Written by Kelly Schreuder – registered dietician
Premenstrual syndrome (PMS) is a collection of physical and psychological symptoms that flare up about a week to ten days before the onset of menstruation, and then ease off after it has started. The symptoms can include bloating, diarrhea or constipation, breast tenderness, weight gain, swollen hands and feet, general aches and pains, headaches, moodiness, depression, tearfulness, feelings of low self-esteem, anxiety and poor judgement. It is estimated that 85% of women experience at least one of these symptoms, which can profoundly affect their daily lives.
What causes it? It is not known precisely what causes all the symptoms and why some women are more sensitive than others. That is why it can be difficult to treat and why symptom management is often the most obvious approach. The hormonal shifts that happen during and after pregnancy can make PMS symptoms more severe for some women.
It is thought that the emotional aspects of PMS are due to hormonal changes, because the areas of the brain that control our emotions are driven to a large extent by sex hormones e.g. oestrogen and progesterone, levels of which fluctuate during the menstrual cycle. This fluctuation can affect two specific neurotransmitters – serotonin and GABA – which are targeted in treatment of PMS.
There are some risk factors that are associated with the experience of PMS, such as:
- Being overweight or obese
- History of trauma or abuse
- Smoking, or exposure to smoking
- A sedentary lifestyle
- Excessive caffeine intake
- Excessive alcohol consumption (Alcohol consumption should be avoided entirely during pregnancy and breastfeeding).
Many of these can be targeted with consistent healthy lifestyle measures that are associated with the relief of symptoms.
What can you do? Begin with some simple lifestyle measures and keep a symptoms diary for up to 3 months to note if there is any change in your experience.
Try the following 10 things:
- Eliminate junk food – this will help to manage your weight, your moods and your energy levels.
- Carbohydrate-containing foods can temporarily elevate serotonin levels. Be careful of overeating sugary foods – that will cause an insulin spike and rebound low blood sugar, which will make you feel even worse. Eat about a cup at a time of whole grains, fruit or starchy vegetables, 3 or 4 times a day to maintain your blood glucose levels without overdoing it.
- Add more nutritious food to every meal and snack. Deficiency of vitamins and minerals like the B vitamins, calcium, magnesium and iron can contribute to feelings of fatigue and depression. Eating a healthful diet with plenty of variety is the best way to get what you need.
- Balance your meals and snacks with some lean protein, good quality carbohydrates from starchy vegetables like sweet potato, whole grains, legumes or fruit, good fats from nuts, seeds or avocado and lots of vegetables.
- Eat 3 servings (about 2.5-3 cups) of low fat or fat free dairy to ensure you get enough calcium in your diet. Another good source of calcium is canned fish with the bones mashed up and eaten with it e.g. sardines, pink salmon or pilchards. Calcium supplementation of 1200mg per day has been linked to relief of PMS symptoms, so if you do not eat dairy every day, try a supplement.
- No more than 1 cup of coffee daily.
- No more than 1 unit of alcohol daily (e.g. 125ml wine or 330ml beer). If you are pregnant or breastfeeding it is best to avoid alcohol entirely.
- Get some moderate exercise at least 5 times a week – a daily 30-minute walk is enough.
- Manage your stress levels. If you experience a lot of stress, try to focus on ways to reduce that. You might benefit from some life coaching or counselling if you feel that you are stuck.
- Vitamin B6 and magnesium supplementation might help, but these are most effective if there is a pre-existing deficiency. If you want to try these, do not exceed your RDA and monitor your symptoms.
If you find that there is really no relief of symptoms with self-treatment and you feel that your PMS affects your daily life more than it should, then please consult your doctor for further assistance.