a myth; they do affect almost every facet of our lives.
I’d love to hear how you’re finding ways to grow your health. Please join the conversation and leave a comment below!
This document is for educational and informational purposes only and solely as a self-help tool for your own use. I am not providing medical, psychological, or nutrition therapy advice. You should not use this information to diagnose or treat any health problems or illnesses without consulting your own medical practitioner. Always seek the advice of your own medical practitioner and/or mental health provider about your specific health situation.