PMS FAQs, by Dr Anne Henderson

Dr Anne Henderson

Pre-menstrual syndrome (PMS) and menopause specialist

09 October 2020

1. What are the symptoms of PMS?

PMS is often the result of hormonal sensitivity; it follows then that PMS sufferers tend to be more sensitive to fluctuating levels of hormones than other women. Oestrogen and especially progesterone fluctuations in those who are more sensitive to PMS can cause a multitude of symptoms including:

• Erratic/heavy menstrual bleeding
Irritability and anxiety
Depression/labile mood
• Brain fog
Sleep problems
• Fatigue
• Low libido
• Food cravings
Spotty skin/greasy hair
Breast tenderness
Stomach Cramps

2. Why do I get stomach cramps?

The correct terminology for period pain is dysmenorrhoea. Cramps are a very individual symptom – some women never experience them whilst others struggle throughout the whole period. Most women sit somewhere in the middle and may have cramps/pain on the first few days of their period when bleeding tends to be heaviest.

Period cramps occur due to pain receptors in the muscle wall of the uterus (womb) which is a highly sensitive organ in the pelvis. As the uterine cavity fills up with blood, often accompanied by clots, the muscle wall has to contract to expel the contents.

It is a combination of the stretch and tension placed on the muscle followed by the muscle contraction to empty the uterine cavity which is responsible for the sensation of “cramps” which usually register as “period pain”.

What can I do to relieve cramps?

Like many of the women I speak to, if you’re unlucky enough to be troubled by monthly cramps, there are some steps you can take from home to help relieve some of the discomfort:

  • Stock up on magnesium – magnesium when taken in sufficient amounts can act as gentle muscle relaxant in the body. Unfortunately, due to diminishing levels in our food, plus magnesium-draining habits such as excess caffeine or stress, many of us ladies are deficient. Try upping your dose to 200-400mg to help ease off any cramps.
  • Try Agnus castus - assuming you aren’t currently on any hormonal contraceptives, Agnus castus may help to relieve painful cramps, and is an especially useful herb if you also experience heavy periods. Read more about this herbal remedy below:

Using Agnus castus:

For women experiencing premenstrual symptoms, take 15 to 20 drops in a little water twice daily.

Please note, the effects of this product may not be felt immediately. For best results you should take this product for up to 3 months.

"Very effective, definitely makes a difference."

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3. Why do I feel nauseous before my period?

Most PMS symptoms are due to the substantial rise the hormone progesterone which peaks just before the period begins and then gradually declines for the remainder of the bleed.

Some symptoms are due to the excessively low levels of oestrogen, the other main female hormone, which follows an opposite pattern and plummets substantially before a period begins.

One of the side effects of progesterone is relaxation of smooth muscle: this type of muscle is found throughout the gut, including the food pipe (oesophagus) and so on. Some of the nausea is due to relaxation of this smooth muscle.
It is thought that progesterone may also have a direct effect on the centre in the brain responsible for sickness as well.

Is there anything I can do to relieve the nausea?

If your monthly period comes hand-in-hand with unpleasant nausea symptoms, you may want to try some of my tips, as follows:

  • Introduce some ginger – ginger has been well known to help quell nausea, and has been used in this way, traditionally, for thousands of years. Ginger can be taken in many forms including raw (grated into some hot water and lemon), in ready-made tea bags or in powder form.
  • Silicol® Gel – Silicol® Gel can help to create a protective, soothing barrier throughout the length of the digestive tract, which may help to calm the symptoms of nausea.

4. Why do my muscles ache during my period?

Muscle aches during menstruation is another individual symptom which only affects certain women. The effect is likely to be due to escalating progesterone levels, as outlined above. This can impact on the build-up of certain toxins such as lactic acid within the muscle due to altered blood flow resulting in muscle aches and pains during menstruation.

How can I relieve muscle aches and pains?

