female hormonal balance

How Lifestyle and Environmental Factors Contribute to PMS

For many women, "that time of the month" isn’t just the week of their period. Premenstrual syndrome (PMS) consists of a variety of physical and emotional symptoms that women experience during the two weeks between ovulation and the start of their period. There are a wide variety of PMS symptoms, and it's difficult to determine why some women suffer more than others. But research indicates everyday factors – like the air you breathe and how much you move your body – can impact PMS symptoms, making them worse or better. 


PMS is Real and Affects Many Women 

More than half of menstruating women experience some form of PMS with up to 30 percent of women experiencing moderate-to-severe symptoms.1-3 You likely have PMS if you experience symptoms within five days before your period (and that primarily occur only during this time) for three cycles in a row.2 

Common symptoms of PMS include:2

  1. Swollen and/or tender breasts
  2. Diarrhea or constipation
  3. Bloating and weight gain related to fluid retention 
  4. Cramping
  5. Anxiety
  6. Irritability, mood swings, and angry outbursts
  7. Crying spells
  8. Feeling depressed
  9. Appetite changes and/or food cravings
  10. Trouble falling asleep (insomnia)
  11. Headache
  12. Backache
  13. Less interest in sex (lower libido)


What Causes PMS?

Although the exact cause of PMS isn't known, there seem to be many contributing factors, including:2-4

  1. Hormonal changes: The hormone levels of estrogen and progesterone change naturally during a menstrual cycle. As these levels fluctuate, signs and symptoms of PMS can appear and resolve. 
  2. Chemical changes in the brain: The level of the neurotransmitter serotonin varies throughout the menstrual cycle. As its level decreases, mood-related symptoms like feeling depressed, fatigue, and sleep problems can increase. 

How sensitive a woman is to the hormonal and chemical changes occurring during her cycle is another factor. Some women are more sensitive to these changes and experience more severe PMS symptoms. This might explain why symptoms vary so much from woman to woman.2-4

Even though there might not be a consistent cause of PMS in all women, there is evidence that lifestyle and environmental factors can influence symptoms.


Body Fat and BMI Can Factor Into PMS 

Maintaining a healthy weight is important in helping prevent chronic conditions like high blood pressure, diabetes, and coronary heart disease. There might also be a relation between body mass index (BMI) and PMS. One study found that women with a BMI of 30 or higher were three times as likely to experience PMS symptoms.5,6

Although body fat and BMI are connected, it's important to note that BMI is not a direct measure of body fat. For example, athletes can have a high BMI due to increased muscle mass and not increased body fat.6


Air Pollution Can Increase PMS Symptoms

Air pollution adversely affects many aspects of life on earth, including a woman's reproductive health. Small particles of soot and traffic pollution (particulate matter) and acidic-gas air pollution can contribute to ovarian failure, endometriosis, and reduced fertility. Scientists are now making a connection between air pollution and PMS symptoms.7,8

Recent research shows more women experience PMS symptoms in areas with higher concentrations of sulfur dioxide, nitric oxide, nitrogen oxides, nitrogen dioxide, and particulate matter in the air. These pollutants appear to affect the balance between progesterone and estrogen, which can trigger PMS symptoms.7

More research is needed to see if filtering the air – by wearing an N95 mask outdoors or using an air conditioner – helps reduce PMS symptoms.7


Exercise Can Reduce PMS Symptoms

Exercise helps reduce the risk of chronic health conditions like diabetes, heart disease, and some types of cancer. But there is another reason to add cardio to your schedule: for many women, regular aerobic exercise can reduce the severity of PMS symptoms like fatigue and depression.9,10

Aerobic activity is any activity that causes you to breathe harder than normal and your heart to beat faster than normal. Cardio activities to consider include: 11

  1. Brisk walking, jogging, and running
  2. Cycling
  3. Dancing
  4. Swimming
  5. Playing sports like basketball or soccer
  6. Active forms of yoga like power yoga or Vinyasa
  7. General house or yard work like pushing a lawn mower or vacuuming

Aim for at least 30 minutes of cardio activity most days of the week – not just when you're experiencing PMS symptoms.10


Diet Can Affect PMS Symptoms 

Choosing to eat healthy foods will benefit your overall health and might reduce some of your PMS symptoms. Consider adopting the following dietary guidelines during your menstrual cycle:10,12

  1. Eat smaller, more frequent meals. This helps ease bloating and keeps your blood sugar stable. Keeping your blood sugar stable can decrease PMS symptoms.
  2. Eat more calcium-rich foods. Low calcium levels can make PMS symptoms worse, so add yogurt and leafy green vegetables, like kale and spinach, to your grocery list. 
  3. Add in complex carbohydrates. These reduce food cravings and mood-related symptoms like irritability. Try fruits, vegetables, and whole grains, like brown rice, beans, and whole wheat pasta.
  4. Limit your sugar and salt intake. This helps reduce bloating and weight gain related to fluid retention.
  5. Avoid caffeine and alcohol. These can make PMS symptoms worse.

Although you might not be able to completely resolve all your PMS symptoms, you can take steps to alleviate them using lifestyle strategies. Talk to your doctor if your symptoms are severe or get in the way of your everyday life.2 


Information provided by Thorne

Although diet and lifestyle changes can go a long way toward alleviating PMS, some women still need a little more help. Thorne’s DIM Advantage provides botanical extracts from broccoli and pomegranate to support hormone balancing. 

※ This article is transplanted from Thorne's website and partially edited for Asian region. Original one is here.


  1. Appleton S. Premenstrual syndrome: Evidence-based evaluation and treatment. Clin Obstet Gynecol 2018;61(1)52-61.
  2. Premenstrual syndrome (PMS). Office on Women's Health.  https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome. [Accessed July 3, 2021]
  3. Freeman E. Premenstrual syndrome. In: Conn’s Current Therapy 2021. 1st ed. Elsevier; 2021. https://www.clinicalkey.com. [Accessed July 3, 2021]
  4. Yonkers K, Casper R. Epidemiology and pathogenesis of premenstrual syndrome and premenstrual dysphoric disorder. https://www.uptodate.com/contents/search. [Accessed July 3, 2021.]
  5. Masho S, Adera T, South-Paul J. Obesity as a risk factor for premenstrual syndrome. J Psychosom Obstet Gynecol 2005;26(1):33-39. 
  6. About adult BMI. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. [Accessed July 3, 2021]
  7. 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.
  8. Tiotiu A, Novakova P, Nedeva D, et al. Impact of air pollution on asthma outcomes. Int J Environ Res Public Health 2020;17(17):6212.
  9. Physical activity: Why it matters. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/about-physical-activity/why-it-matters.html. [Accessed July 3, 2021]
  10. Premenstrual syndrome (PMS). American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/premenstrual-syndrome. [Accessed July 3, 2021]
  11. Physical Activity Guidelines Advisory Committee Report, 2018: To the Secretary of Health and Human Services. Washington, DC: U.S. Dept. of Health and Human Services, 2018.
  12. Abdi F, Ozgoli G, Rahnemaie F. A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstet Gynecol Sci 2019;62(2):73-86.
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