Q: Hi Tracy, why are some women’s PMS experiences so much worse than others? I’ve read that diet is a big deal, but that can’t be all that matters. I am sure there are a lot of reasons but what are the biggest drivers? I get this question a lot and obviously it’s a big concern for women clients for all of us.
A: It’s all a matter of how quickly things go downhill – literally! Generally speaking PMS (pre-menstrual syndrome) refers to a group of symptoms (mild, moderate, or crazy) which women can experience in the week or so leading up to the beginning of her menstrual cycle (when she starts menstrual bleeding). Technically, this is the time from a woman’s mid-luteal menstrual peak and the end of the monthly menstural cycle. During this time, her progesterone and estrogen levels are both falling. Please reference the diagram below; this fall-off begins around day 21 (the mid-point of the luteal phase and the typical start of the “PMS” window). The question is (1) how quickly estrogen and progesterone are falling and (2) if progesterone is falling more rapidly than estrogen. Generally speaking levels of progesterone in the body protect us from feeling symptoms of “estrogen dominance”. These symptoms include the puffiness, bloating, mood swings, breast tenderness, weepiness, and weight gain we associated with PMS.
There are three typical imbalances involved here. (1) PMS may be severe because a woman has relatively high estrogen levels all the time, so as progesterone falls, estrogen continues to dominate (this often has environmental roots). (2) Or PMS may be severe because a woman’s baseline estrogen levels are normal but her progesterone levels are on the lower side; thus, as progesterone falls, it drops lower than what is needed to “buffer” her body from estrogen. (3) PMS may also be severe because a woman’s body is poor at detoxifying and ridding itself of estrogen in the liver (often due to poor methylation in the liver or issues in the GI tract such as estrogen binding and/or reabsorption due to constipation). The common element is this: temporary (or ongoing) estrogen dominance yields what we call “PMS” symptoms.
High and/or ongoing stress will also exacerbate PMS. When we are stressed, our adrenal glands secrete large amounts of a stress hormone called cortisol (to protect the body from the affects of short-term stress). Cortisol, however, competes with progesterone for receptor sites in our cells. So even with normal progesterone production, high levels of cortisol can prevent a women from benefiting or “feeling” the benefits of having healthy progesterone levels (and estrogen dominance will occur anyway).
Realize that lifestyle choices can also make PMS worse. In particular, a diet that includes
Realize too that our “fat cells” (adipocytes) generate their own estrogen. Thus women with excessive amounts of body fat often struggle with estrogen dominance and worse PMS (keep in mind that even individuals with normal weight may still have an excessive percentage of body fat) . This is one reason why overweight, postmenopausal women are several times more likely to develop breast cancer than postmenopausal women of normal weight.
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