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Healthy lifestyle tips to support menstrual comfort An Expert Series on Women’s Health, Part I

By Felice Gersh, M.D.+ 

Premenstrual Syndrome (PMS) is a common group of symptoms experienced by reproductive-aged women on a global scale. Estimates are that up to 75% of menstruating women experience PMS to some degree. A syndrome, PMS manifests as a collection of symptoms, present in varying degrees, during the luteal phase of the menstrual cycle – the two weeks following ovulation until the onset of bleeding, and sometimes including the first few days of bleeding. The large constellation of symptoms women may experience include irritability, mood swings, anxiety and depression, water retention, fatigue, food cravings and appetite dysregulation, breast tenderness, achy joints, nausea, various intestinal and digestive discomforts, acne, headaches, insomnia, brain fog, and cramping. 

 

The etiology of PMS has long been debated. Theories include estrogen and progesterone excess or deficiency, or an abnormal sensitivity to those hormones, prolactin increases, and abnormalities with neurotransmitters and their interactions with hormones, including the neurotransmitters serotonin, gamma-aminobutyric acid (GABA), and the catecholamines. Abnormal hypothalamic-pituitary-adrenal (HPA) axis function, insulin resistance, genetic tendencies, and nutritional issues have also been implicated as factors involved in PMS.  

 

Tracking symptoms over the menstrual cycle is the mainstay of diagnosis. Once a diagnosis is made, therapeutics can include lifestyle modifications, stress reduction techniques, nutraceuticals and/or pharmaceuticals.  

 

Lifestyle solutions & natural products for menstrual comfort 

 

Lifestyle interventions are generally safe and beneficial and should be part of all PMS treatment plans. These include exercise, stress reduction, chemical avoidance, proper sleep, morning light exposure, meditation, and improved nutrition.  

 

Nutraceuticals that may support menstrual comfort and mood include vitamins, minerals, Omega 6 fatty acids, and plant extracts. Published data supports calcium supplementation as an effective way to support mood in PMS women by affecting serotonin production and tryptophan metabolism. The symptoms most helped by calcium include mood swings, anxiety, depression, fatigue, and dysregulated appetite.1  

 

The benefits of Evening Primrose Oil (EPO) are also well documented. EPO is a derivative of Omega 6 fatty acid that contains linoleic acid and a smaller amount of gamma linoleic acid. Essential fatty acids such as EPO  support menstrual comfort particularly breast tenderness (mastalgia). The beneficial results, however, may take up to 4-6 months and women should be counseled appropriately to stay on this supplement to achieve the desired benefits.2 Gamma-linolenic acid (GLA), a derivative of EPO, is also used for supporting menstrual comfort. Benefits include reduction of breast tenderness, mood support, fluid retention, and digestive symptoms.3 

 

Vitamin D has been shown in multiple studies to supportmany PMS symptoms, including body aches, mood swings, and cramping.4 Vitamin B6 has been shown to support/promote positive mood mood.5 Another beneficial supplement is a derivative of green tea, L-Theanine. Studies clearly document L-Theanine’s impact on PMS symptoms, including support for irritability, mood swings, and crying. No adverse effects have been reported.6  

 

 

Male doctor talking to his female patient for an appointment.

 

Taking control of women’s menstrual cycles 

 

For many women, improvements in lifestyle combined with targeted nutraceuticals will lead to support for menstrual comfort. Untreated PMS can have serious negative consequences on the quality of life of young, reproductive-aged women. But with treatment protocols derived from the significant, high-quality research that has been published on PMS, no woman has to be seriously impacted by her menstrual cycles. With consultations from your healthcare practitioner, commonsense lifestyle measures, and targeted natural products- and pharmaceuticals only when necessary- all women can have the opportunity to lead lives unhindered by PMS symptoms.  

 

Ask the Expert  

 

How common is PMS? 

 

Up to 70% of menstruating people experience PMS to some degree. 

 

What causes PMS? 

 

The causes are likely multifactorial and vary from person to person. Probable culprits include genetics, fluctuating hormones and neurotransmitters, environmental endocrine disruptors and other toxins, nutritional deficiencies, and circadian rhythm dysfunction.  

 

When do the symptoms of PMS appear during a menstrual cycle? 

 

Most people experience PMS symptoms during the luteal phase of the menstrual cycle – the two weeks following ovulation until the onset of bleeding, and sometimes including a few days after the bleeding begins. 

 

What natural approaches are there to improve the symptoms of PMS? 

 

Lifestyle interventions are often successful in reducing PMS severity. Moderate exercise, improved sleep, and eating a high fiber, nutrient-rich, plant-focused diet can be helpful. Targeted nutraceuticals may also improve symptoms. 

 

Meet Our Expert  

Image of Felice Gersh, M.D.

 

Felice Gersh, M.D. is a multi-award-winning physician with dual board certifications in OB-GYN and Integrative Medicine, with degrees from Princeton University, University of Southern California School of Medicine and University of Arizona School of Medicine. 

 

She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic and holistic medicine. For many years, she taught obstetrics and gynecology at Keck USC School of Medicine as an Assistant Clinical Professor. She now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine through the University of Arizona School of Medicine.  

 

Dr. Gersh is a prolific writer and lecturer who speaks globally on women’s health and regularly publishes in peer-reviewed medical journals. She has been featured in multiple medical documentaries, including the Real Skinny on Fat, Fasting, and The Business of Birth Control. She is the bestselling author of the PCOS SOS series and Menopause: 50 Things You Need to Know.   

 

+Our Medical Consultants are retained advisors to Pure Encapsulations.   

 

 

REFERENCES 

 

  1. Shobeiri F et al. Obstet Gynecol Sci. Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. 2017; 60(1): 100–105. 

     

  2. Filho EA. Reprod Health. Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study 2011; 8: 2. 

     

  3. Mahboubi M. J Menopausal Med. Evening Primrose (Oenothera biennis) Oil in Management of Female Ailments. 2019; 25(2): 74–82. 

     

  4. Bahrami A. Gynecol Endocrinol. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents 2018 Aug;34(8):659-663. 

     

  5. Maroufi, M., Marofi, M. Ann Gen Psychiatry 5 (Suppl 1), The efficacy of vitamin B6 for treatment of premenstrual dysphoric.  S306 (2006). 

     

  6. Timmcke JQ et al. Efficacy and Short-Term Safety of L-Theanine in Randomized, Double-Blind, Parallel-Group Study. The FASEB Journal Nutrition; 2008; Supplement .760