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PMS: What is normal and how to relieve symptoms?

PMS: What is normal and how to relieve symptoms?

Jackie Vinyard, M.S. Health Sciences | August 1, 2018 | Uncategorized
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Have you heard that craving chocolate during your period may be a cultural experience rather than a biological reaction (source)? Say what? Yes, this may actually be true. For those of us who munch down a box of cookies and tell ourselves it’s because our bodies are craving it, well, it may just be what we grew up being told instead of reality. Reality is that when we get our periods we should in fact be eating veggies, rather than sweets, to reduce PMS symptoms.


In addition to chocolate being cultural…….are you ready for this…… emotional PMS symptoms are questioned as well. How can this even be questioned you may wonder? Periods often take the blame when women show more aggressive and emotional behaviors. How many times you been asked by a partner or family member if you are on your period when you were simply trying to express being upset about something?  Dr. Sarah Romans, lead author of a study showing that PMS failed to show the existence of negative mood syndrome in the general population, believes PMS perpetuates the ideal that women should be giving and kind all the time (source). She states, “the whole PMS notion serves to keep women non-irritable, sweet, and compliant the rest of the time. There is a range of paradoxes -- world-turned-upside-down events -- like festivals, Mardi Gras, where people are socially prescribed to behave out of role...I think PMS is a bit like that. 'We'll let you be cranky and bad-tempered now, but just for one or two days. The rest of the time you've got to be like a true woman.'"


While Dr. Romans’s study found PMS negative mood symptoms may not exist, or are at least exaggerated, other research shows that about 75%-90% of women experience both physical and emotional symptoms before their period (source). The medical community, including the prestigious American College of Obstetricians and Gynecologists (ACOG) recognizes PMS mood symptoms, which include crying spells, depression, and feeling angry (see chart below).. These are considered normal symptoms of PMS. That is unless they are interfering with your life.


In about 3-6% of women, severe symptoms of PMS (called premenstrual dysmorphic disorder) significantly interrupts their life each month (source). PMDD goes beyond being irritated or sad. PMDD is marked when a woman has debilitating anxiety, depression or irritability the week before their period. Two to three days after their period starts, the symptoms go away (source). For a diagnosis of PMDD, your doctor would look for 5 symptoms that appear up to a week before a woman’s period and then disappear a couple of days after it starts (source).


Researchers do not know for sure what causes PMDD or PMS. Hormonal changes throughout the menstrual cycle may play a role. A brain chemical called serotonin may also play a role in PMDD. Serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes. Many women with PMDD may also have anxiety or depression. For more details on the symptoms and information on PMDD Symptoms click here


In addition to the negative mood symptoms of PMS being challenged, PMDD is also questioned. Some research indicates PMDD may be due to something other than the menstrual cycle. Regardless, PMDD is found to be a serious, chronic condition that needs treatment. For some women, the severity of symptoms increases over time and lasts until menopause. For this reason, a woman may need treatment for an extended time. Medicine dosage may change throughout the course of treatment. To read more about the debate of PMDD, click here


No matter how intense your symptoms may or may not be, charting your cycle symptoms can be incredibly insightful to see if you notice any patterns. If you are feeling stressed, depressed or have stomach issues, they it may be due to factors other than your cycle. If you see a pattern emerge after several cycles, you and your doctor may be able to identify if the symptoms appear to be related to your period or not. You may also be able to see if lifestyle habits make a positive impact on your symptoms.


PMS may not interfere with your everyday life, but feeling down and getting irritated for a few days to a week each month isn’t exactly fun. Making healthy changes, such as working on convincing yourself that you crave salad instead of chocolate, may help relieve both PMS and PMDD symptoms. WomensHealth.gov says eating a healthy combination of foods across the food groups, cutting back on salty and sugary foods, and getting more physical activity, may also help relieve some PMDD symptoms.

Some recommendations to relieve PMS and PMDD symptoms include:


  • Add or continue regular exercise
  • Cut back on caffeine and alcohol
  • Quit smoking
  • Get enough sleep
  • Use relaxation techniques (warm bath, mediation, yoga)
  • Changes in diet to increase     protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol
  • Regular exercise
  • Stress management
  • Vitamin supplements (such as vitamin B6, calcium, and magnesium)


Medication typically used for PMDD (in addition to recommended lifestyle changes)


  • Anti-inflammatory medicines
  • Selective serotonin reuptake inhibitors (SSRI)
  • Birth control pills


Dr. Romans, regardless if her research is reflective of what most women experience or not, has a valid point: periods should not be used as an excuse to put women down and women should be aware of what has been taught culturally versus what is best for their bodies.  If you have been charting your cycles and changing your lifestyle habits for healthier ones, have you noticed any changes? Oh and about chocolate, no need to entirely deprive yourself, moderation not deprivation :) 


Additional References: 

1. Harvard Review of Psychiatry (2009),  "Update on Research and Treatment of Premenstrual Dysphoric Disorder." 

2. Gynecological Endocrinology (2007), "Clinical Diagnostic Criteria for Premenstrual Syndrome and Guidelines for Their Quantification for Research Studies."

3. Harvard Health. Women's Health Treating PMDD 

4. Mayo Clinic

3. Medlineplus




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