Although many women spend the majority of their childbearing years striving for an uneventful, pain-free menstrual period, nearly all women have experienced at least one or two signs or symptoms associated with PMS, sometimes only occasionally, sometimes every month. Happily, many have found solutions that work for them to minimize these symptoms. This article focuses on preventive measures, including nutritional supplements, that can mitigate discomfort before or during your period.
Several decades ago, PMS was identified as a “thing” – not just a figment of women’s imagination – when an enterprising researcher in the field, Guy Abraham, identified various four categories of PMS. In the absence of any specific organic pathology, these categories were based on predominant symptoms and imbalances: hormone or neurotransmitter imbalances, nutrient deficiencies or excesses, and altered prostaglandin synthesis – or a combination of these, were all implicated.
The most common type, which seems to affect 70-80 percent of women dealing with premenstrual issues, is believed to primarily be caused by a sex-hormone imbalance often referred to as estrogen dominance. Although hormone levels might be within the normal range, estrogen dominance occurs when the level of estrogen is high relative to the level of progesterone or other hormones (primarily progesterone when talking about women). It is also described as an estrogen-to-progesterone ratio that is shifted too far to the estrogen side of the ratio. This imbalance often results in many of the symptoms associated with PMS, including breast tenderness, bloating, weight gain, and mood changes like tension and irritability.
What to do before your period comes
What can you do? Prevention is key. First, let’s discuss estrogen and how it’s metabolized. Estrogen is metabolized in the liver in a 2-step process, which is why you want your liver in tip-top shape, particularly during the time leading up to your period. Estrogen levels usually drop prior to menses, but if the liver is not working at full capacity to metabolize it, then estrogen can be reabsorbed into the bloodstream, contributing to an imbalance. Things that put added stress on your liver include eating too much fatty food, drinking excess alcohol, and being overweight (which can also add to estrogen load because estrogen is stored in fat cells). One study found a 3-fold increase in PMS incidence among women who had a higher body mass index.1
Being exposed to xenoestrogens – compounds that mimic the effect of estrogen in the body – from hormone-laden dairy or meats or from environmental plastics like BPA and phthalates can also contribute to estrogen burden. Because estrogen metabolites are ultimately removed from the body in the stool, constipation can contribute to poor elimination and potential reabsorption. Bottom line – support your liver and your gut.
Dietary factors include eating liver-supportive foods like lots of green leafy and cruciferous (cabbage family) veggies. Cruciferous vegetables – broccoli, Brussels sprouts, cabbage, kale, cauliflower, and kohlrabi – contain compounds known as indoles that support the liver’s metabolism of estrogen.
Maintain a healthy gut microbiome to support estrogen metabolism and elimination. This means plenty of prebiotic fiber and probiotic-containing foods such as yogurt, sauerkraut, and miso.
Eat less fat overall. One study found that women who derive 20 percent of their calories from fat have significantly lower blood estrogen levels than women who derive 40 percent of their calories from fat.2
What about caffeine? Some women find if they avoid or cut down on coffee and other sources of caffeine, then they have fewer PMS symptoms. This is because caffeine is metabolized by the liver, just like estrogen and alcohol. Also, caffeine is a member of a group of compounds called methylxanthines – found in coffee, chocolate, tea, and cola – that can cause premenstrual symptoms, particularly breast tenderness and lumpiness.
Supplements can provide benefit for balancing estrogen. Go straight to the heart of the matter with Thorne’s DIM Advantage. Why? As noted above, cabbage family veggies can lend a hand when it comes to estrogen metabolism. When these veggies are chewed, they release indole-3-carbinol molecules that combine in the stomach to form diindolylmethane (DIM), a well-studied nutrient that supports the liver’s metabolism of estrogen.*
Sulforaphane glucosinolate (SGS), also found in cruciferous vegetables, is found in particularly high amounts in broccoli sprouts, supports liver detoxification, and provides indirect antioxidant support in hormone-sensitive tissues.*
Pomegranate has been put to the test for estrogen balancing, too.*3 It has what are called phytoestrogens – plant constituents that behave like weak estrogen. But why would you want to use these if you are trying to lower your estrogen? Because these phytoestrogens can bind to the same docking stations on your cells that your own much stronger estrogen is trying to bind to, thus taking up some of these receptors and lowering estrogen’s overall effect.
Thorne’s DIM Advantage provides all three nutrients: DIM, SGS, and pomegranate for a 1-2-3 punch in the nose to PMS.
