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Root Cause of PMS

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

  • a lot of hormones (e.g. dairy foods, conventionally-raised beef),
  • exposure to many xenoestrogens (e.g. BPA in canned foods, triclosan in many antibacterial hygiene products, many pesticides used in conventional food farming or home gardening)
  • high amounts of sugar, refined carbohydrates, and/or caffeine.  Unfortunately the mood swings caused by estrogen dominance often cause our clients to eat even more of these foods, sending their symptoms on a downward spiral.

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.

If you’re passionate about hormones, you may be a perfect fit for our Hormones Demystified clinical course!  It’s self-paced and available to practitioners at any time.

 

 

(Diagram from Wikipedia)

 

P.S.  If you are passionate about transforming healthcare through the power of functional medicine, we encourage you to learn more about our training program here.

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Terrie Pugh
Terrie Pugh

Great info thanks. What is the best test for checking if there is estrogen dominance and the levels of other sex hormones? And if possible, if a client is perimenopausal?
The hospital hormone blood test was ‘normal ‘

Thanks

SAFM Team
Reply to  Terrie Pugh

Please keep in mind that ‘perimenopausal’ is a very broad term that may mean a woman in her thirties, mid-forties or close to fifties – all these women may have a different hormonal balance and all be classified as perimenopausal. What is notable is that typically 5-10 years prior to actual menopause progesterone production starts declining and this often results in relative, low-grade estrogen dominance, which can be a source of PMS for many women. Other factors that contribute to this dynamic at any age are stress and insulin resistance.
To gain insight into the hormone balance and metabolism we typically recommend DUTCH Complete test:
https://dutchtest.com/product/dutch-complete-2/

Anne Markt

Hi there- I have a female client, late 20s. She’s estrogen dominant due to very low progesterone. An FM practitioner gave her bio-identical progesterone cream to use twice a day. She started a week ago, and is doing this in conjunction with other supplements including Estro-DIM 2/day. She has a solid diet and lifestyle already. Her issue is bad PMS, erratic cycles, and severely heavy periods that led to low ferritin. After starting the cream, she became severely moody/mildly depressed 3 days in, so they reduced to 1 dose of progesterone per day. Then on day 17 of her cycle, 7 days in using progesterone, she had very severe cramping which isn’t normal for her. I’ve read somewhere before on the Q&A that initial use of progesterone sometimes worsens symptoms before it gets better, but how bad? Compounding Pharmacist advised her to push through and do the full 2-weeks of progesterone cream, and wants her to add Vitex twice per day on top. He mentioned femenessence maca harmony to boost progesterone as well, but client has tried it and became severely irritable and emotional on it, so stopped. In your experience, is depression/major cramping on progesterone cream normal initially? Does… Read more »