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    Premenstrual Syndrome (PMS)

    Painful periods, hormonal migraines and changes with mood, can be symptoms that come to mind when we think of PMS, or pre-menstrual syndrome.  Although these symptoms can be seen as common occurrence for many menstruating people, they are not symptoms that should simply be tolerated as being ‘part of life’.

    It becomes important to adequately address PMS, in order for all menstruating people to show up in their careers, relationships and in life, as their very best self.  To start, let’s discuss the most common PMS symptoms to look out for, before we get into the specific support available.

    Signs and Symptoms

    For signs and symptoms to be classified as part of PMS, at least one of the following symptoms will need to start five days leading up to menstruation, and resolve a few days after menstruation begins, over at least 3 cycles:1

    Signs and symptoms of PMS. Feeling overwhelmed or irritable, menstrual cramping or discomfort, headaches or muscle aches, abdominal bloating or weight gain, low mood or social withdrawal, breast tenderness or swelling.

    If some of these symptoms resonate with you, it is important to monitor these symptoms in a few important ways:

    • Startby tracking your cycle. Make note of symptom details in a journal or phone app throughout the cycle.  This will allow you to recall details of past cycles that may be easily forgotten, if not recorded.
    • Track any days missed from work or school, due to PMS. This is a more objective measure for how your PMS symptoms are ideally lessening over time.
    • Track the need for pain medication. If you find yourself currently relying on ibuprofen or acetaminophen for period pain reduction, tracking the amount and frequently of those as needed medications, can be an important measure for how well your symptoms are lessening.

    Keeping in mind, if symptoms remain past menstruation or are moderate to severe in intensity, it becomes important that other concerns that present similarly, are ruled out as a possibility.  Moderate to severe forms of PMS should have us exploring these potential concerns:

    • PMDD (Premenstrual Dysphoric Disorder). PMDD is often thought of as the more severe form of PMS.1 
    • Endometriosis. Often associated with painful menstruation, pain throughout the cycle irrespective of menstruation, and pain during intercourse.1

    As always, contact your medical provider for a full assessment, and to answer any questions you may have about how you are feeling.

    Causes and Prevalence

    PMS can significantly impact quality of life, which was highlighted in a nationwide survey on productivity and absenteeism in the workplace due to PMS related symptoms.  Out of the 34 thousand women surveyed, here is that they found:

    • Missed days due to PMS. 14% reported being absent during a menstrual cycle, with 4% being absent almost every menstrual cycle.2  The average number of days missed due to PMS symptoms was only 1.4 days out of the year.2
    • Decrease in productivity. For those that attended work while experiencing PMS symptoms, there was a decrease in productivity.  Of the 81% who reported being present at work during their period, they reported on average a 23-day decrease in productivity per year2

    As a concern that is thought to impact up to 20% of menstruating people, with 5-8% of those experiencing moderate to severe symptoms,3 it is essential that we explore potential contributing factors leading to the occurrence of PMS. 

    While the exact cause of PMS is still being explored, cyclical changes in estrogen and progesterone, along with the subsequent effect that hormones may have on brain chemicals such as serotonin, GABA and dopamine, are some of the more widely accepted contributing factors to PMS.2

    Nutrition

    Optimizing nutrition is an excellent starting point for addressing PMS.  Aside from the fundamentals, such as ensuring adequate amounts of protein, healthy fats, soluble and insoluble fibre sources, variety in fruits and vegetables, and complex carbohydrates, there are specific nutritional adjustment that have shown to reduce both PMS severity and frequency.  Here is what we know:

     