And don’t forget the importance of gut health in clearing estrogens from the body. Not getting enough fermented foods in your diet? Then consider a supplemental probiotic.
What about some old standbys? Vitamin B6 has been a staple in menstrual support for decades because it can modulate estrogen in relation to progesterone – shifting the ratio in the direction of progesterone.* The active form of B6 – pyridoxal 5’ phosphate (P5P) – might be preferable because it does not need to be activated by the liver, and because the active form is used in the formation of several neurotransmitters, an imbalance of which is also implicated in premenstrual tension.*
And don’t forget magnesium. Vitamin B6 and magnesium are BFFs when it comes to working together for the good of womankind. For one thing, B6 in the form of pyridoxine requires magnesium to be converted in the liver to active P5P. But it’s not just a one-way street. Magnesium needs B6 too – for uptake and utilization in cells. Some studies have shown that women with PMS have low red blood cell magnesium levels compared to women who don’t experience PMS;4 therefore, some of the benefit may lie in correcting a deficiency.* One study found the combination of B6 and magnesium attenuated PMS symptoms significantly better than magnesium alone.*5
What to do during your period
Some women experience relief almost immediately on starting their period. However, for others the fun is just beginning. While some women experience only minor menstrual cramping, others can be bed-ridden with a heating pad. Although everything you do prior to menses can support a pain-free period, you might need additional help for cramping.
Dietary: Focus on an anti-inflammatory diet, like the Mediterranean diet – with lots of fresh vegetables and fruits, olive oil, legumes, and fish if you’re not a vegetarian. Thorne’s Modified Mediterranean diet goes one step further and suggests eliminating foods you know you are sensitive to.
Supplements: Magnesium should become your best friend during your entire menstrual cycle, and perhaps no more so than during menses itself, particularly if you experience cramping.* Magnesium is used by the muscles (including the muscles of your uterus) to achieve relaxation – in fact, it’s essential.*
If you are also having less than restful sleep, then reach for the form of magnesium bound to glycine.* Glycine is an amino acid that, when bound to a mineral like magnesium, enhances its absorption and decreases its laxative effect. Glycine also adds to the relaxation effect of magnesium, because it acts as an inhibitory neurotransmitter in the body, which, similar to GABA, helps modulate stress and tension.*
You should also consider adding calcium to the mix, particularly if you do not have much calcium in your diet. Although the research on magnesium and menses is more robust, research also supports the use of calcium for menstrual discomfort.* In one placebo-controlled study, 1,000 mg of calcium daily significantly improved menstrual discomfort compared to the women in the placebo group.6
Or if you prefer, you can take calcium and magnesium in a single supplement.
Omega-3 fatty acids have also been shown in double-blind studies to benefit women with menstrual discomfort when taken over a 3-month period.7 Why is that? Your body produces chemicals called prostaglandins or PGs for short. PGs can either be anti-inflammatory (“good PGs”) or pro-inflammatory (“bad PGs”).
Although you actually need both kinds, it’s really a matter of balance. Pro-inflammatory PGs are released from the uterine lining and can contribute to cramping. The more estrogen effect you have during a menstrual cycle, the thicker the uterine lining and the more pain-producing prostaglandins are released. This is where fish oils come in (and also a certain omega-6 fatty acid called GLA – found in borage, black currant, and evening primrose oils). These beneficial fatty acids drive the body to produce more of the “good” prostaglandins.*
What to do after your period is over
After your period ends, you might be tempted to throw caution to the wind, but this is not the time to let up on your balancing act. In fact, this can be the most important time to focus on estrogen metabolism because the greatest estrogen peak occurs during this segment of your cycle. Continue with a low estrogen diet – avoid hormone-laden meat and dairy products.
Although all dairy products naturally contain hormones, if you eat dairy, then look for organic with “no added hormones” on the label. Studies estimate that milk and other dairy products are the source of as much as 70 percent of estrogens in the human diet.8 Because estrogen is fat-soluble, it stores in the fat – so, unfortunately, full-fat dairy products have the most. Continue to eat the liver-supportive foods discussed above and avoid exposure to environmental xenoestrogens found in plastics, skin-care products, pesticides, and building supplies.
If you have particularly heavy menstrual periods, then you should monitor your iron level and red blood cell count. If these are low, then you might be feeling fatigued, so you should supplement with some blood-building foods and nutrients. When it comes to food, liver is an excellent source of iron (6-7 mg of iron in a 3.5-ounce serving). Don’t like liver? Don’t eat meat? Don’t worry – you can get about the same amount of iron in a cup of cooked lentils.