If monthly aches and pains trouble you, then some of my advice below, may help to relieve some of the discomfort:

  • Keep hydrated – dehydration can further contribute to muscle aches and pains, so this is a state to avoid getting yourself into. Ensure you are drinking up to 2l of water daily to help protect against this.
  • Up magnesium – if you experience regular muscle aches and pains, it could be a sign that you are running low in the essential mineral magnesium. Try taking at least 200-400mg daily, to see if you notice some improvement in your symptoms.
  • Atrogel® – Atrogel® Arnica gel can be used as a solution for muscle aches and pains. Simply apply Atrogel to the affected area, up to 4 times daily, for effective pain relief.

5. Why do I feel exhausted during my period?

Some women actually feel quite energised just before and during a period. Many women, however, do suffer from tiredness, sleep disruption and exhaustion. The low oestrogen levels drive the sleep disruption, particularly the deep non-REM sleep that is needed to enable you to wake feeling refreshed. This phenomenon is very similar to the sleep disturbance which women experience around the time of the menopause.

One of the side effects of high progesterone levels is also a sensation of calm, lethargy and feeling quite sleepy – the hormone is known as "the hormone of sleep". This also contributes to the fact that many women feel less sharp and on form during their period.

How can I protect my energy levels during this time?

If you are affected by energy slumps each month, some of the following tips could help to prevent you feeling so exhausted:

  • Keep your water intake up - unbeknown to many, something as simple as upping your water intake could really help to improve your energy levels, since dehydration can be a major contributing factor of tiredness or fatigue. Aim to drink 1.5-2l of water daily.
  • Don't let your sleep suffer - the obvious area to focus on if you're feeling tired is your sleeping patterns. Establish a good sleep routine which doesn't vary too much come the weekend. Try downloading a Sleep Cycle App to help you.
  • Prioritise essential nutrients – low energy levels could signal a deficiency in certain vitamins and minerals. Try Balance Mineral Drink which contains essential nutrients including vitamin D and magnesium, for a week or two to see how you feel. Please note, if your symptoms of tiredness or fatigue don't start to improve, you should consider visiting your doctor so they can investigate this further.

6. Is it still normal to experience PMS while taking the contraceptive pill?

Many women do experience PMS symptoms, classically during the seven-day gap when they stop taking the pill. During this time oestrogen levels can plummet substantially, often reaching the menopausal range which can account for many of the classical symptoms.

For those women who take the pill in a back-to-back manner, which is increasingly common nowadays as women prefer to avoid a regular monthly withdrawal bleed, the incidence of PMS is substantially reduced. Taking the pill in this manner can actually be a successful treatment for significant PMS.

7. Can PMS cause bloating?

Bloating is largely mediated by the sharp rise in progesterone levels, which cause excess relaxation of the smooth muscle throughout the gut.

What can be done to help with bloating?

If bloating is leaving you feeling uncomfortable, some techniques to try and limit this symptom of PMS are as follows:

  • Choose water – it's a common theme here, but water really is the key to keeping you feeling at your best and contrary to popular belief, it will help relieve bloating rather than add to it. Also, be sure to choose water over any caffeinated or fizzy drinks which could risk making the problem worse.
  • Add fibre to your diet – there's nothing that will add to the problem of bloating more than a bunged-up bowel. Choose fibre-rich vegetables and wholegrains to help keep your digestive system moving and protect against constipation.
  • Keep moving – much like the positive effects of fibre, physically moving more can help to gently massage your large intestine into action and keep your toiler habits more regular. A gentle walk each day can make the world of difference, so you don't necessarily need to employ any extreme measures.

8. Why is my period different this month?

Periods are generally driven by ovulation which usually occurs on a regular basis between 24-32 days. A cycle can be shorter or longer and some women will therefore have either more or less frequent periods.

Ovulation is driven by a part of the brain called the hypothalamic-pituitary axis. This area is affected by numerous factors including illness, physical and mental stress, medications and so on.

Some women are simply less likely from genetic or hereditary view point to have a regular cycle, and may follow the pattern which their mothers and other female members of the family experienced.

