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What is PMS (Premenstrual Syndrome)?

PMS is a group of symptoms linked to the menstrual
cycle. These symptoms begin within the ten days before menses and almost disappear after the first day of menstruation.

What are the symptoms of PMS?

A typical list of symptoms for PMS would include mood disorders such as mood swings, irritability, depression, and short temper.[1] Also, other symptoms include swelling of extremities, breast pain or tenderness, abdominal bloating, lower abdominal cramping, headache, fatigue, sugar cravings, and insomnia. It is reported that up to 85% of women experience some PMS symptoms and over 40% of women who are suffering from PMS took over-the-counter medication regularly.[2]

What are the triggers for PMS?

Hormone Imbalance
Hormone unbalance
Changing levels of reproductive hormones throughout women’s life cycles can have a significant impact on mood through interactions with neuroendocrine and neurotransmitter systems. Recent studies showed that insufficient progesterone levels after ovulation may lead to estrogen dominance and contribute to more pronounced PMS symptoms.

Progesterone levels are relatively low before the ovulation
of the menstrual cycle, and then rise dramatically during the second half of the cycle from ovulation to menses. During the second phase of the menstrual cycle, progesterone acts as an antagonist to estrogen, but if progesterone levels are low and insufficient when cycles are disturbed or imbalanced, estrogen becomes dominant, and this can lead to worsened PMS symptoms. Progesterone declines naturally near the end of the second phase, which prompts the menses to begin.

Chronic Inflammation
Chronic inflammation
There are many contributors to the inflammatory process, and prostaglandins (PGs) play a key role in the generation of the inflammatory response. Prostaglandins are a group of lipid compounds that are derived from fatty acids. They are mediators and carry a variety of physiological effects, such as regulating inflammatory mediation and the contraction and relaxation of smooth muscle tissues. A recent study suggested that prostaglandins promote not only acute inflammation but also chronic inflammation.[3]

One role that PGs play in such processes is amplifying cytokine signaling. Cytokines are proteins that act as mediators between cells and they regulate various inflammatory responses. However, not all prostaglandins are bad, some promote inflammation and some inhibit it. The best way to ensure balanced prostaglandins production along with the various series and pathways is to follow a balanced and healthy diet that provides fuel for good prostaglandins and keeps their pathways free of blocks.

The first step in the production of prostaglandins is from essential fatty acids including omega-3 and omega-6 fatty acids.

Omega-3 fatty acids and omega-6 fatty acids are distinguished by the position of the first double bond. The first double bond of Omega-3 fatty acids is at the third carbon atom from the methyl end of the carbon chain while the first double bond of omega-6 fatty acids is at the sixth carbon atom from the methyl end. Alpha-linolenic acid (ALA) is an omega-3 fatty acid and linoleic acid (LA) is an omega-6 fatty acid, and they are considered essential fatty acids because they cannot be synthesized by the human body. The long-chain omega-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can be synthesized from ALA, but their synthesis may not be sufficient under certain conditions. EPA and DHA provide many health benefits such as cardiovascular disease prevention and anti-inflammatory effects, and they are important for visual and neurological development. Both Omega-6 and omega-3 are important structural components of cell membranes. Adequate amounts of omega-6 fatty acids are also beneficial to human health, especially the ones involved in the immune response. However, because omega-3 and omega-6 compete for the same enzymes in the synthesis of longer-chain polyunsaturated fatty acids (PUFA), the overwhelming intake of omega-6 can interfere with the proper function of omega-3 fatty acids.[4] In addition, too much omega-6 in the diet “uses up” the enzymes needed for the omega-3 pathway.[5]

Eicosanoids are derived from PUFA (Polyunsaturated fatty acids), and they are potent chemical messengers that can be metabolized by enzymes to form prostaglandins. When the action of the enzymes is blocked, the entire pathway is blocked as well. These important enzymes can be blocked by trans fat that is found in margarine, shortening, and hydrogenated fats.

Stress and Sugar Cravings
Stress and sugar cravingsMany of us may not realize that we are under different levels of stress such as emotional stress and physical stress, and sometimes stress can lead to chronic inflammation in the body if it is prolonged and untreated.

