Premenstrual Syndrome (PMS)

Treatment Protocols for PMS

Premenstrual syndrome (PMS) is a condition characterised by physical and psychological symptoms that occur during the week before menses begins (luteal phase) and end within a few days of the onset of bleeding. PMS symptoms do not occur in prepubertal, postmenopausal, anovulatory women, or women who have undergone oophorectomy (removal of ovaries). Approximately 75% of women experience PMS to some degree. PMS should not be confused with dysmenorrhoea, which refers to pain or cramps during menstruation. Progesterone, oestrogen and their metabolites—secreted in high amounts in the luteal phase— and their variable tissue metabolism may be responsible for PMS.

Decreased synthesis of serotonin during the luteal phase may also play an important role of this neuroendocrine mechanism in PMS. Premenstrual Dysphoric Disorder (PMDD) is a severe, disabling form of PMS. In PMDD, the main symptoms are mood disorders such as depression, anxiety, tension, and persistent anger or irritability. These severe symptoms lead to problems with relationships and carrying out normal activities. Women with PMDD usually also have physical symptoms, such as headache, joint and muscle pain, lack of energy, bloating and breast tenderness. According to the American Psychiatric Association, a woman must have at least five of the typical symptoms to be diagnosed with PMDD. The symptoms must occur during the two weeks before her period and go away when bleeding begins.


Factors that can contribute to PMS include:

  • Personal or family history of depressive mood, anxiety or bipolar disorders
  • History of postpartum depression or psychotic episodes
  • High consumption of caffeine, salt, chocolate, tobacco and/or alcohol
  • History of other reproductive disorders – e.g., PCOS, endometriosis, etc
  • Poor blood glucose regulation – e.g., insulin resistance, hypoglycaemia
  • Nutritional deficiencies – such as vitamin B6, essential fatty acids, iodine, magnesium and/or zinc
  • Excessive fluid retention due to poor lymphatic function and/or hypoadrenalism
  • High glycaemic load diet
  • Dysbiosis and leaky gut
  • Increased toxic load
  • Disordered oestrogen metabolism


Common signs and symptoms of PMS include:

  • Mood swings and/or depression
  • Irritability anxiety, insomnia and/or nervous tension
  • Mental confusion, poor concentration and forgetfulness
  • Abdominal bloating, distension and weight gain
  • Breast swelling and tenderness
  • Fatigue often accompanied by sleep disorders (e.g., insomnia, hypersomnia)
  • Physical fatigue / weakness and mental fatigue
  • Skin disorders (e.g., acne, oily skin)
  • Changes in appetite, including food cravings (e.g., chocolate) or overeating
  • Changes in libido
  • Headaches, backaches, and cramps
  • Joint or muscle pain
  • Headaches and/or migraines
  • Digestive issues, such as Irritable Bowel Syndrome (IBS) or nausea


Treatment for PMS

Many factors can contribute to PMS (as detailed in the list above), and for each individual a number of factors are usually at play. Effective treatment involves:

  • Supporting progesterone synthesis (where mood disturbances and/or breast tenderness predominate)
  • Addressing hormonal imbalance ensuring healthy oestrogen metabolism and clearance
  • Correct nutrition to manage mood, blood sugar control and support hormonal balance 
  • If with premenstrual IBS, considering dietary sensitivities or environmental toxicity
  • Correcting dysbiosis (gut flora imbalance)
  • Supporting health of the thyroid gland (if hypothyroid)


Herbal Medicines, Diet, Specific Nutrients and LIfestyle factors play an important role:

  • Herbal Medicines: Chaste Tree, St John's Wort, Kava, Turmeric, St Mary's Thistle, Barberry, Phellodendron, Peonia, Cramp Bark, Corydalis, False Unicorn, Fennel and others
  • Nutrients: Iodine, Zinc, Pyridoxal-5-phosphate (B6), Activated B Vitamins, Magnesium, EPA & DHA, Calcium D-Glucarate, Idole-3-Carbinol and others
  • Probiotics (if dysbiosis present): Lactobacillus rhamnosus GG (LGG), L. plantarum (299v) and others
  • Diet: Anti-inflammatory diet, Identify food intolerances, low alcohol and caffeine, minimise processed foods
  • Lifestyle: Activities that help relieve stress e.g. bush walking, yoga, tai chi, meditation, relaxing baths. Regular exercise is also important