Dramatic weight loss or gain can also impact the menstrual cycle.

9. Why do I feel faint during my period?

This is due to multiple factors including variations in blood sugar levels (affected by both oestrogen and progesterone which impact on insulin metabolism).

Blood pressure can also drop slightly around the time of periods due to the effect of progesterone on blood vessels, making them dilate which contributes to lower blood pressure.

What should I do if I feel faint each month?

Whilst feeling faint should always be taken seriously, if it occurs at the same time each month, we can often assume that your symptoms are as a result of fluctuating hormones. Some steps that may help to lessen the severity of this symptom are as follows:

  • Drink enough – I'm mentioning water again, but it really is crucial! A lack of water intake can easily affect your blood pressure at the best of times, never mind when we have fluctuating hormones to contend with too.
  • Watch your diet – if wobbly blood sugar is likely to be adding to your symptoms, then tweaking your diet may be the way to go. Limiting sugar and including healthy fats, enough protein and blood-sugar protecting herbs such as cinnamon, are some useful dietary tips.
  • Consider your iron levels – feeling faint could be a sign that you're at risk of anaemia. Ask your doctor to check your iron levels, and in particular your ferritin levels, to help give a better idea of your iron status. If your levels are low, a gentle, yet iron-rich supplement such as Floradix may be a good option for you.

10. Why are my periods so heavy?

Blood flow during periods is a very individual and subjective issue. There are strong inherited menstrual patterns within families and women tend to follow in the footsteps of their mothers, grandmothers and so on. In some cases, it may be helpful to ask female members of your family if they are, or have been, affected in the same way.

Periods tend to get heavier with age, deteriorate after childbirth and particularly during the peri-menopause and menopause. Whenever the uterus becomes larger, for example after childbirth or where fibroids are present, there is an increased surface area from which bleeding will occur and consequently bleeding becomes heavier.

The vast majority of women who have heavy periods have dysfunctional bleeding, which means that the bleeding is not associated with any underlying organic pathology such as fibroids, endometriosis or infection. However, if you are worried or experience regular, heavy periods, you should always consult your GP for further advice.

11. Why do I get headaches during my period?

Headaches are due to the complex relationship between oestrogen and progesterone on blood vessels, including those found in the brain, as part of the Central Nervous System (CNS). Progesterone tends to cause dilatation of blood vessels which can be exacerbated by low oestrogen levels which occur during a period, although not all women experience this phenomenon to a significant degree.

The fluctuating hormone levels can lead to alternating dilatation and constriction of blood vessels as well which can worsen headaches.

Many women have a susceptibility to a condition called menstrual migraine, which represents clusters of moderate to severe migraine headaches which occur in the week leading up to a period and during the bleed itself. This group of women have receptors in the brain which are acutely sensitive to hormone fluctuations and they will also experience worsening migraines in the run up to the menopause and sometimes post-natally as well.

How can I manage monthly headaches?

Monthly headaches can be debilitating, so hopefully some of my tips below could help to protect against this rather nasty symptom. However, as always, if things don't improve, it's time to let a doctor investigate this further:

  • Choose water – being dehydrated will only risk making headaches worse, but the key is also to choose water over any other drink option which could also exacerbate your symptoms. Caffeine or sweetener-laden soft drinks should be limited as much as possible.
  • Try magnesium – as magnesium is a well-known muscle relaxant, upping your daily levels you could help to relieve tension in and around the head and neck and therefore help to improve the incidence of headaches. Try taking 200-400mg daily.

12. Will avoiding certain foods and drinks help relieve PMS?

There is a lot of debate in the medical and complementary health community surrounding diet and PMS. In my view, much of the evidence regarding food intake is based on "soft" data rather than robust, placebo-controlled double-blind studies, which are the gold standard for research. This does not, however, mean that the data are not relevant and worth considering.

