Premenstrual Disorder (PMS)

The menstrual cycle is divided into 3 phases: estrogen phase, progesterone phase, and menstrual phase.

Estrogen phase

This phase begins during the week following your menstrual period when levels of estrogen begin to rise. It lasts 7–12 days and usually ends in ovulation. During this phase, you generally feel and look your best (no bloating, food cravings, or imbalanced moods).

During the estrogen phase, your body prepares itself for ovulation and fertilization. Estrogen is also responsible, during this phase, for creating clearer skin complexion and glossier hair. Your body metabolism is increased during this time so you might feel more energized and self-confident.

Progesterone phase

This phase begins during ovulation (days 14–16 of your menstrual cycle) and lasts about 2 weeks. During this phase, your body prepares for a possible pregnancy; your metabolism slows down, and your body becomes calm. Once the body realizes that there is no pregnancy, progesterone levels drop. This is the time when the majority of premenstrual symptoms develop. Approximately 3–5 days before your “period” (the actual time of bleeding when you are shedding the accumulated uterus lining ), your body goes into progesterone withdrawal, causing myriad symptoms of premenstrual syndrome.

Menstrual phase

This phase begins the day you start bleeding and lasts 3–6 days while your uterus sheds its lining. During this phase, your levels of progesterone and estrogen hormones are relatively low and a hormone-like substance called prostaglandin is released at this time. As a result, your uterus experiences mild contractions to force the release of the lining it prepared in case you became pregnant. Your emotions become more stable during this time, while your body might experience discomforts such as cramping, headaches, and body aches.

Premenstrual Syndrome – (PMS) is a condition involving a variety of symptoms (emotional, physical, and behavioral) that are directly related to a woman’s menstrual cycle and develop 7–10 days prior to your period. It is considered the luteal or progesterone phase of the menstrual cycle during which time there is a shift of hormones from estrogen to progesterone and might be linked to insufficient production of progesterone. Some of the PMS symptoms might result from an interaction between progesterone and brain neurotransmitters called serotonin (which is responsible for our mood stability).  Research shows that serotonin levels are much lower during the luteal phase in women with PMS. Other symptoms of PMS, such as fluid retention and bloating, may be caused by the impact of progesterone and estrogen on kidney function, affecting the balance of salt and fluid retention in the body.

• Symptoms of PMS include a wide variety and might be different for each woman. Below is the list of the most common ones. You don’t have to experience all of these symptoms to be diagnosed with PMS. Having only 3–4 symptoms might be a sufficient indication of your hormonal imbalance.
• Abdominal bloating
• Abdominal discomfort and cramping
• Acne breakouts
• Anger and rage
• Brain fog
• Alcohol intolerance
• Irritability and anxiety
• Back pain
• Breast tenderness and swelling
• Easy bruising
• Depression
• Edema and swelling
• Fatigue and malaise
• Fainting (vasovagal syncope)
• Salt or sweet cravings
• Headache, migraine
• Heart palpitations
• Insomnia or excess sleepiness
• Joint swelling and pain
• Nausea and vomiting
• Low libido

If you experience severe menstrual pain and heavy bleeding with clots, it warrants an evaluation by your gynecologist as these might be symptoms of more serious conditions such as:

• Endometriosis
• Uterine fibroids
• Pelvic inflammatory disease

In addition, if behavioral and emotional symptoms are intense and interfere with daily activities, they might represent a more serious condition called Premenstrual Dysphoric Disorder (PMDD).

It is recommended that you see your health care provider immediately,  if you have symptoms of hopelessness, despair, lack of energy to perform your daily activities, and feel overwhelmed or out of control. PMDD is a more serious condition than PMS and warrants a careful diagnosis, medical treatment, and monitoring of symptoms.

In our practice, we utilize an individualized integrative, functional medicine approach and offer extensive hormonal testing to people suffering PMS symptoms. We might ask you to keep a symptom journal where you will record your symptoms on a daily basis. It will help us to determine your premenstrual symptoms triggers and different problems associated with them. It might also help you to see the pattern of your symptoms and you could predict when the symptoms will start again.

Our goal is to help you to alleviate your suffering and we will provide you with an integrative therapy program to balance your hormones including:

• • Vitamins
  • Herbal supplements
  • Bioidentical Hormone Replacement Therapy (BHRT)
  • Diet modification
  • Lifestyle modification

Mild symptoms of Premenstrual Syndrome (PMS) may be successfully treated by simple changes in your lifestyle and some home remedies. Below is a brief explanation of a few:

• To relieve pain and cramping during your period, you may take over-the-counter medications such as ibuprofen as directed on the package insert. Ibuprofen is a nonsteroidal anti-inflammatory medication, which works by blocking the production of prostaglandins—a major contributor to pain and cramping during your period. Prostaglandins cause the inflammatory response in the body and might also contribute to symptoms of bloating, nausea, muscle aches, and generalized discomfort. It is important to take ibuprofen at the first sign of your symptoms or a day before the bleeding starts in order to decrease the production of prostaglandins and prevent symptoms from getting worse.
• Nutritional supplements such as vitamin B_6, calcium, vitamin D, and magnesium have been shown to decrease symptoms of Premenstrual Syndrome (PMS).
• Your daily nutrition should include a variety of foods that offer balanced amounts of carbohydrates, proteins, healthy fats, vitamins, minerals, and water. A healthful diet includes an appropriate amount of “healthy fat” (omega-3 fatty acids, for example) essential in maintaining an important balance to counter PMS symptoms. Hormones are produced by the body from sterols. Sterols are fatty substances we get only from a food source. If your diet lacks a proper amount of healthy fat, you might have difficulty producing sufficient amounts of hormones.
• You might find that reducing your intake of alcohol, caffeine, salt, artificial sweeteners, and refined sugar reduces or eliminates your Premenstrual Syndrome (PMS) symptoms.
• Sodium in salt affects your body by retaining water; therefore, you might feel more bloated and swollen if you consume higher amounts of sodium-containing products.
• Alcohol and coffee are stimulants. These substances put a great burden on your adrenals, which eventually causes an imbalance in cortisol production, leading to progesterone imbalance. Stimulants such as coffee also contribute to fluid retention and irritability. Try to gradually decrease your coffee intake by substituting it with more healthful caffeinated beverages, such as green tea.
• Some alternative treatments, such as acupuncture, aromatherapy, healing oils, and reflexology, were also found to be helpful in relieving certain Premenstrual Syndrome (PMS) symptoms.