Diet for PMS/PMT/PMDD
by Sue Kira, Naturopath & Clinical Nutritionist
Pre-menstrual syndrome, also known as PMS, refers to a range of symptoms, both physical and emotional that many women have in the lead up to a menstrual period. It is also known as premenstrual tension (PMT) and Pre-menstrual Dysphoric Disorder (PMDD) – a more severe form of PMS.
Symptoms usually go away once the period begins and there is usually at least one symptom-free week per month. The latest research suggests that it is due to changes in brain chemicals (neurotransmitters) in the time after ovulation and before menstruation.
But hormones, stress, nutritional deficiencies, and genetics may also play a role. Although the cause isn’t conclusively known, PMS can be managed well with the use of diet and lifestyle modifications
Symptoms of PMS
PMS can differ from one lady to the next, but may include any of the following:
- abdominal bloating
- depression and lowered mood, which may include suicidal thoughts
- difficulties in concentration, memory lapses
- digestive upsets, including constipation and diarrhoea
- drop in self-esteem and confidence
- drop in sexual desire, or (occasionally) an increase
- feelings of loneliness and paranoia
- fluid retention
- food cravings
- headache and migraine
- hot flushes or sweats
- increased appetite
- increased sensitivity to sounds, light and touch
- irritability, including angry outbursts
- mood swings, weepiness
- sleep changes, including insomnia or excessive sleepiness
- swollen and tender breasts.
When emotions spiral out of control due to PMS, the consequences can be severe. Loss of emotional control can affect parenting, relationships, job performance and more.
Just because many women suffer from PMS, it doesn’t make it ‘normal’ or mean you should suffer the ill effects for a large part of your life. It’s your body telling you that something is wrong, that you have unbalanced hormones and/or low levels of certain neurotransmitters and specific nutrients.
This means you will need to make some changes in your life. If you are not prepared to do this, then the pill offers a simple effective treatment for many women, but it comes with potential side effects and risks. However, if you would like to balance your body naturally, please read on…
Healthy hormones and neurotransmitters begin with a healthy gut and the only way to promote a healthy gut is with a nutrient dense diet and the right balance of bacteria. A diet that is 80% fresh plant matter (preferably organic) from vegetables and some fruit is a great place to start.
Researchers have found that some women have lower blood levels of calcium from ovulation to period time (PMS time) so adding calcium rich foods can make a big difference when dealing with PMS symptoms. The body can’t effectively absorb calcium without vitamin D, so it is important to get enough of both of these nutrients.
Many fish, including mackerel, salmon, herring, and sardines are great sources of vitamin D. Apart from helping calcium absorption, the vitamin D in these fish may act via additional pathways to reduce PMS symptoms. Studies suggest a diet rich in vitamin D foods may reduce the risk of PMS by about 40 percent, which is quite awesome. Also, the Omega essential fats in these fish give the body a boost of anti-inflammatory nutrients (think pain relief).
Whole grain staples such as rice, quinoa and beans contain three of the nutrients — magnesium, vitamin B6 and manganese – which can improve PMS symptoms. Magnesium helps to fight water retention and bloating. Vitamin B6 helps the body to make dopamine and serotonin – the neurotransmitters that can help reduce irritability and depression. B6 is also good for breast tenderness, while manganese may help with issues like irritability and depression.
Zinc rich foods help to support hormone balance. Zinc can be found in certain seeds like pepitas, seafood and meat.
Sometimes pain, cramping, menstrual migraines and other PMS symptoms can arise due to an increase in estrogen (or low progesterone in relation to estrogen levels). More estrogen can increase histamine levels which creates a problem if consuming high histamine foods and beverages such as alcohol, coffee, tea, nuts, and certain fruits such as citrus, strawberries, papaya, pineapple and tomatoes.
Foods/drinks that would normally not be an issue can trigger all sorts of responses when estrogen is higher, so if you find that the recommended foods in this article do not appear to help, or make things worse, I suggest considering the Low Histamine Diet for additional support, perhaps even for this time frame of the month.
Incidentally, histamine can also be reduced on a Low FODMAPs Diet. Studies have shown that a low FODMAPs diet can help to reduce the pain associated with hormonal imbalances including endometriosis pain.
A sign of sensitivity to high FODMAP (fermentable) foods is wind or gut pain from eating foods like onions, garlic, and legumes. More on this can be found in the Low FODMAPs Diet.
