It was a typical Tuesday morning and my exhaustion was both overpowering and all-compassing. My temples throbbed and my lower back ached. I rested in half-sleep until I had no choice but to surrender to my alarm clock and double over myself to get to the office.
Two days came and went and I still felt like this sick and mercurial version of myself. As I crawled under the covers early on Wednesday evening, I thought, surely, I have the flu. On Thursday, I woke up with my period. I had not had a cold or the 24-hour flu. Rather, my hormones had taken over. I had an irate case of PMS. My cycle had duped me.
Many of my friends are able to recognize period-related symptoms as such, whether they have learned to identify them after years of behavioral patterns or by monitoring their menstrual cycle using a period-tracking app like Clue or Kindara. But I’m an anomaly. I spent ages 23 to 25 without a period and accompanying PMS. It was only recently, when I started eating meat after five years without it, that my period returned to me. I finally had an end to the health questions that neither my gynocologist nor my holistic nutritionist could definitively answer. But when my period came back, so too did the hormones, and they were wildly unrecognizable to me.
As it turns out, I’m not alone in my misunderstanding or misdiagnosis of PMS. That’s because we don’t even know what we’re looking for; there is little medical research done to define its signs and symptoms. According to an article by ResearchGate, 90% of women suffer from at least one symptom of premenstrual syndrome, but its root cause — and whether it is actually a medical condition — remain a mystery.
What the hell is PMS, actually?
PMS (premenstrual syndrome) is a hormonal imbalance during the luteal phase of the menstrual cycle, between ovulation and menstruation, ranging from a few days to a week before. The imbalance is a result of an increase in estrogen levels and a decrease in progesterone, causing changes to both the body and the brain. As a result, women might experience bloating, sugar cravings, breast tenderness, cramping, sleep disturbances, irritability and up to 150 more symptoms.
Suffering can be perpetuated and accentuated by lifestyle habits. Robin Berzin, M.D. and Founder/CEO of Parsley Health, says that dietary factors that stimulate and aggregate PMS include a high-sugar and refined carbohydrate diet as well as caffeine, dairy and environmental toxins like pesticides and pollutions. “Imbalances in the gut bacteria can worsen the situation because they lead to the reabsorption of estrogen from the gut,” Berzin says.
While popular culture has led us to believe that PMS is a natural part of being a woman, and we should simply endure our cravings, cramps and mood swings, research proves that there are many natural treatments and modifications to relieve or reduce symptoms. Below, nine PMS best practices.
1. Assess Your PMS Beliefs
Many influences — from media to advertising — inform our perspectives of PMS. Where did you learn that PMS was inevitable, that it is a part of being a woman? Were your beliefs ingrained by family members, media, your doctor or your own experiences? Take note of these perspectives and what has shaped this understanding of menstruation and PMS. Then ask yourself: What do I find challenging? What do I want to make better? What do I want to improve? What does a positive practice of PMS look like to me?
2. Food Matters
Food is the most effective way to balance your hormones, one reason being that our body responds to food so quickly. In a cross-sectional study, researchers at UC Davis found an association between PMS symptoms and the presence of certain biomarkers for inflammation, as measured by a high-sensitivity C-reactive protein. After testing 3,202 women from five ethnic groups, the study found that people with higher CRP were more likely to experience certain PMS symptoms including bloating, mood changes or cramps. According to Berzin, “the first step is cleaning up your diet to remove dairy, sugar, gluten and processed foods.” Eating an anti-inflammatory diet reduces the activity of aromatase, the enzyme that converts testosterone to estrogen. (Increased levels of estrogen or what we call “estrogen dominance” cause symptoms of PMS.) Foods that are supportive to our bodies include cruciferous vegetables — which are high in indole-3 carbinol and support liver detoxification of estrogens — as well as flax seeds, white button mushrooms and goji berries, which aid in the metabolism of estrogen. Eating organic, plant-based phytonutrients and having protein, healthy fat and fiber with every meal will help to balance your blood sugar and hormones.
3. Combat Stress
The benefit of tracking your cycle, even if it is irregular, is that you can be more prepared for hormonal changes as they naturally occur throughout the month. “We expect our bodies and energy to be constant and the reality is it changes,” says Surtees. Adjust your schedule in the luteal phase of your cycle to make time for restful activities, such as breathing exercises, yoga, taking a bath or candle-lit shower. When you are chronically stressed, you produce cortisol, a hormone that’s supposed to be released only in times of short-term or acute stress. Being in a state of chronic stress affects the balance of hormones in your body and should not be underestimated.
