Causes, symptoms and treatment options for PMS

 

Premenstrual syndrome (PMS) affects approximately 75% of women worldwide and can significantly impact daily life. The severity of symptoms varies considerably. Approximately 20-30% of women report symptoms that significantly interfere with their daily activities, while approximately 3-8% suffer from a particularly severe form of PMS, known as premenstrual dysphoric disorder (PMDD). This blog post will explain in detail the various causes of PMS, the symptoms, and the best dietary and supplementation strategies for relief. We will also discuss why women with PCOS are particularly at risk for PMS.

Causes of PMS

1. Hormonal fluctuations

A lack of progesterone in the second half of the cycle is one of the main causes of PMS. Progesterone deficiency is caused by a lack of ovulation, corpus luteum weakness, or high stress levels. The resulting estrogen dominance leads to typical symptoms such as mood swings and feelings of tension.

2. Serotonin deficiency

Low serotonin levels lead to depression, irritability, and food cravings, which are common symptoms of PMS. A deficiency in L-tryptophan, one of the nine essential amino acids, can cause this serotonin deficiency.

3. High caffeine consumption

The relationship between PMS (premenstrual syndrome) and high caffeine consumption has been investigated in several studies, and the results show that high caffeine consumption can worsen PMS symptoms. Caffeine affects the central nervous system, increasing cortisol levels, can increase feelings of anxiety and nervousness and Increase the excretion of magnesium and calcium through urine. Both minerals are important for muscle relaxation and hormonal balance. A deficiency in these minerals can lead to more severe PMS symptoms such as muscle cramps and headaches. A study from the University of Massachusetts found that women who consume more than 200 mg of caffeine per day have an increased risk of more severe PMS symptoms. Other studies have shown similar results, emphasizing that the consumption of caffeinated beverages such as coffee, tea, and cola is associated with an increased prevalence and severity of PMS symptoms. Women who suffer from PMS should reduce or completely avoid their caffeine consumption, especially in the second half of their cycle.

4. Alcohol

Alcohol consumption can worsen PMS symptoms and has far-reaching effects on liver function and estrogen metabolism. The liver plays a central role in the metabolism of hormones, including estrogen. Alcohol affects liver function and can impair the liver's ability to effectively metabolize estrogen. This leads to increased estrogen availability in the blood, which can exacerbate hormonal imbalances and worsen PMS symptoms. One study has shown that alcohol can slow the breakdown of estrogen, leading to elevated estrogen levels. High estrogen levels are associated with increased PMS symptoms such as breast tenderness, mood swings, and water retention.

5. Chronic inflammation

Chronic inflammation in the body is often indicated by elevated levels of inflammatory markers such as C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and interleukins (e.g., IL-6). Studies have shown that women with PMS have higher levels of these inflammatory markers, and there is a direct link between elevated inflammatory markers and the severity of PMS symptoms.

6. Chronic stress

Chronic stress leads to a sustained release of stress hormones like cortisol. Cortisol disrupts the balance between estrogen and progesterone by reducing progesterone production and promoting estrogen dominance, which can exacerbate typical PMS symptoms such as irritability, mood swings, and breast tenderness. The so-called "cortisol steal" phenomenon describes how, under stress, the body converts progesterone into cortisol to meet the increased demand for stress hormones. This leads to a progesterone deficiency, which can worsen PMS symptoms such as insomnia, anxiety, and depression. Because progesterone has a calming effect on the nervous system, a deficiency of this hormone can intensify the emotional and psychological symptoms of PMS.

7. Magnesium deficiency

Magnesium plays an important role in muscle relaxation and function. A magnesium deficiency can lead to muscle cramps, tension, and pain, which are common symptoms of PMS. Women with PMS often report increased cramps and pain, which can be exacerbated by low magnesium levels. Magnesium has a calming effect on the nervous system and helps reduce stress and anxiety. Women with PMS often experience elevated levels of stress and anxiety. Adequate magnesium levels can help alleviate these symptoms by supporting the nervous system and regulating the production of stress hormones like cortisol. Women who take magnesium report significant improvements in their PMS symptoms, including reduced cramps, improved mood, and less fatigue.

8. Vitamin D deficiency

Vitamin D has anti-inflammatory properties that can help reduce chronic inflammation. Since inflammation plays a role in exacerbating PMS symptoms, a vitamin D deficiency can lead to an increased inflammatory response and thus worsen PMS symptoms. Women with low vitamin D levels suffer from PMS symptoms more frequently and intensely. Taking vitamin D can significantly improve symptoms. About 15-20 minutes of sunlight on uncovered skin daily can be enough to support the body's own vitamin D production.

9. Hypothyroidism

Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones. Thyroid hormones, particularly thyroxine (T4) and triiodothyronine (T3), play a key role in regulating other hormones in the body, including estrogen and progesterone. An underactive thyroid can lead to irregular menstrual cycles, which can worsen premenstrual symptoms. Women with hypothyroidism often report longer and heavier periods and more intense PMS symptoms.