Stress elevates the stress hormone – cortisol. Cortisol is responsible for providing you with energy, but if cortisol levels are too high, it can also cause a stress response in the body. Stress triggers your brain to look for quick energy. As a result, your appetite is increased and you are craving those comforting foods that are high in sugar, carbohydrates, and fat to immediately satisfy your nervous system’s hunger. It has been documented that stress tends to increase cravings for sweets, and fatty and salty foods, which makes you gain more weight.[6] This creates a vicious cycle: Excess cortisol in your system slows down your metabolism and leads to more muscle loss and shapes you with more belly fat.

Too much sugar in the diet leads to elevated stress hormones and stimulates the production of inflammatory prostaglandins. Excess consumption of sugar also contributes to insulin resistance and fluctuating blood sugar,[7] and this creates another vicious cycle – high levels of blood sugar stimulate the release of cortisol, which in turn causes more sugar cravings. As a result, you gain more weight!

Furthermore, increased cortisol levels from stress block progesterone from its receptors and excessive cortisol reduces available progesterone and leads to estrogen dominance during the second phase of the menstrual cycle. As a result, this causes hormone imbalance and sets up for PMS.

How to reduce PMS and sugar cravings?

Anti-inflammatory Diet
Anti-inflammatory diets
Tip 1. Eliminate processed foods that contain trans-fats. They are likely presented in fried foods, fast foods, and pastries.

Tip 2. Improve the Omega-3 to Omega-6 fatty acids ratio by cutting back on vegetable oils high in omega-6 fatty acids and increasing your intake of omega-3 fatty acids. The standard American diet leads to an overwhelming intake of omega-6 fatty acids but not enough omega-3 fatty acids. Additional omega-3 such as DHA and EPA can reduce inflammatory signaling by increasing the production of anti-inflammatory prostaglandins and reducing the formation of pro-inflammatory ones. Foods that are rich in omega-3 fatty acids are fatty fish salmon, sardines, tuna oysters, mackerel, hemp seeds, flax seeds, walnuts, etc.

Tip 3. Cook with olive oil or coconut oil. There is some evidence that oleic acid (found mainly in olive oil and nuts) may inhibit inflammatory prostaglandin production.[8] Lauric acid, a saturated fatty acid found mainly in coconut oil, has an anti-inflammatory effect.[9] To learn more about the health benefits of coconut oil and lauric acid, you could read The Secret of Amazing Health Benefits-Coconut flour and Coconut Oil.

Tip 4. Magnesium is very important for the metabolism of minerals and vitamins in our body and plays a wide range of roles in our body functions. Research indicates that magnesium deficiency can cause elevated PMS, hypertension, mood swings, muscle weakness, and cramps.[10] In addition, a study suggested that more than 75% of North Americans are deficient in magnesium.[11] Magnesium-rich foods are dark leafy greens, nuts and seeds, fish, beans and lentils, whole grains, avocados, bananas, dry fruits, dark chocolate, etc. And you may need supplementation to obtain a sufficient amount of magnesium. The recommended dose of magnesium is as follows.


Recommended Dietary Allowance (RDA)


1-3 years

80 mg/day

4-8 years

130 mg/day

9-13 years

240 mg/day


14-18 years

360 mg/day

19-30 years

310 mg/day

31 years and over

320 mg/day


Under 19 years: 400 mg/day

19 to 30 years: 350 mg/day

31 years and up 360 mg/day


Under 19 years: 360 mg/day

19 to 30 years: 310 mg/day

31 years and up: 320 mg/day


14-18 years

410 mg/day

19-30 years

400 mg/day

31 years and up

420 mg/day

(Note: It’s safe to get high levels of magnesium from food. But excessive use of magnesium supplements can be toxic.)

