Women worldwide, irrespective of their ethnicity, experience an undefined set of difficult complications a few weeks or just before their menstruations or periods at some point in their lifetime. This is known as premenstrual syndrome or PMS, which certainly disrupts good health and greatly impacts quality of life. PMS is an unresolved yet important issue in women’s health and demands immediate serious attention and management.
What is PMS?
According to the American Congress of Obstetricians and Gynecologists (ACOG), PMS is a group of physical or mood changes that occur one to two weeks before menstruation. Symptoms usually stop as the period begins.
How often does PMS happen?
Approximately roughly 85% of women display at least one PMS symptom during their monthly cycles. Many of these women will display mild symptoms that don’t require any treatment. Less than 20% of women with symptoms meet the Doctor for PMS. An even smaller percentage, less than 10%, have a more severe form of the syndrome called premenstrual dysphoric disorder (PMDD).
What are the symptoms of PMS?
- Most women suffer from depression, irritability, fatigue, abdominal cramping, breast tenderness, and headaches.
- The other symptoms include abdominal bloating, fluid retention, constipation or diarrhoea, headaches or migraines, changes in appetite, weight gain, acne, and muscle or joint aches.
- Women also experience anxiety, insomnia or sleep disturbances, change in sex drive or interest, irritability, anger or hostility, mood swings, difficulty concentrating and crying.
- Food cravings revolve around carbohydrate-rich foods, particularly sugar, and also alcohol develop during PMS. This happens because carbohydrates provide tryptophan, the precursor to serotonin. A craving for or an increase in carbohydrate intake is likely a result of the body’s attempt to increase serotonin levels, which helps to improve mood.
- Increased intake of simple refined carbohydrates during cravings causes spikes in insulin levels, leading to more fluid retention.
All these complications ultimately hamper work efficiency, relationships with co-workers and family, and ability to manage home responsibilities and social activities.
What are the causes of PMS?
It is not well defined and clear why PMS happens but scientific data predicts that it may happen due to hormonal dysregulation and fluctuations during menstrual cycles. Estrogen and progesterone, are both involved in regulating two neurotransmitters: serotonin and gamma-aminobutyric acid (GABA). Serotonin helps to regulate mood and behaviour, while GABA tends to promote calmness and ease anxiety.
Research suggests that women who suffer from PMS may have abnormal serotonin neurotransmission, leading to symptoms such as irritability, depressed mood, and food cravings.
Who is at the risk?
- More prevalent in the age group of the late 20s to early 40s
- If a woman’s mother suffers from PMS, she’s also more likely to develop it
- Undergoing mood or anxiety disorders like depression and postpartum depression
- Poor eating habits such as high intake of sugar, alcohol, caffeine, and sodium
- Weak emotional health, distress and stressful lifestyle
- Vitamin and mineral deficiencies
- Obese and overweight individuals
How do eating patterns influence PMS?
As per scientific supportive data, diet contributes to the developing PMS and is sometimes related to symptom severity. Unhealthy eating habits and undisciplined lifestyles such as skipping breakfast, grabbing ready to eat high-fat sugar and salt-containing processed food options and irregular sleep patterns due to overindulgence in digital media before sleep increase the odds of PMS.
Nutrition and food sources to help ease PMS
Nutritional factors are the most modifiable parameters that can be taken into account as a strategy in PMS management.
- Calcium and vitamin D
Adequate intake of both these micronutrients is linked to estrogen, hence reducing the risk of PMS. The deficiency of any of them increases the risk of experiencing PMS symptoms. Rich sources are low-fat milk and dairy products, cod liver oil, ragi and green leafy vegetables.
- B vitamins
This vitamin group is required for performing daily activities and deficiency of even one B vitamin may trigger PMS symptoms. So it is always healthy to include fresh fruits, vegetables, whole grains, low-fat fish, eggs and green leafy vegetables.
- Vitamin B6
A low level of vitamin B6 impairs the liver’s capacity to bind blood estrogen levels, hence increasing the body’s estrogen level. This leads to the development of PMS symptoms. Adequate intake of vitamin B6 is important for proper estrogen activity and neurotransmitter transmission. Rich sources include eggs, carrots, spinach, sweet potato, green peas and banana.
Eating an appropriate amount of iron-rich foods and maintaining haemoglobin levels between 11.6 to 15 mg per deciliter improves PMS symptoms. Good sources of iron are spinach, cauliflower leaves, beetroot, potatoes, broccoli, soybean, pomegranate, apples, strawberries, liver, low-fat chicken and fish, black beans, chickpeas, brown rice and dry fruits.
It is involved in neurotransmitter synthesis hence reduces fluid retention, and improves mood swings, breast tenderness and insomnia. Rich sources are pulses, green leafy vegetables, nuts and cereals.
- Essential fatty acids
Gamma-linolenic acid (GLA), an essential fatty acid plays an important role in hormone regulation. Adding GLA rich evening primrose oil to daily routine improves symptoms like depression, fluid retention, breast tenderness and irritability. GLA usage should be done under an expert’s guidance.
Foods to avoid
It is always better to avoid or restrict the high intake of processed food, deep-fried food, sugary and salty foods, coffee, alcohol, empty-calorie energy drinks and sodas. Also, fad diets, binge eating and erratic food eating times should be changed.
PMS is common and inevitable in women of reproductive age. The only thing that can be done is to take corrective actions to ease the symptoms. It is advisable not to chase a PMS specific diet but to regularly eat a balanced diet and adopt a healthy easy to follow lifestyle. Expert consultation should always be done whenever PMS symptoms become unbearable rather than suffering in silence.
- Obstet Gynecol. 2000;95(4):Suppl 1-9.
- Nutrition’s Role in Premenstrual Syndrome, Today’s dietician a magazine for nutritional professionals, March 2016.
- APPLIED NUTRITIONAL SCIENCE REPORTS, 1999;5:6