Premenstrual Syndrome: Finding Balance Through the Storm
Janet Maendel DO(EUR), DNM
Premenstrual Syndrome (PMS) is widely recognized as a cluster of emotional and physical symptoms that appear in the days or weeks before menstruation, but the popular definition only scratches the surface of what is happening physiologically. While mild discomfort is considered normal, many women experience symptoms significant enough to impair quality of life—cramping, bloating, fatigue, headaches, breast tenderness, mood swings, irritability, anxiety, depression, and cognitive changes such as poor focus or forgetfulness. These experiences are not random inconveniences; they are outward signs of imbalance within a woman’s internal environment, pointing toward deeper disruptions in hormonal regulation, inflammation, and stress physiology.
Menstrual Cycle Rhythm
A healthy menstrual cycle is remarkably coordinated, unfolding like a rhythm or dance between hormones, the brain, and the ovaries. The follicular phase, beginning with menstruation, reflects an intricate exchange of signals along the hypothalamic–pituitary–ovarian axis as the brain cues the ovaries to mature follicles and produce estrogen. Rising estrogen eventually triggers ovulation, leading into the luteal phase, where the corpus luteum generates progesterone. If fertilization does not occur, progesterone declines and the cycle begins again. When this rhythm is intact, PMS symptoms remain mild. Yet even small shifts in timing, hormone production, detoxification, or receptor sensitivity can set off a cascade of symptoms. Because every hormone influences the next, imbalances rarely occur in isolation. Instead, they ripple outward like a row of dominoes.
Hormone Metabolism and Detoxification
One of the central contributors to PMS is impaired hormone metabolism—particularly the detoxification of estrogen. The liver plays a critical role in processing estrogen into safe metabolites, but when nutritional deficiencies, inflammation, oxidative stress, insulin resistance, fatty liver, or genetic variations interfere with this process, estrogen can accumulate in more reactive forms. These partial metabolites may linger longer in the system and exert stronger effects, contributing to heavier periods, mood changes, breast tenderness, or intensified cramping. Genetic differences in detoxification pathways (such as variations in CYP1A1, CYP1B1, or CYP3A4) can further influence how efficiently hormones are metabolized. These genetic tendencies are not destiny; they are modifiable through targeted nutritional, lifestyle, and botanical support.
Inflammation
Inflammation is another foundational factor. In a healthy cycle, the uterus generates inflammatory prostaglandins to stimulate contractions that help the body shed its lining. When underlying inflammation is already elevated—due to poor diet, chronic stress, metabolic dysfunction, autoimmune activity, or environmental toxins—this natural process becomes amplified, resulting in more severe cramping and pain. Inflammation also affects the brain and gut, disrupting serotonin levels and contributing to emotional symptoms such as anxiety, irritability, or feelings of depression before menstruation. Chronic inflammation taxes the immune system, interferes with cellular repair, and is implicated in nearly all modern chronic conditions, from joint pain to autoimmune disease.
Stress
Modern stress physiology adds another layer of complexity. The stress response, designed to activate briefly in moments of danger, now remains chronically elevated for many women. Persistent cortisol elevation creates inflammation, disrupts sleep and circadian rhythm, raises insulin, and competes with sex hormones for metabolic resources. Over time, this results in hormone dysregulation that intensifies PMS symptoms. For some women, unresolved pelvic trauma or chronic tension patterns may further amplify sensitivity during the menstrual cycle, calling for trauma-informed therapeutic approaches.
Because the hypothalamic–pituitary–adrenal axis governs both stress hormones and reproductive hormones, any disruption in one system inevitably affects the other. Thyroid function is also intertwined with this network, which is why symptoms of PMS often intersect with symptoms of thyroid dysfunction. Environmental factors contribute as well. Exposure to endocrine-disrupting chemicals—found in plastics, cosmetics, pesticides, cleaning products, heavy metals, and even certain medications—can mimic or interfere with natural estrogen. These xenoestrogens bind to receptors, alter signaling, and increase hormonal burden in the body, exacerbating symptoms.
Test & Assess
For these reasons, meaningful evaluation goes beyond tracking symptoms. Urinary hormone metabolite testing offers insight into how estrogen and progesterone are being processed, where detoxification bottlenecks may exist, and which epigenetic influences may be involved. Blood tests can assess hormone levels at strategic points in the cycle,
while fasting insulin, HbA1c, and metabolic markers reveal whether glucose regulation is contributing to inflammation. Basic labs such as a CBC and CMP can uncover nutrient deficiencies or immune imbalances that influence hormone production.
PMS can also be influenced by underlying conditions such as endometriosis, polycystic ovarian syndrome (PCOS), premature ovarian insufficiency, Hashimoto’s thyroiditis, and other autoimmune disorders. Identifying these conditions early allows for more targeted support and prevents unnecessary suffering.
When women ask, “What can I do for PMS?” the most honest answer is that relief comes from addressing the interconnected systems driving the symptoms—not from a single remedy. Nutritional therapy is often the most powerful place to begin. Anti-inflammatory diets rich in fiber, whole foods, healthy fats, and micronutrients support hormone production, detoxification, and gut health. Stabilizing blood sugar alone can have a profound impact on mood, inflammation, and cramping.
Interventional Approaches
Botanical and supplemental interventions offer additional support. Magnesium, omega-3 fatty acids, vitamin D, ginger, curcumin, cramp bark, and hormone-modulating herbs such as chaste tree, peony, motherwort, and fennel can significantly reduce symptoms when used appropriately. Supporting liver function through botanicals like milk thistle enhances estrogen metabolism and reduces toxic metabolite load.
Lifestyle Measures
Lifestyle practices play equally important roles. Exercise remains one of the most effective, evidence-based therapies for PMS, improving mood, metabolism, circulation, immune function, and hormonal balance. Sleep—one of the body’s most potent regulatory systems—anchors circadian rhythm and coordinates detoxification, hormone production, and cellular repair. Even one disrupted night can affect multiple physiological pathways that contribute to PMS. Ancient practices such as cycle-syncing with the lunar rhythm, though not strongly supported by research, may offer structure and encouragement for women who find nourishment in cyclical living. Acupuncture has shown measurable benefits, improving overall PMS symptoms by rebalancing nervous system and endocrine function. Castor oil packs, warm baths with Epsom salts, and intentional relaxation support pelvic blood flow, decrease inflammation, and calm the nervous system.
Finally, creating a healthy internal and external environment is crucial. While it is impossible to eliminate all toxins, women can meaningfully reduce exposure by choosing
cleaner water, organic foods, low-toxin personal care products, and reduced plastic use. Just as important are the toxins we hold internally. Negative thoughts and chronic worry activate the same stress pathways that worsen PMS. Gratitude—unlike a simple expression of thanks—represents a cultivated internal state that reduces stress hormones and shifts the body toward healing.
As women learn to support their physiology, nourish their bodies, and cultivate peace rather than pressure, the premenstrual phase transforms from a storm to a signal—an opportunity to listen more deeply and care more intentionally for themselves.