Tip 5. Studies showed that women with PMS appear to have high copper levels and low zinc levels in the blood.[12] Zinc deficiency leads to decreased secretions of progesterone and “feel good” neurotransmitters such as dopamine and serotonin. Zinc is also a cofactor required for the conversions of inflammation messenger prostaglandin. Because copper competes with zinc for absorption and binding sites, a high copper level can affect the availability of zinc in the body. Therefore, the Zinc to copper ratio plays an important role in PMS management. Specifically, vegetarian women need to pay attention to zinc levels due to possibly insufficient zinc intake from a vegetarian diet. zinc-rich foods are oysters, beef and lamb, pork and chicken, spinach, mushroom, wheat germ, pumpkin seeds and other nuts, beans, cocoa, and chocolate, etc. The best source of zinc is from foods. Because your body does not store zinc, it’s important to make sure you get enough zinc from your diet or supplementation. However, excessive zinc intake from a supplement can lead to adverse health consequences. The RDAs (Recommended Dietary Allowances) for zinc are as below.

Recommended Dietary Allowances (RDAs) for Zinc (* adequate intake: AI)
Age Male Female Pregnancy Lactation

0–6 months

2 mg*2 mg*  

7–12 months

3 mg3 mg  

1–3 years

3 mg3 mg  

4–8 years

5 mg5 mg  

9–13 years

8 mg8 mg  

14–18 years

11 mg9 mg

12 mg

13 mg

19+ years

11 mg8 mg

11 mg

12 g

Tip 6. B vitamins are needed to synthesize various neurotransmitters in the brain. B6 acts as a coenzyme to many other enzymes in the body and the biosynthesis of neurotransmitters including several mood-related neurotransmitters such as dopamine and serotonin. These are also the most important “feel good” neurotransmitters. Vitamin B6 deficiency can cause symptoms such as mood swings, insomnia, and anxiety, which are also part of PMS symptoms. B6-rich foods are sunflower seeds, pistachio nuts, fish, turkey and chicken, pork, dry fruits, avocados, bananas, spinach, etc. The best source to obtain adequate B6 is from foods. The RDAs (Recommended Dietary Allowances) for B6 are as below.

Recommended Dietary Allowances (RDAs) for Vitamin B6 (*adequate intake: AI)

Birth to 6 months

0.1 mg*

0.1 mg*  

7–12 months

0.3 mg*

0.3 mg*  

1–3 years

0.5 mg

0.5 mg  

4–8 years

0.6 mg

0.6 mg  

9–13 years

1.0 mg

1.0 mg  

14–18 years

1.3 mg

1.2 mg1.9 mg

2.0 mg

19–50 years

1.3 mg

1.3 mg1.9 mg

2.0 mg

51+ years

1.7 mg

1.5 mg  

Tip 7. Minimize caffeine consumption. Caffeine is known as a stimulant for the nervous system. Caffeine has been reported to further aggravate PMS symptoms. It is recommended to have no more than 3 cups of coffee (up to 300mg of caffeine) a day.

Tip 8. Limit alcohol consumption. Alcohol leads to blood sugar fluctuations and excessive insulin release, which can cause low blood sugar (hypoglycemia) among those with diabetes. Alcohol aggravates PMS syndromes by increasing sugar cravings, headaches, and fatigue.

Tip 9. Incorporate a high-fiber diet. Fiber-rich foods are particularly important to maintain healthy estrogen levels because fiber can remove excess estrogen from the body. The best sources of fiber are whole grains, legumes, dark leafy vegetables, fresh fruits, etc. Especially those natural anti-estrogenic foods such as citrus fruits (lemons, oranges, grapefruits) contain Indole-3-carbinol that changes the way estrogen is metabolized in a positive manner, which may lower estrogen levels.[13]

Tip 10. Choose organically produced foods. Xenohormones from chemical solvents and pesticides can affect estrogen balance in our body because they have hormone-like and estrogen-like activities. More discussion about xenohormones is in How to balance your hormone and prevent weight gain.

Tip 11. Research also indicates that soy is an excellent source of phytoestrogens, it contains plant-derived estrogens that cause the body to produce fewer amounts of unhealthy estrogen metabolites. It helps balance estrogen levels by reducing the body’s need to produce human estrogens.[14] However, eating soy products may affect your thyroid function if you have a thyroid disorder.

