PMS: It’s so common but is it normal?

What would you do if you found out that PMS, or premenstrual syndrome, isn’t something that you have to go through each and every month? Chances are that you’d cry blasphemy. But here’s the thing, even though PMS is a common occurrence in our modern society and normalized by media, it is not necessarily normal and can improve. While the exact cause of PMS is up for debate, it is generally agreed upon that hormonal imbalance plays an important role. The female hormonal cascade is an intricate dance between a handful of hormones, with each one occurring in specific amounts at specific times of the month. Loosely speaking, estrogen levels tend to be higher during the first half of the menstrual cycle (the follicular phase), while progesterone tends to be higher in the second half (the luteal phase). It is important to maintain a healthy estrogen to progesterone ratio.  It’s a relative thing.  

Meet the players

Estrogen:

There are three forms of estrogen in the human body, estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the predominant estrogen during reproductive years and is much stronger in its effect when compared to estrone and estriol. Estrogen tends to be predominant during the first half of the menstrual cycle

Estradiol has many functions in the body, including:

• Structural: formation of female secondary sex characteristics, accelerates metabolism, stimulates endometrial growth, increases uterine growth, increases vaginal lubrication, maintains vessels and skin, reduces bone resorption
• Protein synthesis: increases hepatic production of binding proteins
• Coagulation: increases circulating levels of factors 2, 7, 9, 10, plasminogen, decreases antithrombin III, increases platelet adhesiveness
• Lipids: increases HDL, TG, decrease LDL and fat deposition
• Fluid balance: sodium and water retention, increases cortisol, SHBG
• GI: reduced bowel motility, increased cholesterol in bile
• Melanin: Increased pheomelanin, reduced eumelanin
• Cancer: supports hormone-sensitive breast cancer
• Uterus lining: works with progesterone to promote and maintain uterus lining for preparation of implantation of fertilized egg, upregulates oxytocin receptor in myometrium
• Ovulation: induces release of LH → triggers ovulation
• Sexual behavior: Without estrogen, free testosterone decreases sexual desire
• Males: important for maturation of sperm and necessary for healthy libido

Progesterone: 

Progesterone is known as the “feel-good” hormone and tends to promote a more relaxed state. It tends to be higher during the second half of the menstrual cycle.

Functions of progesterone include:

• Prepares endometrium for potential pregnancy after ovulation

• Reduces anxiety, increases sleepiness
• Helps build/maintain bone
• Slows digestive process
• Promotes appetite and fat storage
• Helps mature breast tissue and prepare breasts to produce milk

While hormones – specialized chemical messengers – are minuscule in terms of size, the effect they have on human physiology is impressive. In terms of female reproductive health, the main players are estrogen and progesterone. When there is an imbalance of any of these hormones, we begin to run into problems. The most common imbalance tends to occur between estrogen and progesterone, with estrogen being more dominant. Estrogen-dominance is common in women in their reproductive years and can be a contributor to the development of premenstrual syndrome (PMS), polycystic ovarian syndrome (PCOS), and/or endometriosis. The combination of an endogenous estrogen (i.e. the estrogen that your body creates) and exogenous estrogen (i.e. the estrogen-like compounds in the environment) have an additive effect. The extra estrogen can have many effects on the body, including weight gain, decreased libido, and anxiety.

While it may not be feasible to shield yourself from all sources of exogenous estrogen, there are a few steps that you can take to minimize your exposure.

1. Opt for glass or stainless steel over plastic
   • You’re already taking lunch to work (yay for you!), but did you know that your plastic container could be leaching estrogen-like compounds into your food? Instead of plastic or styrofoam, try using glass jars and steel containers instead.
2. Increase cruciferous vegetables
   • Your liver loves cruciferous vegetables, and so should you! Veggies such as broccoli, cauliflower, and cabbage are rich in a compound called indole-3-carbinol (I3C). I3C plays a role in metabolizing excess estrogen in the body, thus lessening your total load.
3. Know your dirty dozen and clean fifteen
   • Conventionally grown vegetables are exposed to pesticides that can increase your exposure to exogenous estrogen-like compounds. The dirty dozen contains the highest loads of pesticide residue, so you are better off avoiding them/eating organic or ensuring you are washing them before eating. The 2017 dirty dozen are strawberries, spinach, nectarines, apples, peaches, celery, grapes, pears, cherries, tomatoes, sweet bell peppers, and potatoes.  Don’t get lost in perfection:  Eating vegetables is more important than avoiding these but if you can make a shift here bonus.  
4. Sprinkle in some flax
   • Flaxseeds are a rich source of phytoestrogen, which can negate the effects of estrogen-dominance. Freshly ground flax can be easily incorporated into smoothies and baked goods, increasing both the flavor and fiber content of your food.

Estrogen-dominance a term used to describe this relative mismatch between estrogen and progesterone is becoming more and more prevalent in our society.  It can be associated with symptoms of PMS that include irritability, low mood, breast tenderness, cramping, heavy menses and clots in the menses.   

However, it is not mandatory to feel less-than-optimal.

There is functional hormone testing available that can give us a greater view of your hormones.  We can see how you make them but also how you break them down.

If you have any questions or would like to book an appointment please don’t hesitate to reach out.