The PMS Solution: 3 Steps to Hormonal Resilience

premenstrual syndromePMS is my favorite thing to treat because it responds so well to natural treatment. I love to hear patients say: “I was surprised when my period just arrived. I didn’t even feel it coming.”

No irritability. No headache. No food cravings. It is possible.

The first step to easy periods is to value female hormones. Both estrogen and progesterone are powerful assets, and not something to be switched off with hormonal birth control.

For example, estrogen boosts serotonin and oxytocin. It improves mood and libido and enhances insulin sensitivity. Progesterone is soothing and calming because it connects with GABA receptors. It’s also anti-inflammatory and supports thyroid function.

It’s precisely because your hormones are so beneficial that you feel it when they rise and fall and fluctuate.  But fluctuation is not a bad thing. Hormones fluctuate because they’re made in a cyclic pattern with ovulation, and that is the only way they can be made.  If you’re going to have female hormones, they’re going to fluctuate.

The PMS solution is to be physiologically adaptable to the natural, necessary fluctuation of hormones. I call this “hormonal resilience”.

PMS is common, but it's not normal.

The PMS Cure:

1. Enhance and stabilize progesterone

Women with PMS and PMDD (a severe form of PMS) have GABA receptors in the brain that are more sensitive to the ups and downs of progesterone. The strategy is to stabilize the GABA receptors and establish progesterone resilience.

Treatment ideas:

2. Reduce Estrogen Excess

Estrogen is a great hormone, but if you experience premenstrual irritability and breast tenderness, it may be a sign that you have a little too much estrogen.

The main way that estrogen contributes to PMS is that it can cause or worsen histamine intolerance. Read The Role of Histamine and Mast Cells in PMS and PMDD.

Treatment ideas:

  • Reduce histamine by avoiding cow’s dairy, alcohol, and high-histamine foods.
  • Supplement with vitamin B6 to assist with the healthy clearance of both histamine and estrogen.
  • Ensure adequate iodine, which stabilizes and down-regulates estrogen receptors.
  • Improve gut health to improve the metabolism and healthy clearance of estrogen.

3. Reduce Inflammation

Chronic inflammation interferes with hormonal health on every level. It impedes ovulation and depletes progesterone. It also impairs estrogen detoxification, blocks progesterone and GABA receptors, and hyper-stimulates estrogen receptors. Chronic inflammation is the perfect storm for PMS.

Treatment ideas:

  • Reduce inflammatory, histamine-activating foods such as cow’s dairy.
  • Supplement with natural anti-inflammatories such as magnesium.
  • Maintain healthy gut bacteria.

For more information, read Chapter 8 in Period Repair Manual.

34 thoughts on “The PMS Solution: 3 Steps to Hormonal Resilience”

  1. Hi Lara,

    I know this is an old post, but I wanted to ask about symptoms that come when the period actually arrives, rather than prior. I get headache, nausea and very low mood at the onset of bleeding – what does this mean? It usually last for the first day only, but ranges from the first few hours of period to the first two days. Getting my period used to be a relief, but now I absolutely dread it! The only thing that helps is anti-inflammatories (e.g. Voltarin), but I am avoiding them at the moment as I am trying to conceive. Would Vitex help with this, and if so, would it interfere with trying to conceive? I ovulate regularly, so was considering taking Vitex in the luteal phase only (in consultation with an ND), from what I’ve read I thought it might also help in TTC. Recent Day 3 blood tests seem to be in the upper limit of normal range (FSH – 9.5, LH – 5.8, E2 – 224pmol/L), or do you think these numbers are too high? I’m 37.

    Thank you so much!
    Claire

  2. Hi Lara. I have read your book many times and it has helped me very much. Although i just cant seem to get rid of pms. I have tried everything now and I just feel like I have to surrender and go on the pill.. I dont want to but I cant live like this any longer. I have two beautiful daughters who I”m distroying acting like this..

    I am 26 years old. My daughters are 4 and 1,5 years old. I eat healthy, organic, almost no additives at ALL. No dairy, no wheat, I dont use any “bad” hygiene products or cosmetics, avoid chemicals and plastics as much as I can. I take a prenatal vit/min supplement, 600-700 mg magnesium, extra zink, b6 in high dose, vitex, probiotics. my adrenals are fine and I have no candida/ other infections in my gut. I have a very healthy cycle ; always ovulation om day 14-15 and 14 days lutealphase. I bleed 60 ml a day 1-5 in cycle. No cramping at all. No spotting, no extremely large clots.

    But I have horrific symptoms. I am gaining weight, I have a lot of water retention, lumps in my breasts that wont go away, anger, depression, anxiety, apathy… I feel best durring cycle day 3-10, other weeks are just horrible and I just cant cope with it anymore. Before i started vitex (after reading your book) i had it even worse, it helped me right away from the start and now I cant even understand how bad it was back then… I tried to stop vitex to see what would happen but I just cant… I feel to awful in this already. Do you have any idea on whats causing my pms?