Lifestyle changes that can help PMS
- Exercise regularly, at least three times a week – try to exercise daily as this helps with hormones, and serotonin increases with exercise
- Don’t smoke as this affects your liver’s ability to convert hormones
- Avoid caffeine and alcohol as these disrupt hormones
- Make sure you get enough sleep to help balance neurotransmitters and hormones
- Manage your stress in whatever way works for you – counselling, meditation, walking, gardening, playing with a pet etc
Herbs known to relieve PMS symptoms
- Black cohosh (Actaea racemosa)
- Chaste tree or chasteberry (Vitex agnus castus)
- Dandelion (Taraxacum officinale)
- Dong quai (Angelica sinensis), also known as Chinese Angelica
- Evening primrose oil (Oenothera biennis)
- Ginkgo (Ginkgo biloba)
- Lemon balm (Melissa officinalis)
- Maca (Lepidium meyenii)
- John’s wort (Hypericum perforatum)
- Wild yam (Dioscorea villosa)
- Raspberry leaf (Rubus idaeus)
If needed, these can be prescribed by your health care provider.
The best way to describe a diet for PMS is one that is rich in plant foods with much needed calcium, magnesium, B vitamins, vitamin D (also get some from the sun) as well as gut balancing and healing foods to support neurotransmitter balance and healthy hormone levels.
Vegetables, fruits, salads, nuts, and seeds comprise about 80% of the diet combined with proteins and healthy fats from good quality omega fat rich fish, grass-fed poultry, and a small amount of grass-fed red meat.
Before you commence your diet, see your medical or health care professional for qualified guidance about what foods and supplements are best for your body. While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional.
During the early stages of a new diet, you may experience symptoms such as fatigue, headaches, or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.
Client name and identifying information changed
Veronica was very distraught when she came to see me in the middle of a PMS nightmare. Her boyfriend told her that if she didn’t get her PMS under control soon that he would leave as he couldn’t cope with her mood shifts and unpredictability. She was very upset as you can imagine, but she also knew that something had to be done.
Every month, one to two weeks before her period, she turned into ‘the witch from hell’ (her words – or maybe his). Her symptoms included being super sensitive, teary, angry, up and down with her moods, including bouts of depression and anxiety. She also had excruciating cramping pains at ovulation time and for the first two days of her period.
The only time she felt normal was a few days each month at the beginning of each new cycle and her boyfriend’s patience was growing thin (as it was for her boss, but she didn’t care much about that).
Discussions revealed that Veronica had a terrible diet. Breakfast was usually a piece of toast, banana bread or a muffin, along with coffee (of course) from the drive-through café and eaten on the drive to work. Some days she ate nothing for breakfast as she often preferred to sleep till the absolute last minute before flying out the door for work.
For a quick, cheap lunch she ate oodles of two-minute noodles most days, which suited her busy working day but not her body. She also craved chocolate when pre-menstrual and ate lots throughout the month, but more when affected.
Veronica was racy in most things that she did, but was exhausted at the same time, driving herself on coffee, chocolate, and adrenaline. This alone would be enough to make someone irritable at the best of times let alone when pre-menstrual. The only good meal she had was dinner that her boyfriend cooked for her at night.
We had a serious talk about the importance of good nutrition and how to look after herself, otherwise she was on the way to losing her boyfriend, her job, and her health. Even if her job and boyfriend could be replaced, her health would surely deteriorate if she continued her eating regime. She sobbed with regret, but totally agreed and committed to making the much-needed changes.
Veronica had never been taught how to cook when she lived with her parents, which made things difficult. But her boyfriend was a good cook, so we asked him for some favours and he was very willing to help by sharing his cooking knowledge, and to cook together at night, while also making extra so she could have leftovers for lunch.
If they had some form of protein food for dinner with veggies, then she had some of the protein with salad for lunch. For breakfasts she had a paleo style muesli with coconut milk so she could get extra nutrients in a quick and easy to eat blend. Some days she had a super smoothie to take to work if she was running late. She had to get out of bed a little earlier most days, but it didn’t take too long for her energy level to improve and not need the extra sleep.
Basically, Veronica’s diet was gluten, dairy, and sugar free. Her foods were fibre rich to help support good bacteria in her gut and her meals were simple but tasty. To help repair her gut, we also included a bone broth that they made up together on weekends, which she drank from a thermos during the day instead of coffee and cola drinks.
By her next period her symptoms improved by 50%. She was in a better relationship with her partner as they shared jobs, like shopping and preparing meals together. This was very bonding for them both.