Herbal remedies and natural solutions to manage PMS

Tip 12. Use natural progesterone Wild yamto correct estrogen dominance. Currently, many nutritionally oriented physicians are recommending natural progesterone. The most common form of natural progesterone is found in the wild yam. This yam contains a sterol called diosgenin, which can be converted into progesterone. Dr. John Lee’s book “Dr. John Lee’s Hormone Balance Made Simple” has an in-depth discussion about how to use natural progesterone cream.17 More discussion about hormone balance is in How to balance your hormone and prevent weight gain.

Tip 13. Dong Quai (Angelica Sinensis)Dong Huai is honored as “Female Ginseng” in Chinese medicine. Dong Quai can lengthen the time for blood to clot. It contains phytoestrogens that may regulate estrogen activity.[15] People with bleeding disorders or on blood thinners such as warfarin (Coumadin) or aspirin should not use Dong Quai.

Black cohosh rootTip 14. Black cohosh root(Cimicifuga racemosa) has been used by Native Americans for more than two hundred years. It contains chemicals that seem to have effects similar to the female hormone, it may soothe irritation and congestion of the uterus and acts as an anti-inflammatory agent.[16]

Tip 15. Evening Primrose Oil(Oenothera biennis)Evening Primrose Oil is a source of gamma-linolenic acid (GLA), which is an omega-6 fatty acid that may have an anti-inflammatory effect. Some women reported that taking evening primrose oil helped improve PMS such as reducing swelling and bloating from fluid retention and relieving breast tenderness. However, studies are not consistent regarding its effectiveness for PMS symptoms. The normal dose of evening primrose oil standardized extract is 500- 1,000 mg per day. Evening primrose oil may increase the risk of bleeding. If you take blood thinners such as warfarin (Coumadin) or aspirin, you should consult your doctor before taking evening primrose oil.[16]

Tip 16. Take a liver-supporting and cleaning herbal formula that contains milk thistle, dandelion root, goldenseal or barberry, etc.[17]

VitexTip 17. Vitex agnus castus is also called Vitex, Chaste tree, Chasteberry, or Abraham’s Balm. Research indicated that Vitex helps increase the production of luteinizing hormone (LH), a hormone that is secreted from the brain to stimulate the production of progesterone. Several studies suggest that Vitex and wild yam may help reduce symptoms of PMS, including a headache, irritable mood, and breast tenderness.[17]

Tip 18. Ginger helps improve adrenal fatigue if you feel tired and lack of energy during PMS.

Tip 19. Applying castle oil packs to the lower abdomen helps reduce inflammation and relieve PMS symptoms such as abdominal cramps and bloating. How to make castle oil packs: fold the flannel or wool cloth 2 to 4 layers thick to cover the treatment area, saturate the cloth with castor oil, apply the pack to the treatment area and place the plastic wrap over the pack, and then place a hot bottle with comfortable temperature on top of it. Leave the pack for 45-60 minutes for each treatment, just relax and enjoy the treatment.

Reduce Stress

MeditationTip 20. Meditation. Research suggests that daily meditation improves both physical and emotional responses to stress. People who meditate regularly show less activation of their immune systems and less emotional distress when they are in stressful situations. The relaxation response from meditation helps lower blood pressure and improves heart rate, breathing, and brain waves.[18]

Tip 21. Breathing exercise. Deep breathing is one of the best ways to lower stress in the body. The movements of the diaphragm during the deep breathing exercise massage the stomach, small intestine, liver, and pancreas. The upper movement of the diaphragm also massages the heart. Deep breathing triggers your parasympathetic nervous system to respond, which leads to relaxation.

Tip 22. Laughter. Laughter triggers the release of protective endorphins. These endorphins, one of the complex neuropeptide chemicals produced in the brain, manage pain and promote feelings of well-being.[19]

Tip 23. Listen to the music and get moving. Get movingListening to music can have a tremendously relaxing effect on our minds and bodies, especially classical music, which can have a beneficial effect on our physiological functions, such as slowing the pulse and heart rate, lowering blood pressure, decreasing the levels of stress hormones, and may be beneficial to heart disease patients.[20] Additionally, physical activities such as dancing ease your stress level by increasing the production of your brain’s feel-good neurotransmitters (endorphins) and improving your sleep, which is often disrupted by stress.

