Your menstrual cycle is composed of two distinct phases over an average of 28 days. Your cycle begins with the first day of your period - day 1. From this point until roughly day 1 until day 14 is what’s known as the follicular phase. Days 15 to 28 is known as the luteal phase. Ovulation occurs right in the middle around day 14. PMS or premenstrual syndrome typically occurs 5-7 days before your period starts. While many women will experience some sort of PMS each month, the degree will vary greatly from woman to woman.
What causes PMS?
PMS is sometimes also called your high hormone phase as around 5 days before your period, both oestrogen and progesterone reach high levels. This cyclical rise in hormones can affect a lot in our body including mood, exercise metabolism, plasma volume levels which are involved in temperature control, heat tolerance and of course, menstruation.
What are the symptoms of PMS?
PMS symptoms can vary from person to person but can include mood swings, bloating, feelings of anxiety, low moods, low energy, increased appetite, cravings and headaches. Many women may also find that their performance in the gym and recovery are negatively affected in this stage due to the effects of high oestrogen and progesterone which can reduce the anabolic capacity of muscle and increase muscle breakdown.
Can I get PMS when on the pill?
Yes, and no. It’s important to remember when you’re on hormonal contraception such as the pill, your cycle has been stopped. The hormones you’re taking in the pill are similar to oestrogen and progesterone but not entirely the same. It’s thought that hormonal contraception such as the pill mimics the high hormone phase meaning many women using such methods might experience these PMS symptoms throughout the whole time that they take the pill.
Is PMS normal?
Yes, to a certain degree. Hormones are powerful and as you can see, they can affect a lot in our system. It’s not surprising that as our cycle changes, we also experience changes and symptoms associated with these changes.
A 2013 study by Pandey et al. examined the prevalence of psychological and physical symptoms of PMS in female students. The findings reported that 100% of women had experienced at least one symptom of PMS. They also found that 42.5% of participants had experienced more than five symptoms of PMS. The most common symptom reported was lethargy. Other commonly reported psychological symptoms were anger, anxiety, feeling overwhelmed and insomnia. Women also reported physical symptoms such as joint and muscle pain, backache, bloating, breast tenderness and acne.
This study shows that PMS is common and something experienced by many women. So yes in some ways, it can be considered normal. But normal doesn’t mean that something cannot be improved or that it should be something that people need to put up with. You shouldn’t have to be crippled with mood swings, bloating, low energy and poor performance in this phase. Just because many women experience this, it doesn’t mean they should just have to get on with putting up with such debilitating symptoms. It’s clear that many women find the days before their period unbearable but just because this is common, it does not mean that it’s okay. Unfortunately, so many women are just told to accept these debilitating symptoms.
Nutritional Strategies
Luckily, there’s a lot you can do to help make this high hormone phase more bearable. The best advice is to work with your body, not against it. There are many lifestyle and nutritional strategies which you can put in place to lessen the symptoms of PMS that you experience each month.
Increase Calories
Increased hunger and cravings for carbohydrate foods are common in women with PMS. This actually makes sense though as it h as been shown that women actually burn more calories during the high hormone phase when PMS occurs which translates into increased hunger. For most people, this means that they usually roughly burn an extra 200 calories a day in this phase due to increased body temperature. This might be a good time to increase calories in the form of carbohydrates. This can also really help with managing cravings.
This was actually studied by a group of researchers in a study known as the Menstralean study. In this study, they took two groups of women and put them all in a caloric deficit with the view of losing body fat. However, one group was given 200 calories extra in the form of chocolate during their period, while the other group’s calories remained constant. The group who received the 200kcal extra of chocolate during their period had greater overall weight loss, a lower dropout rate from the study and greater long-term success than the group whose calories remained constant.
Magnesium and Zinc
During this phase of your cycle, your requirement for magnesium and zinc also increases. Increasing your intake of these nutrients alongside omega-3 fatty acids can really help with managing symptoms of PMS and can help alleviate cramping as they have an ability to reduce the effect of prostaglandins involved in cramping. Upping your intake of magnesium and zinc rich foods such green leafy vegetables, almonds, red meat, shellfish and pumpkin seeds is recommended. You can also consider taking a supplement of magnesium and of zinc alongside an omega-3 fish oil for the week before your period.
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Vitamin B6
Vitamin B6 has been shown to be highly effective in reducing PMS symptoms, especially psychological symptoms. A 1999 meta-analysis by Wyatt et al. found that woman with PMS found supplementation with vitamin B6 to be more effective than a placebo drug. A double-blind RCT by Kashanian et al. found that vitamin B6 supplementation was associated with significant reductions in PMS symptoms such as mood swings, anxiety and irritability. A good dose to aim for is a 20-50mg supplement of the active form of vitamin B6 - pyridoxal 5'-phosphate (P5P). It’s also worth upping your intake of foods rich in B6 such as salmon, liver, chicken, turkey, eggs, pistachio nuts and sunflower seeds.
Eat your Greens
Green cruciferous veggies such as broccoli, kale, cabbage and Brussel sprouts contain a compound known as DIM. DIM helps to break down oestrogen compounds into more favourable metabolites for excretion. This can help contribute to regular oestrogen levels. The fibre and potassium found in the greens can also help with controlling PMS symptoms such as bloating and water retention.
Reduce Stress
Stress can play a big part in worsening PMS symptoms. Chronic stress over time can lead to increased levels of the stress hormone cortisol. High circulating levels of cortisol can cause issues with our other hormones. Increased cortisol may decrease the production and activity of progesterone, oestrogen, DHEA, and testosterone, which can result in all hormones being a bit out of whack. It can also worsen symptoms of PMS such as water retention and food cravings.
Prioritise Sleep
Sleep and stress management go hand in hand. Sleep plays a key role in regulating cortisol levels. Getting into a relaxing bedtime routine can really help with sleep. This could involve a warm bath, journaling, light stretching or reading your favourite book. Adding a few drops of lavender oil to your bedclothes or drinking some herbal tea such as chamomile or valerian tea can also help you wind down and relax.