Premenstrual syndrome

Often during my appointments,  I will ask if women feel irritable, angry, or bloated before their period and I get the response “just the normal amount”. The problem with this situation is that there shouldn’t be a normal amount. While it is very common to have premenstrual symptoms, it’s not normal and there are things we can do to help improve that. So many women that I see are living two weeks of the month feeling not their selves. So let’s chat about PMS and what it is, so you can know exactly what is normal and what is not.

Before we talk about PMS, let’s do a quick biology lesson in the phases of a typical menstrual cycle.

Phases of the menstrual cycle

  1. Follicular stage – this stage occurs for the first 14 days of our period. During this stage, follicles in our ovaries develop and grow. This is the time of the month where our estrogen hormone is the highest. During this time, we often have the most energy, are more focused, have clearer skin and are most productive.
  2. Ovulation – This is the release of one egg from the ovary. This usually happens around day 14 and lasts for about 24 hours. This provides the opportunity for sperm to fertilize an egg and start a pregnancy.
  3. Luteal – This stage occurs between ovulation to menstruation. At this time, estrogen starts to decline, progesterone reaches it’s highest and the endometrial lining is thickening. This stage typically lasts 14 days and typically we will have a little less energy.
  4. Menstruation – this occurs when the body identifies that it is not getting pregnant. During this time the uterus sheds its endometrial layer resulting in bleeding. Bleeding typically lasts 4-5 days.


A diagnosis of PMS is difficult because there is no clear cut lab ranges, it is based off of symptoms. Ideally, three months of tracking your menstrual cycle is ideal before baseline is ideal, however, this is not always doable, because often when I see women in my office, they need support and changes quickly. When diagnosing PMS, we want to make sure we have ruled out other causes of symptoms that are similar to PMS, these include hypothyroid, iron deficiency, and prolactinoma.

Symptoms of PMS vary greatly between person to person. In order for it to be diagnosed as PMS though, it needs to occur in the luteal phase of the cycle and be absent in the follicular phase. If you have the symptoms all month long but they get worse in the second half of the cycle this is considered premenstrual exercabation which is not quite PMS. In order to have PMS, you must also be ovulating. If you are using oral birth control, you are not ovulating, so PMS is less likely in this population. Symptoms must also cause significant impairment in ones life to be considered PMS. If you


PMS symptoms can be both physical and or or mental/ emotional. Some of the common symptoms of PMS include:

  • Abdominal Bloating
  • Body Aches
  • Breast Tenderness and/or fullness
  • Cramps / Abdominal Pain
  • Fatigue
  • Headaches
  • Nausea
  • Swelling of Extremities
  • Weight Gain
  • Anger, Irritability
  • Anxiety
  • Changes in Appetite (overeating or food cravings)
  • Changes in Libido
  • Decreased concentration
  • Depressed mood
  • Feeling out of control
  • Mood swings
  • Poor sleep or increased need for sleep
  • Tension
  • Withdrawal from usual activities

Top 3 Dietary Strategies for PMS

There are several naturopathic strategies we can use to help support people with PMS. We typically like to start treatment with the pillars of health which include diet and lifestyle interventions.

Here are a couple recommendations you may receive when talking with a naturopathic doctor about your PMS:

  1. Limit alcohol, particularly in the luteal phase. Women who drink more, report worsen PMS symptoms during the luteal phase, particularly an increase in anxiety and a decrease of sleep quality.
  2. Reduce simple carbohydrates such as white breads, pastas and pastries and increase amounts of complex carbohydrates including vegetables and whole grains.
  3. Caffeine – some people notice a decrease in symptoms, particularly bloating and breast tenderness from reducing caffiene intake during the luteal phase. It is worth trying a 50% reduction in caffiene during the luteal phase and tracking your symptoms.

If you want to know more about PMS, book an appointment with one of our naturopathic doctors. We love helping you understand your hormones !

Dr. Sydney Speer ND

Also Read:

Acupuncture and Fertility: What You Need To Know