Nutritionist Ro Huntriss looks at how your diet can affect premenstrual syndrome, a common condition affecting nearly half of women worldwide.

Premenstrual syndrome (PMS) is the name used for the symptoms that some women experience in the weeks or days leading up to their period. Not all women experience PMS however the worldwide prevalence is estimated to be 47.8%, making it much more common than one may expect.

So what is PMS and how does it affect people? Each person's symptoms vary and they can differ from month to month. Most of the time symptoms don't disrupt daily life. However they can on occasion, and many women need to seek treatment options for their symptoms on a monthly basis. One study found that 23-31% of women who experience PMS do so to a degree where it affects their daily life.

PMS can affect mental health. It can affect people’s quality of life, can increase levels of stress and has even been linked with depression. Open conversations about how PMS affects people and what coping strategies are available are important, not only to help women who experience it understand that they are not alone but also so it is understood that there is support available.

Speaking openly about PMS also allows people who have not experienced it to be educated on what it is and what its effects can be. For example, previous research has suggested that non-menstruating people such as men, know little about PMS and can be insensitive toward women at this time. Discussing PMS can help promote empathy and support personal and professional relationships.

Talking about the condition more also allows more people to recognize that more research is required to understand the condition, encouraging more funding for research studies to investigate the PMS with the hope of finding potential management options.

What is PMS? The main symptoms of PMS

PMS is a collection of symptoms that occur in the weeks or days leading up to a woman’s period. They can vary person to person and even month to month and can range in severity.

Symptoms include:

• breast tenderness
• headaches
• mood swings
• feeling upset, anxious or irritable
• tiredness or trouble sleeping
• bloating or tummy pain
• spotty skin or greasy hair
• changes in appetite and sex drive

There is a severe form of PMS called Premenstrual Dysphoric Disorder. It differs from PMS with respect to the intensity of symptoms and the predominance of mood symptoms and is associated with significant functional impairment which can have a major impact on quality of life.

What causes PMS?

The exact physiological mechanism behind why PMS symptoms occur is unknown. It is thought however that it happens in response to the cyclical changes in the hormones estrogen and progesterone during the menstrual cycle, particularly in the luteal phase when hormone levels peak and then drop significantly.

Proposed theories for why symptoms occur include the effect of progesterone on neurotransmitters such as serotonin, opioids, catecholamine and GABA. Increased prolactin levels or increased sensitivity to the effect of prolactin, insulin resistance, sensitivity to endogenous hormones, abnormal hypothalamic-pituitary-adrenal axis function and nutritional deficiencies.

Research has found that symptoms of PMS can be exacerbated by certain elements of our diet and lifestyle. For example, smoking is associated with an increased risk of reporting psychological and behavioral symptoms.

How might your diet negatively affect PMS?

Research has shed light on multiple ways in which diet is linked to PMS and its symptoms. For example, if your diet is higher in calories, fat, sugar and salty foods, this may increase your risk of experiencing physical symptoms of PMS.

Linked to this, research has also shown that there is a relationship between weight and risk of PMS. For instance, one study found that for every 1kg/m2 increase in BMI there was a 3% increase in PMS score. It is thought that carrying higher amounts of body fat can interfere with hormonal and neurochemical factors which could lead to symptoms.

Drinking alcohol is associated with a moderate increase in the risk of experiencing PMS. Heavy drinking specifically is associated with a more considerable increase in risk.

Not consuming enough calcium and vitamin D, particularly during the luteal phase of the menstrual cycle, may play a role in causing or exacerbating the symptoms of PMS.

How might your diet positively affect PMS?

Conversely, there are multiple ways in which your diet can positively affect PMS.

Aim for 5 portions of fruit and vegetables per day

Some evidence suggests that women with PMS may have decreased antioxidant status and increased levels of inflammation. We know that fruit and vegetables contain an abundance of antioxidant nutrients. Fruit consumption specifically has been associated with decreased risk of reporting behavioral symptoms of PMS.

Consume adequate amounts of calcium and supplement with vitamin D

A diet that is rich in calcium and vitamin D has been shown to eliminate or at least reduce the symptoms of PMS. Calcium can be found in dairy foods such as milk or yoghurt or fortified plant-based alternatives. Canned sardines and salmon with bones in as well as tofu made with calcium sulphate are good sources of calcium. We cannot get adequate amounts of vitamin D from food alone and so in the winter months, specifically October to March in the UK, is it recommended to supplement with at least 10mcg of vitamin D to ensure we are getting adequate amounts.

Include rich sources of vitamin B6

Evidence suggests that vitamin B6 could be beneficial for treating PMS. Pork, poultry, some fish, peanuts, soy beans, wheatgerm, oats, bananas, milk and some fortified breakfast cereals are good sources of vitamin B6. The nutrient reference value for vitamin B6 is 1.4mg/day however additional vitamin B6 can be taken in the form of a supplement. The safe upper limit proposed by EFSA is 12mg/day.

Consider your intake of zinc

Ensuring you are getting enough zinc in your diet could be beneficial for supporting sleep in women who suffer from poor sleep due to PMS. Meat, fish and other seafoods are the richest sources of zinc, it can also be found in supplement form.

Include wholegrains

Research has found that swapping refined grains to wholegrains can lead to significant decreases in the general, mood, physical and behavioral symptoms of PMS. Wholegrains are rich in vitamins and minerals and maintain all of the grain kernel including the bran, endosperm and germ.

Opt for a Mediterranean-style dietary pattern

Some research suggests that low adherence to a Mediterranean-style diet and a higher intake of bread/snacks is associated with an increased risk of PMS.

Key takeaways

• PMS is a widespread condition affecting nearly half of menstruating people

• Its symptoms occur every month and can vary between women

• Symptoms can disrupt daily activities and affect the quality of life

• Diet and lifestyle can influence the severity and likelihood of symptoms

• Seek advice from your healthcare provider if symptoms are affecting your daily life