Do you have PMS?

MenstruationWomen's Health
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As I was growing up, the word PMS was always used as an insult. Not having a good day? Probably PMS-ing. Craving some red velvet cake? PMS-ing. Won't crack a smile? PMS-ing for sure. It's time to reclaim this word and instead of 'tossing' PMS around as an excuse for something, I want to examine it a bit further and see what it actually is. So I can ultimately help you figure out if that red velvet craving is real - or just a sign that you have good taste in cake. 

What is PMS

Otherwise known as premenstrual syndrome, PMS is a collection of emotional, behavioural and physical symptoms which pop up before your period, and may negatively impact your quality of life. Almost 80% of women experience at least one symptom during the end of their menstrual cycle! 

Why does PMS happen?

Like most women's health conditions (ie. endometriosis), we don't know why PMS happens. However, it's thought that it may be due to interactions between hormonal changes (estrogen and progesterone) of the menstrual cycle and neurotransmitters.  

Symptoms of PMS

There are 10 groups of emotional and behavioural symptoms, and only 1 group of physical symptoms in diagnostic criteria. 

Emotional & behavioural symptoms of PMS include:

  • Feelings of depression, sadness, hopelessness, worthless of guilty

  • Feelings of anxiousness, tension, edginess

  • Mood swings, feelings of rejection, easily hurt feelings

  • Feelings of anger or irritability

  • Less interest in usual activities (work, school, friends, hobbies)

  • Difficulty concentrating

  • Feelings of lethargy, fatigue, or lack of energy

  • Increased appetite, cravings for specific foods

  • More sleep (including naps), hard to get up, trouble getting or staying asleep

  • Feelings of overwhelm, inability to cope, out of control feelings

Physical symptoms of PMS include:

  • Breast tenderness, breast swelling, bloated sensation, weight gain, headache, joint or muscle pain, or other physical symptoms

Diagnosing PMS

In order to diagnose PMS, someone cannot just be craving red velvet cake. They must be experiencing some of the above symptoms during a specific time in their cycle. Moreover, it actually takes at least 2 months to diagnose PMS.  

Here's the specific criteria:

  • Symptoms occur after ovulation (aka. if you're not ovulating, it's not considered PMS)

  • Any number of symptoms can be present

  • Symptoms recur in the luteal phase 

  • Symptoms disappear by the end of ovulation

  • No symptoms should be experienced by the end of your period and before ovulation

  • Symptoms must be rated (the best tracker to use is called the Daily Record of Severity of Problems)

  • Symptoms do not occur because of an underlying issue (see conditions below)

  • Symptoms must affect your normal daily functioning, interfere with work/school/relationships, or cause significant distress

Conditions that may worsen PMS

There are other health conditions that may mimic the symptoms of PMS. They include:

  • Anxiety

  • Depression

  • Perimenopause

  • Chronic Fatigue Syndrome

  • Irritable Bowel Syndrome

  • Thyroid Disease

So, how do you differentiate these conditions from PMS? First of all, these symptoms need to be tracked on the DRSP. Secondly, if PMS is truly the reason for these symptoms, they should be disappearing at or after your period. If they are occurring all month long, then there's probably an underlying issue that's not PMS, and instead these symptoms are being magnified during your period! 

Non-Pharmacologic PMS Treatments

Reducing inflammatory foods

Admittedly, this is probably not the treatment you're most excited about (I get it), but it is a helpful one! Inflammation disrupts communication between hormones, and can affect neurotransmitters. 

Start slow, and say "see ya" to dairy first. Once you've got that covered, add alcohol to the list too. 

Reducing stress

Stress causes inflammation. I've talked about it before. While I'm not suggesting to quit your job or leave your partner, it's important to identify the biggest source of your stress and see if anything can be done. 

To help manage stress, you may want to look into journalling, yoga, meditation, or other forms of exercise. 

Prioritizing Sleep

This might seem like a no-brainer, but sleep is critical when it comes to ensuring that our body has recharged. What's my sleep routine? I aim for 8 hours of sleep, in a cool, dark and quiet room. If I'm using a device before bed, I'll have it on night mode. And on some nights, I start to wind down with a glass of chamomile and lavender tea. 

Magnesium

This often deficient nutrient, is needed in almost 300 of our body's chemical reactions! It helps to reduce inflammation, stress, and acts as a muscle relaxant. Leafy greens and pumpkin seeds contain magnesium, but often choosing the right form and dose of a supplement will help replenish your stores faster. 

Vitamin B6

This vitamin has mixed reviews when it comes to helping PMS. It also helps reduce inflammation, promotes better detoxification of estrogen, and is needed for the formation of progesterone and neurotransmitters. Too much Vitamin B6 might cause numbness in the fingertips and toes, so be sure to work with a healthcare practitioner when using it. 

Chasteberry (Vitex Agnus Castus)

This one of my most beloved herbs. It improves communication between the brain and ovaries, and helps to calm the nervous system. I frequently recommend it to my clients.  

Next Steps

Now that you're pretty much an expert when it comes to PMS, the first thing you should be doing is tracking your symptoms for at least 2 months using the DRSP. I recommend doing so on paper, rather than a period app, because you can track each specific symptom and the severity. 

Tracking your symptoms will give you an idea if you're dealing with PMS, or an underlying condition. 

If it is PMS, you can certainly adopt some of the treatment measures listed above. However, be mindful that if you choose to use supplements - it's best to do so under the supervision of a Naturopathic Doctor. I strive to recommend the highest quality products, ingredient forms, and dosages. 

Enjoy your red velvet cake (without a side of PMS)!

PS. If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

References

Walsh S, Ismaili E, Naheed B, O'Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician & Gynaecologist. 2015;17(2):99-104. doi:10.1111/tog.12180.

Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health. 2005;9(1):41-49. doi:10.1007/s00737-005-0103-y.

Nevatte T, O’Brien P, Bäckström T et al. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16(4):279-291. doi:10.1007/s00737-013-0346-y.

O’Brien P, Bäckström T, Brown C et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14(1):13-21. doi:10.1007/s00737-010-0201-3.

Dickerson L, Mazyck P, Hunter M. Premenstrual Syndrome. Am Fam Physician. 2003;67(8):1743-1752.

Ismaili E, Walsh S, O’Brien P et al. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016;19(6):953-958. doi:10.1007/s00737-016-0631-7.

Kadian S, O'Brien S. Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders. Menopause Int. 2012;18(2):43-47. doi:10.1258/mi.2012.012017.

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