month you put up with all kinds of bull that you won’t tolerate the week before your period.
I say, let it be a lesson to you. Perhaps you should be putting up with less all month long. The dissatisfaction that comes on a monthly schedule is a gift to you, a chance to make some much-needed changes in how you’re living your life and how much you’re giving, bending, and stretching to meet everyone else’s expectations. What I stress with my patients is this: the thoughts and feelings that come up during this phase of your cycle are real; they are genuine. If you’re feeling overwhelmed or underappreciated, that you’re taking on more than your partner, or that things are out of balance, chances are it’s all true.
Remember that our animal imperative is to reproduce. Every cycle is a chance to propagate the species. Just as your hormones allow your uterus to fluff up and prepare for a new embryo, they also push you to “nest.” When a woman is in the later months of her pregnancy and progesterone levels are at their highest, there is a frenzy that overtakes her to clean the house and prepare for the arrival of her baby. Every month, when your body prepares for a possible embryo implantation, progesterone levels are building and causing a smaller form of nesting. Toward the end of the cycle, a woman might become dissatisfied with her environment and obsessive about making changes in order to make sure the setting is appropriate next month for the burrowing of the embryo into the uterine lining. PMS is a time of psychological inventory, to take stock and make sure you are where you want to be in your life. Every cycle is an opportunity for a fresh start, to make your life over the way you want it. Pay attention to that critical eye, to those judgmental thoughts. They are probably more valid than you’d like to believe, and I bet they’re actionable, too.
Women’s empathic skills can be a great source of useful information and strength, and there is some evidence that they are highest during our premenstrual days. PMS is a great time to tune in to intuition. Because of lower serotonin levels, we are more “raw” and less emotionally blanketed before we menstruate. It is a time to rest and reflect and to honor deep feelings. Sensitivity is dismissed in our culture, but it really does have its advantages. PMS is an opportunity to listen to your body and to honor your feelings. Trust your PMS bitchiness. And put it to good use the rest of the month. Harness the knowledge you garner when you’re more critical, write it down, and put it into action when you’re more genteel and diplomatic, as soon as your period ends. Try this for a month or two and see if you don’t have some “new month’s resolutions” of your own.
Chocolate and Other Treatment Options
In both depression and PMS, food cravings, typically for carbohydrates, are common. The usual suspects are comfort foods like breads, pastas, and desserts, particularly those of the chocolate persuasion. I’m not typically a dessert person, but if I find myself scrambling through the cabinets for leftover Halloween candy, I know my period is exactly two days away. There are studies that claim that craving chocolate during PMS is specifically American and therefore a learned cultural phenomenon and not related to anything physiological. The theory is that we have been taught that it’s okay to eat chocolate during PMS and we’re taking advantage of that accepted behavior by indulging when it’s our time of the month. I don’t buy that for a minute. First, your body requires more calories when you’re premenstrual, and sweets and carbs can provide them quickly. Second, your magnesium levels are low (premenstrual migraines are a reflection of this), and chocolate can boost magnesium levels.
The most important piece of the puzzle is again serotonin. In depression and in PMS, when serotonin drops, your body tries to fix that imbalance. It begins to want carbs, specifically sugar, and particularly chocolate. Eating carbs is known to boost serotonin levels, but try to stick with complex carbs like whole grains instead of sugary concoctions to avoid the insulin surge and crash of blood sugar levels that follow. Tryptophan is the amino acid your body uses to create serotonin, so it makes sense to eat foods high in tryptophan specifically, instead of carbs in general. One thing I tell my patients about chocolate cravings is that they can sometimes be satisfied by eating bananas, which are high in tryptophan. Milk, lentils, and turkey are also high in tryptophan, especially the dark meat, so the truth is, you’d be better off pulling a King Henry and munching on a turkey leg than scarfing down all those Oreos.
Here’s an even lower-calorie way to boost serotonin levels: the amino acid supplements L-tryptophan and 5-hydroxytryptophan (5HTP), the building blocks for making your own serotonin, are available in any health food store. Nutritional supplements, vitamins, minerals, and amino acids can offer significant symptom relief, but you’ll need to do more legwork to educate yourself about what’s recommended and how to take it. Because of aggressive lobbying, these supplements are not regulated by the FDA to the same extent that prescription medicines are; there can be tremendous variability among brands and even within brands. Enlisting the assistance of an herbalist or naturopath would be wise in many situations.
Vitamin B6 is also helpful for PMS, as it is a cofactor for serotonin synthesis. Adding a magnesium supplement, which can lower anxiety and prevent insomnia, is also a good idea in the days leading up to your period. Magnesium is a diuretic, so it’ll also help with your swollen boobs and bloated pelvis. Calcium can also lessen irritability and help with insomnia, so a calcium-magnesium supplement would work nicely. Sometimes caffeine (or pineapple or asparagus, natural diuretics) can help to get rid of some degree of the bloating and fatigue. Omega-3 fatty acids found in oily fish or fish oil supplements may also help cut down on reactivity and irritability.
Here’s the biggest tip I can give regarding PMS: regular exercise. Cardio, in particular, can help to reduce many symptoms of PMS and moodiness in general. It has been shown to be as effective as antidepressants in improving mood and energy level and reducing feelings of malaise. In many situations, daily cardiovascular exercise can do as much for you as SSRIs, without the weight gain and deadened libido.
Your diet also matters. Estrogen dominance can lead to heavier periods. Hormones in processed meat and certain chemicals in plastics, soaps, and pesticides can mimic estrogen, as can soy, which is added to many processed foods. If you do eat meat and poultry, make sure it’s organic, or at least labeled “hormone-free,” as the hormones used in the meat industry can potentially cause heavier periods. My patients who have switched to a vegetarian or vegan diet are enjoying lighter, less crampy periods. Also, keeping your weight at an optimal level can make a big difference in your monthly symptoms. The more body fat you have, the more estrogen your body is going to make, so aim for a leaner frame if you have significant PMS symptoms or especially heavy periods.
Timing is everything. When you do and don’t have sex can affect a slew of things. For instance, when you started having sex, and how often you have it, can affect fertility. If you started earlier and engage in it weekly, your cycles are more likely to be regular. Weekly sex, with its regular dose of pheromone exposure, also means you’re less likely to have heavier, painful periods, your fertility will more likely stay on track, and your menopause may even arrive later. One more important timing tip: abstaining from intercourse and from orgasm may be just what your uterus needs during menstruation. In a group of women with heavy periods, 83 percent reported sex during menses, compared with 10 percent in the group with lighter periods.
For severe PMS that affects functioning (missing work or school, being unable to perform household chores, having huge, regular blowups with everyone around you), there are prescription medication options. Psychiatrists will commonly prescribe SSRIs or SNRIs (serotonin