    Do you have any advice on something more I can try ?

    Thank you Lara

  3. Hi there. I ran across your website this weekend, and this post hit home for be. I’ve been searching for answers for several months, and every doctor I’ve seen just seems to want to bandage the problem without helping me find a solution. I was hoping you might be able to give me some insight.

    I am 32, mostly healthy, and in decent shape. All my life, I’ve had wonderful menstrual cycles where I didn’t even know it was coming. No mood shifts, minimal cramping, etc. That changed this year, after back-to-back pregnancies.
    In late February of this year, when my babies were 5 months and 25 months, I started having anxiety symptoms. I saw a doctor, who checked thyroid levels, and basically sent me on my way. In May, I started my menstrual cycle again, and I am still breastfeeding.
    I have 2-3 days of anxiety and irritability at ovulation. Then about 3 days before my cycle begins, the mood change becomes EXTREME. It’s rage and anger and insanity and sheer frustration, mixed with heart palpitations. That lasts a few days into my bleeding… and then also once I begin bleeding, I get several days of extreme heart palpitations, get winded really easily, can’t catch my breath even when just sitting. No pain or cramping, just all around feeling awful.. like it’s taking too much out of me or something. It has seemed to get worse; last month I was practically non-functional for about a week. Heavy bleeding, lasting 7-8 days. And then… it’s over, and I’m fine again.

    I saw another doctor 2 weeks ago, and she prescribed an antidepressant. I have been contemplating taking it, just because I can’t live with the mood shift, but I don’t think that’s the answer. I KNOW I’m not depressed. I KNOW this isn’t normal. It’s very obvious that this has something to do with the hormone shift, but I just don’t know enough to be able to pinpoint a cause.

    Does this ring any bells for you? Is there anything you’d suggest I try, or get tested, or… any input at all? Like I said, I’ve been reading your website, but am not sure if anything yet.

  4. Lara, quick question if you have PMS – breast pain and swelling – ( which vitex has helped with ), which indicates estrogen excess but the your period itself it light, not clots and fairly painless – is this not a typical presentation of excess estorgen ?

    • Generally, a light period means a lower level of estrogen, but breast pain can occur even in a lower estrogen situation. It can be from elevated prolactin (which is why Vitex would help), and iodine deficiency.

  5. Hello there. Thank you so much for your work and for creating this blog. I am wondering how much shatavari you would recommend taking per day and if you think a specific form (either powdered or as an extract) would be superior? Thank you so much.

  6. Hello Dr Briden!
    Ive read your blog and that helped me a lot to look what is the cause of my Problems. so Thanks for that!
    I’m suffering from acne since i was 13 Years old. When i was 18 i took an anti-androgenic pill and all of my chest and back acne was gone. over 2 years ago i stopped taking the pill and started taking estroblock. after a year of taking Estroblock it stopped working and my acne came back again. not as bad as it was before, but i was not amused. I’m 25 years old now and i have always had reggular cycles since i stoped taking birth controll (als0 before and while taking birth control). My cycle is always exactly 28 days long. I do suffer from pms and i do feel it when i ovulate every month. And after that, my pms starts to show. My acne gets a bit better within the first part of my cycle and after i ovulate it gets slightly worse. Last month i have tried agnus castus/ Vitex and within 3 weeks my skin was clear. I was so exited, but after the 4th week my acne came back with big under the skin sitting pimples , even on my forehead where i never get pimples, so i stopped taking Vitex and got my Period on the thirtieth day of my cycle( al little later than usual) This is now over 4 weeks ago and my skin got better again, but i have little pimples all over my chest and shoulders. Does this mean Vitex isnt for me? My doctor did a hormone -test and i didnt get the results yet. She testet my DHEA levels, as well as my Testosterone and Progesteron, but she said that she thinks that nothing will be wrong with my hormones, because i get my period so regulary and that im just sensitive to Testosterone and that the birth control would help. I dont want to take birth control anymore, because it made me feel depressed and not good at all. Do you think my doctor is right with the Testosterone- sensitvity?
    Excuse my English, I’m from Germany and i’m not the best English-Speaker or writer.
    kind regards
    Anni

  7. Hello, ive read most of the period repair book, I have had severe pms for as long as I can remember but sadly I also have endometriosis, I cried when I read it could be an auto immune disorder, obviously the spotting means I have even more pms, my life can be a misery. My gyno told myself that I hv a poor quality of life but on the brightside I hv already cut out all the foods mentioned before reading the book. I’m determined to have a healthier quality of life. I’m going to see an endometriosis specialist as I went round in circles with general gynaecology. But I understand it will be drugs I’ll be offered I cannot even have the mirena coil as my mood would drop so low it was frightening. Any pill makes me a complete wreck.

  8. Hi Laura,

    A month ago I was reading through this post and landed on your comment, “If you experience depression and insomnia before your period, then your estradiol is dropping away too quickly. You might benefit from estrogen-promoting herbs such as Tribulus and Shatavari.” I am a thin PCOS’er who suffers from low libido (3 months off the pill) and experiences insomnia in the last week of my cycle. I thought I might benefit from your herb recommendation.