You might have a normal iron level and still feel fatigued. Chronic stress is all wrapped up in hormone imbalances that can lead to difficulties with your menstrual cycle. It’s not uncommon if you’re stressed a lot to have an elevated level of the stress hormone, cortisol. A common pattern in women with PMS and other menstrual irregularities is an imbalance of cortisol in relation to progesterone – high cortisol and low progesterone.
This is because both hormones are made in the adrenal glands (one of the places progesterone is made) from the same building block – pregnenolone. Because your body will try to survive stress at all costs and choose production of cortisol over progesterone, this can throw off the balance of estrogen to progesterone, shifting it toward estrogen dominance. And, chronic stress over a long period of time can tax your adrenal glands and make you feel fatigued. So, in addition to sex-hormone balancing, you might also need adrenal support.*
Or you might be able to address multiple issues – support both your estrogen balance and your adrenals with one solution – DIM Advantage.* It turns out that pomegranate possesses some important adrenal support properties by helping to lower elevated cortisol.*9
In addition to dietary changes and supplement additions, regular exercise is essential during all phases of your menstrual cycle. Exercise decreases fat, which in turn decreases circulating estrogen levels; it decreases stress; and one study found exercise increased the level of “good” (2-hydroxy) to “bad” (16-hydroxy) estrogen.10
Even things you might not expect can contribute to PMS. For example, did you know environmental pollution can contribute to PMS? In a Taiwanese study, exposure to higher levels of particulate matter in the environment and polluting acid gases like sulfur dioxide was associated with 3-8 times higher risk of having PMS than women only exposed to low-level air pollution.11
In short – try to live the cleanest life you can while still enjoying yourself.
- Masho S, Adera T, South-Paul J. Obesity as a risk factor for premenstrual syndrome. J Psychosom Obstet Gynaecol 2005;26(1):33-9. doi: 10.1080/01443610400023049.
- Wu A, Pike M, Stram D. Meta-analysis: dietary fat intake, serum estrogen levels, and the risk of breast cancer. J Natl Cancer Inst 1999;91(6):529-534. doi: 10.1093/jnci/91.6.529.
- Sreeja S, Santhosh-Kumar T, et al. Pomegranate extract demonstrate a selective estrogen receptor modulator profile in human tumor cell lines and in vivo models of estrogen deprivation. J Nutr Biochem 2012;23(7):725-732. doi: 10.1016/j.jnutbio.2011.03.015.
- Rosenstein D, Elin R, Hosseini J, et al. Magnesium measures across the menstrual cycle in premenstrual syndrome. Biol Psychiatry 1994;35(8):557-561. doi: 10.1016/0006-3223(94)90103-1.
- Fathizadeh N, Ebrahimi E, Valiani M, et al. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res 2010;15(Suppl 1):401-405.
- Zarei S, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, et al. Effects of calcium-vitamin D and calcium-alone on pain intensity and menstrual blood loss in women with primary dysmenorrhea: A randomized controlled trial. Pain Med 2017;18(1):3-13. doi: 10.1093/pm/pnw121.
- Rahbar N, Asgharzadeh N, Ghorbani R. Effect of omega-3 fatty acids on intensity of primary dysmenorrhea. Int J Gynaecol Obstet 2012;117(1):45-47. doi: 10.1016/j.ijgo.2011.11.019.
- Malekinejad H, Rezabakhsh A. Hormones in dairy foods and their impact on public health – a narrative review. Iran J Public Health 2015;44(6):742-758.
- Tsang C, Smail N, Almoosawi S, et al. Intake of polyphenol-rich pomegranate pure juice influences urinary glucocorticoids, blood pressure and homeostasis model assessment of insulin resistance in human volunteers. J Nutr Sci 2012;1:e9. doi: 10.1017/jns.2012.10.
- Smith A, Phipps W, Thomas W, et al. The effects of aerobic exercise on estrogen metabolism in healthy premenopausal women. Cancer Epidemiol Biomarkers Prev 2013;22(5):756-764. doi:10.1158/1055-9965.EPI-12-1325
- Lin S, Yang Y, Chang C, et al. Association of fine-particulate and acidic-gas air pollution with premenstrual syndrome risk. QJM 2020;113(9):643-650. doi: 10.1093/qjmed/hcaa096.