I’ve always been fascinated by the menstrual cycle: A monthly phenomenon that occurs without our conscious thought like the changes in the ocean tides and phases of the moon. The cycle reflects our connection to nature and the intelligence at work within us. And our observations about our cycle can also give us insight into our overall health. However, our cycles can be uncomfortable, painful and severely impact our quality of life. To make matters worse, our culture views menstruation as something that should be hidden. As a result, we’re hesitant to be open about our struggles with family, friends, coworkers, employers and teachers. This added pressure to pretend “everything is fine”, makes the discomfort of cycles, even more difficult and isolating. My hope is to shed some light on where premenstrual syndrome, or PMS, comes from and what we can do to reduce the intensity of it and improve our relationship with this sophisticated process.

PMS include physical symptoms and mood changes that are cyclical and occur during the second half of the cycle (Day 1 is the first day of the period) and ends either with the onset of the period or by the end of the period. Typically PMS symptoms occur 1-2 weeks before the period. Some physical symptoms: swelling, breast pain, low back pain, headaches, “feeling puffy.” Some mood changes: anxiety, irritability, aggression, depression, difficulty concentrating, sugar cravings.

Where PMS comes from PMS involves the complex interactions between hormones, neurotransmitters (brain chemical messengers) and inflammation in the body. There’s a link between low magnesium levels and PMS, which likely is associated with magnesium’s involvement in neurotransmitters and inflammation. Liver function is also very important as it contributes to healthy hormones and inflammation levels in the body. Diet and lifestyle modifications can significantly improve PMS. Here are recommendations for PMS from Chinese medicine and specific recommendations for mood/craving issues as well as pain and fluid retention.

  1. Reducing PMS with Chinese Medicine In Traditional Chinese Medicine, PMS arises from a stagnation of the Liver energy (called “Liver Qi stagnation”). The Liver system is responsible for the smooth flow of energy in the body. When this flow becomes stagnant, anger, irritability, constipation, PMS and irregular periods can result. Have you noticed a tendency to sigh throughout the day? This could indicate some LV stagnation. To improve Liver Qi, look for ways to improve the flow of thoughts, emotions and breath:
    1. Emotional expression: make art/music, watch a movie and laugh or cry, deep breaths, walk/run/dance, smell flowers, daydream, journal, talk to a friend
    2. Aerobic exercise: Similarly, studies have shown that aerobic exercise is more beneficial than strength training for PMS and improves many psychological and physical symptoms. Frequency is more important than duration or intensity, for example, aim to walk 5-7 days per week.
  2. Reducing Mood & Cravings When it comes to issues with the cycle, we often talk about hormone imbalances between estrogen and progesterone. Hormone imbalances can certainly be involved in PMS, but we also see PMS occur without hormone imbalances. With mood and craving issues, it’s important to look at healthy brain chemistry as well.
    1. Eat Complex Carbohydrates Those of us who have a tendency to get “hangry” when we miss a meal, know the impact blood sugar can have on our moods. Look for ways to include more fiber every time you eat
      1. Aim for at least half of your plate to be high fiber foods such as non-starchy vegetables like leafy greens and broccoli.
      2. Choose whole foods (foods in their least processed form) like whole grains instead of refined grain products; whole apple instead of apple juice.
      3. Add ground flax seeds, chia seeds, psyllium husk fiber or leafy greens in smoothies
      4. Add zucchini, cauliflower, green beans, or wilted leafy greens like spinach to typically starchy bases like pasta and rice.
    2. Eat Glutamine Glutamine can also be particularly helpful for calming sugar cravings. Glutamine-rich foods include: cabbage, parsley, quality organ meats and bone broth. This amino acid is also great for healing the gut lining.
    3. Eat foods for Brain Health Brain chemical messengers like serotonin are influenced by the cyclical changes in our hormones and can impact cravings, mood and sleep.
      1. Include tryptophan rich foods: High tryptophan foods include nuts, seeds, tofu, cheese, red meat, chicken, turkey, fish, oats, beans, lentils, and eggs.
      2. Include vitamin B6 rich foods: Salmon, chicken, sweet potatoes, avocados
  3. Foods to Reduce Pain & Fluid Retention Pain and feeling “puffy” or “swollen” are common symptoms with PMS. And for some this pain starts premenstrual (before the period) and continues with menstrual cramps. Excessive production of prostaglandins, powerful messengers of inflammation, is linked to PMS and menstrual pain. Thankfully, what we eat can improve our inflammation levels.
    1. Eat Anti-inflammatory Foods
      1. Choose more fish, legumes, nuts/seeds, vegetables; and less red meat and dairy
      2. Choose dairy-free calcium rich foods like dark green leafy vegetables (like kale, collard greens), sesame seeds/tahini (and other seeds), sardines and other canned fish and tofu
      3. Include more essential fatty acids like fish/oil, olive oil, flax seeds/oil
    2. Avoid Fluid Retention Foods Reducing alcohol, caffeine and excess salt can help reduce breast tenderness, breast cysts and fluid retention.

BONUS Tips for Menstrual Cramps
Although menstrual cramps aren’t technically part of PMS, I know it can be a challenging part of the cycle. There’s a link between inflammation (prostaglandin levels) and menstrual cramps just like with premenstrual pain so eating more anti-inflammatory foods (and reducing inflammatory foods) (as above) can be helpful for this. I’ve found supporting healthy muscle function can also help to reduce the intensity of symptoms like stretching exercises and adequate magnesium intake. I also love warming herbs like cinnamon and ginger for easing menstrual cramps. Studies show ginger is anti-inflammatory and can be helpful for menstrual cramps within days.

Menstrual cycles are an awe-inspiring phenomenon of nature but for many of us, it comes with discomfort and pain. PMS symptoms result from a complex interaction between hormone changes and imbalances in our brain chemistry and inflammation levels. These symptoms often reveal underlying, chronic imbalances from stress, diet, medications and other lifestyle factors. As such, lifestyle modifications are the cornerstone of PMS reducing strategies. Herbs, medications and specific nutrients can be helpful for managing symptoms while working on these modifications; always talk to your practitioner before starting any supplement or medication. My hope is that with greater understanding of premenstrual symptoms, we’re empowered to make lifestyle modifications that not only improve our future cycles but also our whole health.

In health,
Dr. Carin