What are your tips to overcome PMS? Please share with us.

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  1. Parry, B. L. and Haynes, P. Mood disorders and the reproductive cycle. 2000 J Clin Psychiatry 61 Suppl 12;22-7
  2. Singh BB, Berman BM, Simpson RN, Annechild A. Incidence of premenstrual syndrome and remedy usage: a national probability sample study. Altern Ther Health Med 1998; 4(3):75-9
  3. http://www.sciencedirect.com/science/article/pii/S0165614712000302
  4. https://www.ncbi.nlm.nih.gov/pubmed/18233953?dopt=Citation
  5. Mary G. Enig, PhD and Sally Fallon. Tripping Lightly Down the Prostaglandin Pathways. Weston A Price Foundation. 22 February 2012
  6. http://www.ncbi.nlm.nih.gov/pubmed/19120115
  7. http://www.nutritionandmetabolism.com/content/2/1/5
  8. Mireia Urpi-Sarda, et al. Virgin olive oil and nuts as key foods of the Mediterranean diet effects on inflammatory biomarkers related to atherosclerosis. Pharmacological Research 65 (2012) 577– 583
  9. https://www.ncbi.nlm.nih.gov/pubmed/20645831
  10. https://www.ncbi.nlm.nih.gov/pubmed/11425281
  11. Jaffe R MD. How to know if you are Magnesium Deficient: 75% of Americans Are ((transcript). 06/16/05. www.innovativehealing.com
  12. https://www.ncbi.nlm.nih.gov/pubmed/8034078
  13. Meng, Q; Yuan, F; Goldberg, ID; Rosen, EM; Auborn, K; Fan, S. (December 2000). “Indole-3-carbinol is a negative regulator of estrogen receptor-alpha signaling in human tumor cells.”. Long Island Jewish Medical Center. PMID 11110848
  14. N. Ishiwata1, et al. Effects of Soy Isoflavones on Premenstrual Syndrome. 5th International Symposium on the Role of Soy in Preventing and Treating Chronic Disease, Sept. 21-24th, 2003. Orlando, FL.
  15. https://umm.edu/health/medical/altmed/herb/dong-quai
  16. https://umm.edu/health/medical/altmed/condition/premenstrual-syndrome
  17. John R. Lee, M.D. and Virginia Hopkins. Dr. John Lee’s Hormone Balance Made Simple. 2006
  18. Wheeler, M. “Evidence builds that meditation strengthens the brain, UCLA researchers say.” UCLA Newsroom, 2012. http://newsroom.ucla.edu/portal/ucla/evidence-builds-that-meditation-230237.aspx.
  19. Dunbar, R.I.M., et al. “Social laughter is correlated with an elevated pain threshold.” Proceedings of the Royal Society. (2011). doi: 10.1098/rspb.2011.1373
  20. Bradt, J. and C. Dileo. “Music for stress and anxiety reduction in coronary heart disease patients.” Cochrane Database of Systematic Reviews. 15(2) (2009). doi: 10.1002/14651858.CD006577.pub2


The root of all health is in the brain. The trunk of it is in emotion. The branches and leaves are the body. The flower of health blooms when all parts work together. ~Kurdish

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About the author: Lucy Liu
Lucy Liu

As a Holistic Health Practitioner, Registered Dietitian, TCM Practitioner, Energy Healer, Master Hypnotist, Reiki Master, Advanced Theta Healing Practitioner, Author and Speaker, Lucy Liu, the founder of optimalhealthsolutions.ca, has gained a good reputation in holistic health after many years of serving patients and clients as a holistic health practitioner. Lucy has developed a unique and comprehensive approach, which combines Western Medicine, Chinese Medicine, Energy Medicine, and Alternative Medicine together, to help others achieve optimal health by creating harmony between the body, mind, and spirit, and maintain long-term success for healthy lifestyle changes.
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