Research shows that about 90% of women of reproductive age experience PMS symptoms. Interestingly, this condition can look very different from woman to woman. That's because there are both physical and mental/emotional symptoms associated with PMS, and it's typical to have just a few from one or both categories. For example, one woman might experience bloat and constipation before her period, while another experiences mood swings and irritability. Both women would be considered PMS sufferers even though their experiences are pretty different.
PMS in conventional medicine doesn't have an exact cause associated with it. However, in functional medicine, we examine the root cause(s), and several clear associations are linked to PMS: Hormonal imbalances, neurotransmitter imbalances, micronutrient deficiencies, dysbiosis in the gut microbiome, and chemical exposures (specifically endocrine disruptors). Luckily functional medicine can help test for those root causes, helping to individualize treatment plans that address why PMS is occurring.
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What is PMS?
Premenstrual Syndrome (PMS) is a combination of physical and mental symptoms that occur 1-2 weeks before the start of the period. It is so common that over 90% of women say they get some PMS symptoms. The severity of symptoms spans an extensive range. Some women can still fully function while experiencing PMS. However, some women feel severe and debilitating symptoms and must miss work or school. In about 5-10% of women, this severe version of PMS is known as premenstrual dysphoric disorder (PMDD).
PMS can happen at any age within the reproductive years. But, women in their 30s are the most likely to experience symptoms. Researchers believe that PMS results from the drop in estrogen and progesterone post-ovulation (when pregnancy does not occur). Regardless of the severity, symptoms go away within a day or two after a woman's period starts, and hormones begin to rise back up. After menopause, when a woman stops cycling, these symptoms will resolve since the hormones discontinue their fluctuations.
PMS Symptoms
PMS has two main categories of symptoms, which are physical symptoms and mental/emotional symptoms. The severity of these symptoms varies between women. While there is a long list of symptoms within these categories, typically, women only experience a few from one or both categories. PMS can therefore look quite different between women.
Physical PMS Symptoms
- Bloating
- Cramping and pain in the lower abdomen or back
- Bowel changes such as diarrhea or constipation
- Breast tenderness
- Weight fluctuations (primarily due to water retention)
- Acne
- Headaches/Migraines
- Achy joints
- Fatigue
- Change in alcohol tolerance
Mental/Emotional Symptoms
- Mood swings, including anger or irritability
- Depressed mood
- Crying easily
- Anxiety
- Appetite changes
- Food cravings
- Insomnia
- Brain fog or difficulty concentrating
- Changes in libido
- Social withdrawal
4 Functional Medicine Labs to Test for the Root Cause of PMS
When considering PMS, understanding the root cause is essential to understanding why the symptoms occur. There are several root causes to explore.
A hormone imbalance is one of the more obvious causes of PMS. However, a simple hormonal blood test could miss the fluctuations leading to the symptoms depending on the day of the cycle that the blood is drawn. Alternatively, the DUTCH Cycle Mapping test is a dried urine test sampling each day of an entire cycle. This thoroughness ensures that fundamental fluctuations are noticed.
Research suggests that lower serotonin can be a cause of PMS symptoms. Studies indicate that micronutrient deficiencies, including vitamins and minerals, play a role in PMS symptoms. Spectracell Laboratories offers the Micronutrients test and ZRT Laboratory offers the Neurotransmitter test to evaluate the status of these vital areas of health and would be an excellent addition in assessing the root cause of PMS.
Gut health is essential to many areas of wellness. Research shows that deficiencies in beneficial microbes within the gut are associated with PMDD, the most severe form of PMS. A comprehensive stool analysis, such as the GI-MAP, can help evaluate the microbiome makeup. This test utilizes technology to assess the DNA of the gut microbiota and can help diagnose a dysbiosis situation (an imbalance between the beneficial and pathologic microbes).
Endocrine disruptors are chemicals and toxins that affect the endocrine system (our hormones). These toxins have been shown to affect PMS due to the hormonal imbalance they create. The total toxic burden on our bodies can be analyzed through environmental toxins, mycotoxins, and heavy metals testing. These include- the Total Mycotoxin Panel by RealTime Laboratories, the RTL Tox Complete by RealTime Laboratories, and the Heavy Metals, 21 Toxic, Urine (24-hour) by Access Medical Laboratories. Additionally, because our liver is the primary organ of detoxification, a Hepatic Function Panel gives a good assessment of liver function to ensure that toxins are efficiently leaving the body.
Functional Medicine Treatment for PMS Based on Labs
Nutrition
Incorporating a nutrient-rich diet is one of the best ways to improve PMS symptoms. A plant-based diet with healthy proteins and fats, such as the Mediterranean Diet (MD), can be helpful for several reasons. This diet has been shown to rebalance the gut microbiome, which would resolve any dysbiosis. It has also been shown to boost micronutrient nutrition because of the number of fruits and vegetables included, reversing any micronutrient deficiencies. These micronutrients are also heavily involved in liver detoxification. So, having higher micronutrient intakes can also affect how well our bodies are ridding toxins.
Looking more indirectly, because this diet positively influences gut health, we will see benefits elsewhere in the body. For example, a healthy gut is vital for healthy hormones and healthy neurotransmitters (because of the gut-brain connection).
Complementary and Alternative Medicine
In addition to a healthy diet, Complementary and Alternative Medicine can also help reduce PMS symptoms.
The addition of certain supplements may be beneficial. For example, probiotics have been shown to reduce the psychological symptoms associated with PMS. Supplementing with Vitamin D has also been shown to relieve symptoms of PMS, such as pain and cramping. Evening Primrose Oil (EPO) has been studied for various women's health conditions, with sufficient evidence specifically on reducing PMS symptoms. However, an immediate effect should not be expected from EPO, and instead, a treatment period of 4-6 months may be warranted before the full effect is experienced.
Certain herbs are also beneficial. Vitex agnus castus, Chasteberry, is a safe and effective herbal treatment choice to support those specifically with a hormonal imbalance.
From a Traditional Chinese Medicine (TCM) perspective, Jia Wei Xiao San is an herbal formula commonly recommended to relieve cramps, hormonal imbalances, and PMS. There is also evidence that acupuncture can help reduce PMS symptoms.
Aerobic exercise and yoga have both been studied and shown to relieve PMS symptoms.
Summary
PMS is so common that nearly all women of reproductive age will experience it to some degree. Some women have symptoms that are so severe that they are diagnosed with a specific form of PMS called PMDD.
Functional medicine helps identify the underlying causes contributing to PMS, such as a hormonal imbalances, gut microbiome imbalances (dysbiosis), neurotransmitter imbalances, micronutrient deficiencies, and exposure to endocrine-disrupting chemicals and toxins. Holistically using a nutrient-dense diet along with various alternative medicine strategies, PMS symptoms can largely be resolved.
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