By Dr. Shawna Darou, ND
All women with circulating hormones experience change in their cycle as estrogen and progesterone levels rise and fall. What this means is that we are not the same every day of the month – one week you may be more sensitive, one week you may be more creative, and another you may have lots of energy. I’ve written about this before, and strongly encourage you to track not only your cycle, but also your symptoms – physical and emotional to understand this better. With a healthy and balanced hormonal cycle, there will still be a difference in how you feel through your cycle, but hopefully one that you can embrace the positive points each week. For example, during the premenstrual week you may be more sensitive and less social, but perhaps you have excellent focus and attention to detail, or are more contemplative and introspective. We’re all different here!
When is it too much?
If you’ve noticed that your premenstrual week is so intense that it is interfering with your life, your relationships and your decisions, this is definitely something to address.
Common symptoms that can arise during this week include:
- feeling irritable or angry
- increased anxiety
- breast tenderness and swelling
- night sweats
- food cravings
- water retention
- the start of menstrual cramps
The first step in understanding how to treat your PMS symptoms is to test your hormones, in particular the balance between estrogen and progesterone towards the end of your cycle, or mid-luteal phase. (This is approximately day 22 in a 28 day cycle, or 7 days post-ovulation). Thyroid testing is also recommended, since thyroid hormone imbalance can make any hormone imbalance more exaggerated. And if you are in your 40’s, we may also test day 3 hormones (estradiol, FSH and LH) to determine if changes in PMS are part of perimenopause.
Premenstrual symptoms can arise from many hormonal scenarios:
- high estrogen + low progesterone
- high estrogen + high progesterone
- normal estrogen + lack of ovulation
- low thyroid function + any variation above (usually presents with a longer cycle (>31 days) and prolonged PMS (>5 days)
In some cases, we may also test for hormone detox pathways, to better assess the balance of the three different estrogens: estrone, estradiol and estriol. (This testing is done through a urine sample, and is called “DUTCH” test. This is especially recommended when the initial testing above appears normal, but there are still significant symptoms, and also when there is a family or personal history of estrogen-stimulated conditions such as endometriosis, breast cancer, endometrial cancer, and uterine fibroids.
Where to start with treatment
Almost regardless of where the hormones show on testing we start with the basics – I’m still amazed at the significant changes in hormone health and balance by addressing nutrition, stress reduction, sleep and exercise.
A diet that balances blood sugar levels is almost always the first place to start: eating at regular meal-times, including protein with each meal, emphasizing lots of vegetables on the plate, and minimizing sugar intake. Balanced blood sugar levels greatly improve hormone expression.
Regular exercise and movement, especially during the PMS week can improve moods, sleep and especially water retention and menstrual pain. Many women report significantly less cramping when they exercise regularly.
3) Stress reduction:
There is an interesting link between cortisol (one of your main stress / adrenal hormones) and progesterone production. During prolonged periods of high stress, cortisol goes high, and progesterone drops. This will make premenstrual symptoms much harder to manage. If your stress is constantly high, take steps especially around your cycle such as yoga, meditation, breathing exercises, guided imagery or others.
Coffee intake in particular is associated with increased breast tenderness and swelling premenstrually, and more irritability. Consider a switch to green tea (which helps hormone detox), or at least a reduction in coffee intake.
5) Digestive flora balance:
Creating better balance in bacteria and other organisms in the gut is actually one of the most effective strategies to reduce your PMS. Hormone detox happens in two phases – first in the liver, and second in the gut, meaning that your digestive function and balance is critical for hormone balance. In many cases a one or two month gentle cleanse including: 1) Minimal sugar and simple carbohydrates, 2) Anti-microbial supplements to clear out the imbalanced organisms, and 3) Probiotics to replenish healthy bacteria, will cause a very noticeable improvement in your premenstrual symptoms, especially mood and bloating.
6) Create space for introspection and embrace the cyclic changes:
Again, remember that women with cycling hormones are not meant to be exactly the same all month long. Track your cycle, pay attention to the changes, and wherever possible embrace the positive changes that show up as your hormones shift.
Remember, if your PMS is interfering with your life it is time to make changes. I look forward to hearing from you.