4. Get A PMS Friend
Find a trusted friend who can read your emotional radar and let you know (gently) if you sound more emotional or sensitive than normal. This person (or people) can add perspective to how you’re reacting by reminding you that certain things might be aggregated by where you are in your cycle. The benefit of having a PMS friend or partner is two-fold: each person becomes more self-aware by being able to recognize patterns in the other.
5. Get Moving and Sleeping
Exercise helps to balance hormones and remove excess estrogen, and is an effective way to reduce PMS symptoms. Hyman recommends 30 minutes of aerobic exercise four to five times a week. We tend to think that every form of exercise needs to be high-intensity to burn calories, but when our body is in a resting phase, this type of activity actually overstimulates cortisol release and destabilizes our hormones. Sleep is as important as movement. In addition to relaxation exercises, getting the recommended eight hours of restorative sleep per night during the luteal phase helps to balance your hormones. This part of your cycle is characterized by a decrease in energy as your body reabsorbs the corpus luteum.
6. Is This Normal?
Hormonal imbalances can sometimes signal underlying health issues — your body’s way of saying, “excuse me, please listen!” Since PMS symptoms share similarities with other hormonal imbalances, such as endometriosis or PCOS, as well as the flu or early stages of pregnancy, it’s important to pay attention to anything that doesn’t feel right or normal and share your questions with a doctor or OBGYN. You can ask for a complete hormone panel test (which includes estrogen, progesterone, folice-stimulating hormones and luteinizing hormones), a thyroid test, a blood sugar exam and a Vitamin D3 test. If your results come back in a normal range, yet you still have persistent symptoms, ask if there’s any indication that your numbers are trending to a hormonal imbalance. Hormonal contraception might compound your issues: A study of over one million people in Denmark found that women — particularly teenage women — who use the combined birth control pill, a mix of estrogen and progestin, were more likely to be prescribed anti-depressants or diagnosed with depression. The study is the first to show a link between depression and birth control, so if you are experiencing symptoms that characterize depression, discuss your medication with your doctor.
7. Consider Your Entire Cycle
Rather than focus on the handful of days you experience PMS, think about your body during your entire cycle. This allows you to compare what’s happening emotionally and physically during your luteal phase versus the other phases throughout the month, knowledge that can prove invaluable. For instance, track your menstrual cycle and you’ll be better able to identify ideal times of the month for exercise, social activity or sex. Begin simply by tracking the dates you get your period each month, and then, over time, monitor further variables such as energy or mood shifts, or creativity and motivation. “Understanding how our body changes, when it changes and why it changes is helpful for our health and productivity,” Surtees explains.
8. Track Your Symptoms Each Month
Every single body works differently, so tracking your symptoms on a monthly basis is crucial. According to a study conducted by sampling 22 types of premenstrual complaints from 101 women, the cyclical pattern of symptoms is the defining characteristic of PMS. It is important to divide those symptoms into physical, emotional and mental, then record according to severity. Take note of any medications that might be contributing to the cause. A study about the management of PMS and PMDD explains that the only way doctors diagnose PMS is through a patient’s self-tracking symptoms diary. A doctor will likely require a chart of two to three months worth of symptoms. “Tracking your cycle and symptoms is possibly one of the most valuable pieces of information you can have about your body, which will continue to get more actionable as we direct further research to female health,” Surtees explains. “This knowledge can be used throughout your life to prevent disease and improve wellbeing.”
9. Change the Conversation Around PMS
Periods happen. PMS is real. Vocal and progressive brands like Thinx and Lola are speaking up to break the taboo around what it means to be a woman. Evolving our mindset is instrumental in evolving our personal abilities to react to it.
In the spirit of change and new beginnings, it’s time we all learn to take control of our hormones. So the next time my period comes a knocking, you can bet I’ll be ready. And if I’m not, you can bet my PMS friend will hear all about it.
Ovary is a research platform and female community dedicated to improving the conversation around women’s health, hormones, fertility and productivity. Visit www.ovary.co for more information or follow us on Instagram @ovary.co. Ovary events take place in NYC, LA, SF and London. Collages by Maria Jia Ling Pitt, images via iStock.