    I started taking Shatavari (only every other day and at half the recommended dose to be safe) and noticed instantly that my libido increased greatly and I had more energy. I was sleeping much better but I also noticed that my daytime anxiety worsened with this additional energy. Within 3 days of starting Shatavari I bled for 3 days and wasn’t sure if this was a late period or heavy spotting. Things were going great, except for the slightly increased anxiety, until my last week. At day 25 I was hit with terribly insomnia and anxiety and had heart palpitations and racing thoughts, much more so than usual. I stopped taking Shatavari because I am worried that I am estrogen dominant and am making the situation worse.

    Here is my question: Is it possible to have the high-estrogen variant of PMS and also have estradiol drop away too quickly at the end of the cycle? If so, what are some methods to ease the transition at the end of the cycle to maintain estrogen but not increase it?

    Thanks,
    Sara

    • Also, I should add that I experience nipple pain the week before my period. I also didn’t get a period this time around, I am currently 2 days late.

      • As I mentioned, you’ve probably started to ovulate, so you’re experiencing a lot more estrogen than before.
        Just for completeness, I should add that nipple pain + late period might mean you want to do a pregnancy test.

    • Great question. Yes, it is possible to have high estrogen at times, and low estrogen at times. With my patients, I address that by stabilising estrogen receptors (with magnesium, iodine, healthy intestinal bacteria — as I describe in my book).
      Also, in your case, keep in mind that you are only 3 months off the Pill, so your hormones would naturally be changing. You may have been relatively low estrogen to begin with, but then your hormones started surging as you starting having ovulatory cycles.

  9. Dr. Lara, I previously asked you about my short cycles. My cycles had been only 24-25 days for a couple years. I reduced my caffeine consumption, which was way too high. I also started taking turmeric and pumpkin seed oil every day. I had a normal 29 day cycle this time around, with no P.M.S.! Thanks for doing this blog, it is so helpful.

  10. Lara, I have a complex problem, I was estrogen dominant so the Dr prescribed progesterone cream however I have 10 times the normal level now and my other hormones are off. I have gained weight ,but my breasts are very enlarged how do I lower my progesterone level and get my breasts back to normal size?

    • Was that high progesterone picked up with saliva test? That’s a common finding, and it should go down on it’s own quite quickly. My favorite treatment for breasts is iodine. Iodine calms the hormone receptors in breast tissue. Please see my breast-iodine post.

  11. Lara, what are some reasons your Estrogen would drop too quickly in the low Estrogen variant? Are there any vitamins/minerals (no herbs please) that can help increase low Estrogen?

    • A low baseline estrogen can be the result of stress, low body weight, smoking, or excess soy. I usually start by looking at those lifestyle factors.

  12. Hi Lara, I have been researching what the best easily-absorbed turmeric supplement is. Some are saying to get Curcumin, and it seems that bioperine/black pepper is included in some supplements to help it be absorbed–I’m not sure which to purchase. Do you have a specific brand or formula to recommend?

    • Hi Kim, wild yam contains diosgenin, which is a phytoestrogen. It can be converted to progesterone but only in the lab – – not in your body. The confusion started in the 1990s when many “wild yam” creams also contained actual (bioidentical) progesterone (the hormone). Bioidentical progesterone works best as a topical cream.
      On the other had, wild yam itself is a useful female herb. Phytoestrogen such as diosgenin buffer estrogen, so they’re helpful for PMS. But they’re best taken orally.

        • No, I don’t see any value in wild yam as a cream.
          You can try it as a tablet, but wild yam is not my first choice for PMS. Better choices are Vitex or anti-inflammatory herbs such as turmeric.

  13. Dr. Lara, I used to have normal 28 day cycles. Since the birth of my third child I’ve had unusally short cycles (24 days) and pms (I never noticed it before). I’m sure I’m still ovulating because I usually get ovulation pain. I also just generally feel irritable and my hair is thinning. I’m only 28. I’m not on any hormonal birth control. Any help greatly would be greatly appreciated. Thanks!

    • There are lots of reasons for a shortened cycle in young women. Most common reason is stress or a problem with your HPA axis (adrenal health). I discuss adrenal health in my upcoming book. You should also think about thyroid.

  14. Hey lara, I was curious how pregnenolone fits in the pms, hairloss, hormonal picture. What exactly is it & what is it supposed to do?

    • Pregnenolone is the precursor steroid to all of our other steroid hormones including DHEA and progesterone. Looking at the steroid cascade, you can see it’s position early – just after cholesterol. Pregnenolone also seems to have some direct activity in the brain, where it blocks GABA.
      I know that some people supplement with it, but in my thinking it’s a bit of wild card. We have no way of knowing which steroid pathway it will then go down (testosterone? estrogen? cortisol?).

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