Restricting certain types of food and drink may produce benefit for individual women, but there is not one particular food type which fits this model, and there is often some trial and error before women find out what suits them best.
In general, women will benefit from following a low glycaemic load (GL) diet in the run up and during their period, as this helps offset any increased insulin resistance which hormone fluctuations can cause. In turn this will help minimise blood sugar fluctuations in the bloodstream which are thought to contribute to many of the common PMS symptoms.

There is lots of helpful information on the internet regarding Low GL food types which I would encourage women to look into themselves; this can help enable a better understanding of what this type of diet looks like and allow for better, more sustainable dietary changes over time. However, I can offer some guidance below, on what foods to try including more of, and those to limit instead.

Although women often experience cravings for sugary foods around their period, these are really best avoided as they will merely exacerbate the problem of insulin resistance, and lead to severely fluctuating blood sugar levels (and all the symptoms that go with this), plus the risk of weight gain.
Foods you should include more of in your diet, during your period, include:

  1. Leafy greens – increase your consumption of leafy greens such as kale or spinach, which are rich in nutrients including iron, calcium and potassium, all of which are thought to help limit troublesome monthly symptoms, ranging from low energy to water retention
    Nutritionist recipe suggestion:Apple & Spinach Smoothie

  2. Oily fish - including salmon, tuna, sardines, trout, anchovies, or herring is helpful as they are particularly rich in omega-3. Unlike excess omega-6, omega-3 is thought to be anti-inflammatory in nature; and research suggests that increasing our intake may help to improve many of the symptoms of PMS – both physical and psychological.1
    Nutritionist recipe suggestion: Grilled Honey Lemon Sardines with Herbed Rice

  3. Wholegrains – these are not only nutritious but also a rich source of fibre. There are thought to be close connections between digestive health and uncomfortable monthly symptoms, so it helps to keep things moving! Some examples of wholegrains worth consuming include brown rice, oats, couscous, lentils, quinoa and barley.
    Nutritionist recipe suggestion: Dried Apricot & Walnut Couscous

  4. Whole fruits – whole fruits such as bananas are a good source of fibre, which helps support your digestion; but fibre also helps to stabilise your blood sugar levels, which can have positive effects on your mood and energy levels. What's more, bananas have the benefit of being especially rich in potassium. Potassium has an important role to play in muscle health and contractions, as well as fluid balance in the body. So, there may just be lots of reasons to stock up - from cramps to bloating.
    Nutritionist recipe suggestion: Healthy Banana Oat Cookies

The lessons learned in managing hormonal symptoms during your menstruating years will pay dividends when you reach menopausal age. Having resolved issues such as blood sugar wobbles, you will be in far better shape to tackle fluctuating hormones at this later stage of life.

13. Can herbal remedies help with PMS?

There is a wealth of evidence, including double-blind, placebo-controlled studies, that certain groups of herbs and natural remedies can help manage the symptoms of PMS. Some top examples include:

1. Agnus castus

One of the most studied herbs within the area of female health is Agnus castus. This herb has performed better than both the placebo and the contraceptive pill in several studies, in helping to manage some of the common symptoms of PMS including bloating, cramping and irritability.

2. Dormeasan

Dormeasan which combines extracts of valerian and hops, can help to limit sleep disturbances, and the associated problems that come with this. Dormeasan has also been shown to improve the quality and amount of deep sleep, another common PMS problem.

3. Balance Mineral Drink

Balance Mineral Drink contains magnesium, calcium, potassium, natural vitamin D3 and zinc, which together, can help to support energy levels and wellness. Magnesium can help to reduce symptoms of tiredness and fatigue, whilst potassium contributes to the normal functioning of the nervous system, normal muscle function, and the maintenance of normal blood pressure. Zinc is thought to help support normal cognitive functions, and vitamin D3 in combination with calcium, contributes to the maintenance of normal bones.

Agnus castus


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A traditional herbal remedy used to relieve the symptoms of PMS
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Here's what I recommend

As the A.Vogel Women's Health advisor, I recommend Agnus castus to help relieve symptoms such as menstrual cramps, breast tenderness and irritability.

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