    • Whole grains vs refined grains.  Opting for more whole grains over refined grains, has shown benefit in PMS reduction.4
    • Calcium for period pain. Supplementing with calcium has been shown to decrease both the occurrence and intensity of menstrual pain.5 PMS symptoms related to mood, emotional and physical symptoms such as water retention, improved within the first and second menstrual cycles following supplementation.6 There can be benefit with the incorporation of calcium food sources, such as plain yogurt, cottage cheese, sardines, salmon, soy milk, tofu, spinach, and foods that have been fortified with calcium.7
    • Vitamin D for period pain. Vitamin D has shown to be effective in alleviating PMS symptoms.8  After two months of supplementation, some studies reported the average period pain score had decreased significantly, compared to those who did not correct for vitamin D deficiencies9.
    • Calcium in combination with vitamin D on PMS reduction. Low levels of vitamin D and calcium may contribute to worsening PMS symptoms.10 There was improvement in PMS occurrence after supplementing with both calcium and vitamin D, in those who had low levels.10
    • Cruciferous vegetables for optimizing estrogen metabolism. Broccoli, cauliflower, kale, and Brussel sprouts, contain a compound called indole-3-carbinol (I3C, for short). I3C coverts into another compound called DIM within the body, and both I3C and DIM have benefits for optimizing estrogen breakdown, into the preferred forms that have protective health benefits on over all health.11
    • Vitex for reducing PMS symptoms, including with period pain. Vitex, also known as chasteberry, is one of the most common herbs used for various women’s hormonal concerns, and for good reason.  Studei shows women taking vitex were 2.5 times more likely to experience a remission in PMS symptoms, compared to placebo,13 and it has also been shown to be well-tolerated, providing benefits for both PMS14 along with an overall benefit in period pain reduction15.

    Cyclesmart by Smart Solutions is a combination of TRU-ID certified formula containing herbs and supportive ingredients which work as a hormone normalizer to help stabilize menstrual cycle irregularities and reduce symptoms of PMS.16 Vitex, zinc, indole-3-carbinol, DIM and more herbs work synergistically for hormone balance to help stabilize menstrual cycle irregularities and helps relieve PMS symptoms associated with cyclical mastaglia (recurrent breast pain.16

    Lifestyle

    What we know to be true regarding support for lessening the occurrence and severity of PMS, is the need to address all aspects, including lifestyle and daily habits.  Here are some specific examples:

     

    • Yoga and aerobic exercising for PMS. Both yoga and aerobic exercise have shown a significant reduction in pain intensity of PMS symptoms, with one study demonstrating yoga to have a more significant reduction in PMS symptoms, compared to aerobic exercise.17
    • Swimming for PMS reduction. This activity has shown benefit on both physical and psychological PMS symptoms, compared to those who did not partake in swimming.18
    • Regardless of the exercise, there is likely to benefit on PMS reduction. The takeaway message should be to pick an activity you enjoy, and turn it into a habit.  This thinking is backed by one study that showed regardless of the form of exercise, there remains a positive impact on improving psychological symptoms associated with PMS, simply by regularly moving your body.19  
    • Avoid smoking. In terms of habits to avoid, smoking may come as no surprise, as smoking has been shown to put women at significantly increased risk for PMS,20 among being a risk factor for various other women’s health concerns on a larger scale.
    • Alcohol consumption impacting PMS. A meta-analysis reported that alcohol consumption had a moderate association with worsening PMS symptoms, which was further worsened as the amount of drinking increased.21 Whether alcohol consumption is a contributing factor to period pains, or women with PMS simply partake in more drinking to mitigate the level of pain, is an important consideration.
    • Aromatherapy benefiting PMS. Aromatherapy was shown to significantly reduce the severity of physical symptoms of PMS.22
    • Acupuncture and acupressure benefiting PMS. Both acupuncture and acupressure may reduce psychological and physical PMS symptoms.23 

