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3 Common Mistakes Patients With PMS Make

Updated: May 1

1. Assume Their PMS Symptoms Are Universal, And Thus They Have To Live With Them.


While PMS is very common and seems to affect the majority of people who menstruate, it is not a universal condition. It is estimated that about 3/4* of menstruating people experience PMS at some point in their lives. 1/4 don't and people who have effective treatment often stop experiencing symptoms.



While the majority seem to be affected, that is not a reason to forgo seeking treatment if you find PMS symptoms adding challenges to your life. There are options in both the conventional and naturopathic systems that work quite well at symptom reduction or cessation.


2. Dropping All Carbohydrates From Their Diet


Carbohydrates are useful in moving tryptophan across the blood brain barrier. Tryptophan is used to make melatonin and serotonin, brain chemicals that help you sleep and be happy. Consuming carbohydrates has been shown to reduce the symptoms of PMS, in particular whole grains but increasing overall carbohydrate intake was also effective in studies that did not include whole grains.


Eating carbs helps women deal with PMS

The bottom line is whole grains helped but so did non-whole grain carbohydrates. Over fueling can also lead to worse PMS symptoms so increasing carbohydrate intake should be done with care and may not be right for everyone.


3. Drinking Too Much Alcohol

Women with PMS tend to drink more. There is debate about whether having PMS causes women to drink more or whether drinking more causes PMS.


A meta-analysis is one of the best kinds of studies. It eliminates some bias and pools data from multiple studies to bring us closer to the truth. A meta-analysis published in 2017 found that women who consumed an average one drink per day were 45% more likely to have PMS compared to non-drinkers. Women who consumed more then 8 drinks per week were 79% more likely to have PMS.


This is a pretty substantial increase but keep in mind, greater than 8 drinks per week can be an average of people who had just 8 drinks per week and people who drank substantially more. What we can conclude from this study is that drinking more is associated with greater risk of having PMS. Association does not equal causation but a dose response effect was found here so it seems likely.


Drinking alcohol is associated with worse PMS symptoms

Another study found similar results. Women who consumed more than 10 drinks per week where more likely to suffer from moderate to severe PMS symptoms compared to non-drinkers.


One small study took women with severe PMS and women with no PMS and injected both groups with alcohol during the follicular phase and during the luteal phase. They measured a PMS related hormone, allopregnanolone, and found that when alcohol was injected during the luteal phase (last half of the cylce) it caused allopregnanolone to fall in both groups. This fall was not seen in the follicular phase (first half of the cycle). Allopregnanolone is involved with the mood related symptoms of PMS. This study showed that alcohol can change the levels of a PMS related hormone in women with and without the condition.


In a perfect world, we would have randomized controlled trials comparing many different levels of alcohol consumption on PMS symptom severity but we don't have that at this point. We have enough information to know that alcohol consumption is likely a contributor to PMS and heavy drinking is more harmful than light drinking but I don't have the evidence to back exactly how many drinks would be "safe" or not contribute to effects.


*I know about that one Canadian study that claims 99% of women experience PMS. Some studies use a broader definition of PMS or have different methodology then other studies. Different studies find different prevalence rates but 99% seems like an outlier. However, as more studies are done and more data collected, I expect these numbers will change a bit over the years.


Sources

Casper, R. Feb 4th 2021. Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the Basics). UpToDate.


Steiner M. Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. J Psychiatry Neurosci. 2000 Nov;25(5):459-68. PMID: 11109297; PMCID: PMC1408015.


Bhuvaneswari K, Rabindran P, Bharadwaj B. Prevalence of premenstrual syndrome and its impact on quality of life among selected college students in Puducherry. Natl Med J India. 2019 Jan-Feb;32(1):17-19. doi: 10.4103/0970-258X.272109. PMID: 31823933.


Sayegh, R., Schiff, I., Wurtman, J., Spiers, P., McDermott, J., & Wurtman, R. (1995). The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstetrics and Gynecology, 86(4 Pt 1), 520–528.


Wurtman, J. J. (1990). Carbohydrate craving. Relationship between carbohydrate intake and disorders of mood. Drugs, 39 Suppl 3, 49–52.


Houghton, S. C., Manson, J. E., Whitcomb, B. W., Hankinson, S. E., Troy, L. M., Bigelow, C., & Bertone- Johnson, E. R. (2018). Carbohydrate and fiber intake and the risk of premenstrual syndrome. European Journal of Clinical Nutrition, 72(6), 861–870. https://doi.org/10.1038/s41430-017-0076-8


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 Nutrition, 121(9), 992–1001. https://doi.org/10.1017/S0007114519000333


Bridget L Perry, Donna Miles, Karen Burruss, and Dace S Svikis

Journal of Studies on Alcohol200465:4, 464-468


Fernández, M. del M., Saulyte, J., Inskip, H. M., & Takkouche, B. (2018). Premenstrual syndrome and alcohol consumption: A systematic review and meta-analysis. BMJ Open, 8(3). https://doi.org/10.1136/bmjopen-2017-019490


Caan B, Duncan D, Hiatt R, et al. Association between alcoholic and caffeinated beverages and premenstrual syndrome. The Journal of Reproductive Medicine. 1993 Aug;38(8):630-636. PMID: 8410870.


Bäckström T, Bixo M, Johansson M, Nyberg S, Ossewaarde L, Ragagnin G, Savic I, Strömberg J, Timby E, van Broekhoven F, van Wingen G. Allopregnanolone and mood disorders. Prog Neurobiol. 2014 Feb;113:88-94. doi: 10.1016/j.pneurobio.2013.07.005. Epub 2013 Aug 23. PMID: 23978486.


Nyberg, S., Andersson, A., Zingmark, E., Wahlström, G., Bäckström, T., & Sundström-Poromaa, I. (2005). The effect of a low dose of alcohol on allopregnanolone serum concentrations across the menstrual cycle in women with severe premenstrual syndrome and controls. Psychoneuroendocrinology, 30(9), 892–901. https://doi.org/10.1016/j.psyneuen.2005.04.016

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