10. Prostaglandin imbalance caused by painkillers

Prostaglandins are hormone-like substances found in almost all tissues of the body and perform a variety of functions, including the regulation of inflammation, pain, and menstruation. An imbalance or excessive production of prostaglandins can contribute to the pain and discomfort associated with premenstrual syndrome (PMS). Pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs)—like ibuprofen and aspirin—are commonly used to relieve pain and inflammation, particularly for PMS symptoms. However, there is evidence that NSAIDs may inhibit ovulation, which could negatively affect progesterone levels and PMS symptoms. It is recommended that NSAIDs be used only for short-term relief of acute pain and cramps in order to minimize potential effects on ovulation.

Why women with PCOS are particularly at risk for PMS

Women with PCOS (polycystic ovary syndrome) are particularly at risk for PMS because they often suffer from hormonal imbalances that can worsen PMS:

1. Infrequent ovulation: Women with PCOS often have low progesterone levels due to infrequent ovulation. Since progesterone helps relieve menstrual discomfort, a deficiency can lead to more severe PMS symptoms.

2. Insulin resistance: Many women with PCOS suffer from insulin resistance, which can lead to higher androgen levels. These hormonal imbalances exacerbate PMS symptoms such as mood swings, acne, and increased body hair.

3. Chronic inflammation: Women with PCOS often have elevated inflammatory markers in their blood, which can worsen PMS symptoms.

4. Stress and cortisol: Women with PCOS often have higher stress levels and therefore increased cortisol levels, which can further impair progesterone production and worsen PMS symptoms.

Symptoms of PMS

In addition to the well-known symptoms, there are many lesser-known complaints. Here are some common and less common symptoms of PMS:

1. depression
2. irritability
3. Anxiety
4. insomnia
5. Headache
6. abdominal pain
7. Breast tension
8. Lethargy and fatigue
9. Bad breath (halitosis)
10. Mouth ulcers
11. Food cravings
12. dizziness
13. Constipation or diarrhea
14. Joint and muscle pain
15. Fluid retention (water retention)
16. Loss of appetite
17. Reduced ability to concentrate
18. Acne and skin changes
19. Hypersensitivity to light and noise
20. Mood swings and sudden crying fits

Treatment options

Nutrition

An anti-inflammatory, protein-rich diet can help relieve PMS symptoms. Here are our strategies:

1. High consumption of omega-3 fatty acids: These have anti-inflammatory properties and can be found in oily fish such as salmon, walnuts, and flaxseed.

2. Avoid processed foods: many packaged, "grab & take" foods often contain high amounts of sugar, sweeteners, preservatives, and saturated fats (e.g., refined canola oil), which can promote inflammation.

3. More complex carbohydrates: Whole grains (oats, barley), pseudo-cereals (quinoa, amaranth, buckwheat), and certain vegetables (sweet potatoes, carrots, pumpkin, green peas, broccoli) can help stabilize blood sugar levels.

4. Magnesium-rich foods: Nuts, seeds, dark green leafy vegetables, and whole grains are good sources of magnesium, which can help relieve muscle cramps and fatigue.

5. Adequate vitamin D intake: Through sunlight and foods such as oily fish, eggs, and fortified dairy products.

Supplements

Supplements can also play an important role in relieving PMS symptoms:

1. Vitamin D: Promotes insulin sensitivity and has anti-inflammatory properties.

2. Myo-Inositol: Can reduce insulin resistance and relieve the symptoms of PMS and PCOS

3. Vitamin B6: Supports serotonin production and can improve mood.

4. Omega-3 fatty acids: Reduce inflammation and can alleviate mood swings.

5. Vitex Agnus Castus (Chasteberry): Can balance hormonal imbalances and relieve symptoms such as breast tenderness and mood swings.

6. Calcium: May help reduce physical and emotional PMS symptoms.

7. Magnesium: Helps with muscle relaxation and the regulation of neurotransmitters.

8. • Magnesium citrate: One of the best-absorbed forms of magnesium, it is often used for constipation because of its mild laxative effect, but can also be effective in relieving PMS symptoms such as cramps and mood swings.
   • Magnesium malate: Magnesium malate is easily absorbed and is particularly beneficial for fatigue and muscle pain. It's a good choice for women who suffer from PMS symptoms such as lack of energy and muscle tension.
   • Magnesium glycinate: is a chelated compound of magnesium and glycine. This form is particularly well absorbed by the body and has a calming effect, making it ideal for treating PMS-related irritability, anxiety, and insomnia.

Lifestyle changes

1. Stress management: Techniques such as meditation, yoga, and adequate sleep can help reduce stress and support hormonal balance.

2. Regular exercise: Can boost endorphin production and relieve symptoms such as mood swings and fatigue.

3. Hydration: Drinking enough water helps prevent fluid retention and supports overall health.

PMS is a complex syndrome that requires a holistic approach. By combining a healthy diet, regular exercise, and appropriate supplements, you can alleviate symptoms and improve your well-being.