    References

    1. Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American family physician, 94(3), 236–240.
    2. Schoep, M. E., Adang, E., Maas, J., De Bie, B., Aarts, J., & Nieboer, T. E. (2019). Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ open, 9(6), e026186. https://doi.org/10.1136/bmjopen-2018-026186
    3. Yonkers, K. A., & Simoni, M. K. (2018). Premenstrual disorders.American journal of obstetrics and gynecology218(1), 68–74. https://doi.org/10.1016/j.ajog.2017.05.045
    4. Esmaeilpour, M., Ghasemian, S., & Alizadeh, M. (2019). Diets enriched with whole grains reduce premenstrual syndrome scores in nurses: an open-label parallel randomised controlled trial.The British journal of nutrition121(9), 992–1001. https://doi.org/10.1017/S0007114519000333
    5. Arab, A., Rafie, N., Askari, G., & Taghiabadi, M. (2020). Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature.International journal of preventive medicine11, 156. https://doi.org/10.4103/ijpvm.IJPVM_243_19
    6. Shobeiri, F., Araste, F. E., Ebrahimi, R., Jenabi, E., & Nazari, M. (2017). Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial.Obstetrics & gynecology science60(1), 100–105. https://doi.org/10.5468/ogs.2017.60.1.100
    7. S. Department of Health and Human Services. (n.d.). Office of dietary supplements - calcium. NIH Office of Dietary Supplements. Retrieved January 24, 2022, from https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
    8. Arab, A., Golpour-Hamedani, S., & Rafie, N. (2019). The Association Between Vitamin D and Premenstrual Syndrome: A Systematic Review and Meta-Analysis of Current Literature.Journal of the American College of Nutrition38(7), 648–656. https://doi.org/10.1080/07315724.2019.1566036
    9. Saei Ghare Naz, M., Kiani, Z., Rashidi Fakari, F., Ghasemi, V., Abed, M., & Ozgoli, G. (2020). The Effect of Micronutrients on Pain Management of Primary Dysmenorrhea: a Systematic Review and Meta-Analysis. Journal of caring sciences, 9(1), 47–56. https://doi.org/10.34172/jcs.2020.008
    10. Abdi, F., Ozgoli, G., & Rahnemaie, F. S. (2019). A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstetrics & gynecology science, 62(2), 73–86. https://doi.org/10.5468/ogs.2019.62.2.73
    11. National Center for Biotechnology Information (2022). PubChem Compound Summary for CID 3071, 3,3'-Diindolylmethane. Retrieved January 23, 2022 fromhttps://pubchem.ncbi.nlm.nih.gov/compound/3_3_-Diindolylmethane.
    12. Jafari, F., Amani, R., & Tarrahi, M. J. (2020). Effect of Zinc Supplementation on Physical and Psychological Symptoms, Biomarkers of Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Young Women with Premenstrual Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial.Biological trace element research194(1), 89–95. https://doi.org/10.1007/s12011-019-01757-9
    13. Csupor, D. et al (2019). Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complementary therapies in medicine, 47, 102190. https://doi.org/10.1016/j.ctim.2019.08.024
    14. Cerqueira, R. O., Frey, B. N., Leclerc, E., & Brietzke, E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.Archives of women's mental health20(6), 713–719. https://doi.org/10.1007/s00737-017-0791-0
    15. Rafieian-Kopaei, M., & Movahedi, M. (2017). Systematic Review of Premenstrual, Postmenstrual and Infertility Disorders of Vitex Agnus Castus.Electronic physician9(1), 3685–3689. https://doi.org/10.19082/3685
    16. Government of Canada. Product information. Accessed on January 29th, 2022 at http://health-products.canada.ca/lnhpd-bdpsnh/info.do?licence=80029413
    17. Vaghela, N., Mishra, D., Sheth, M., & Dani, V. B. (2019). To compare the effects of aerobic exercise and yoga on Premenstrual syndrome.Journal of education and health promotion8, 199. https://doi.org/10.4103/jehp.jehp_50_19
    18. Maged, A. M., Abbassy, A. H., Sakr, H., Elsawah, H., Wagih, H., Ogila, A. I., & Kotb, A. (2018). Effect of swimming exercise on premenstrual syndrome.Archives of gynecology and obstetrics297(4), 951–959. https://doi.org/10.1007/s00404-018-4664-1
    19. Yesildere Saglam, H., & Orsal, O. (2020). Effect of exercise on premenstrual symptoms: A systematic review.Complementary therapies in medicine48, 102272. https://doi.org/10.1016/j.ctim.2019.102272
    20. Choi, S. H., & Hamidovic, A. (2020). Association Between Smoking and Premenstrual Syndrome: A Meta-Analysis.Frontiers in psychiatry11, 575526. https://doi.org/10.3389/fpsyt.2020.575526
    21. Fernández, M., Saulyte, J., Inskip, H. M., & Takkouche, B. (2018). Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis.BMJ open8(3), e019490. https://doi.org/10.1136/bmjopen-2017-019490
    22. Es-Haghee, S., Shabani, F., Hawkins, J., Zareian, M. A., Nejatbakhsh, F., Qaraaty, M., & Tabarrai, M. (2020). The Effects of Aromatherapy on Premenstrual Syndrome Symptoms: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Evidence-based complementary and alternative medicine : eCAM2020, 6667078. https://doi.org/10.1155/2020/6667078
    23. Armour, M., Ee, C. C., Hao, J., Wilson, T. M., Yao, S. S., & Smith, C. A. (2018). Acupuncture and acupressure for premenstrual syndrome.The Cochrane database of systematic reviews8(8), CD005290. https://doi.org/10.1002/14651858.CD005290.pub2
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    Premenstrual Syndrome (PMS) Kit