PMS: Looking Beyond the Monthly Symptoms

Dr. Tracy Tranchitella, ND | Sunrise Functional Medicine

For many women, the days leading up to a menstrual period bring a familiar collection of changes. Perhaps it’s the sudden irritability, the fatigue that seems to come out of nowhere, or the bloating that makes your favorite jeans uncomfortable. Maybe you experience headaches, food cravings, trouble sleeping, or a mood that feels noticeably different from the rest of the month.

If this sounds familiar, you’re not alone. Premenstrual syndrome (PMS) affects an estimated 75% of women of reproductive age. Although symptoms vary from person to person, many women experience a predictable pattern of physical, emotional, or behavioral changes in the days before their period begins. For some, these changes are relatively mild. For others, they can interfere with work, relationships, sleep, and everyday activities. But what if we looked beyond the symptoms themselves?

From a functional medicine perspective, PMS offers an opportunity to explore the connections between hormonal fluctuations, nutrition, gut health, brain chemistry, and other factors that may influence how a woman feels throughout her menstrual cycle. Understanding these connections can help guide a more individualized approach to supporting menstrual health and overall well-being.

What Does PMS Look Like?

PMS doesn’t look the same for every woman. While one person may struggle with mood changes, another may experience physical discomfort, fatigue, or digestive issues. Some women experience a combination of symptoms that change in intensity from month to month. Emotional and behavioral symptoms may include:

• Irritability, anger, or sudden mood swings
• Feelings of anxiety or a depressed mood
• Crying more easily than usual
• Food cravings or changes in appetite
• Difficulty sleeping
• Trouble concentrating or brain fog
• Withdrawing from social activities
• Changes in libido

Physical symptoms can include:

• Breast tenderness
• Headaches or migraines
• Acne breakouts
• Fatigue
• Muscle or joint discomfort
• Abdominal bloating
• Fluid retention and temporary weight gain
• Constipation or diarrhea

One of the distinguishing features of PMS is its timing. Symptoms typically develop during the days leading up to menstruation and improve shortly after the period begins. Recognizing this recurring pattern is an important first step toward understanding what’s happening. If symptoms are consistently interfering with your daily life, keeping a menstrual symptom journal can help you identify patterns. Record when symptoms begin, how severe they are, when they resolve, and whether anything seems to make them better or worse. This information can be useful when discussing your concerns with a healthcare provider.

Why Does PMS Happen?

The precise causes of PMS aren’t fully understood. However, several factors may contribute to the symptoms women experience, and they don’t necessarily affect everyone in the same way. Functional medicine considers these potential influences together rather than assuming that one explanation accounts for every woman’s experience.

Hormonal Fluctuations and Menstrual Health

Hormones naturally fluctuate throughout the menstrual cycle. Estrogen and progesterone play important roles in this process, and changes in their levels may contribute to PMS symptoms. Research discussed in functional medicine suggests that estrogen and progesterone patterns may be relevant to symptom severity. However, the relationship isn’t as simple as having too much of one hormone or too little of another.

Women can respond differently to normal hormonal fluctuations, which may help explain why some experience significant premenstrual symptoms while others experience very few. Looking at hormonal patterns in the context of the menstrual cycle can provide useful information when evaluating a woman’s overall health.

The Connection Between Brain Chemistry and Mood

Have you ever noticed that your mood, concentration, or sleep seems to change during the days before your period? Serotonin, a neurotransmitter involved in mood regulation, is one area of interest in PMS research. Changes in serotonin activity may be associated with symptoms such as low mood, fatigue, sleep difficulties, and food cravings. This is one reason PMS shouldn’t be viewed solely as a reproductive health concern. The menstrual cycle, brain chemistry, sleep, and emotional well-being are interconnected. Understanding these relationships can help inform a more comprehensive approach to managing symptoms.

Nutrient Status Matters

Nutrition is another piece of the puzzle. Calcium and vitamin D have been studied in relation to PMS, with research suggesting a relationship between their status and symptom severity. B vitamins, particularly thiamine and riboflavin, have also attracted interest because dietary intake has been associated with differences in reported PMS symptoms. Magnesium is another nutrient worth considering when evaluating overall nutritional status.

These nutrients support a variety of normal bodily functions, and inadequate intake or deficiencies may affect overall well-being. However, symptoms alone cannot establish that a nutrient deficiency is present. A closer look at dietary habits and, when appropriate, laboratory testing can help determine whether nutritional concerns deserve attention.

Gut Health and Hormonal Balance

Your digestive system does much more than process food. The gut microbiome—the community of microorganisms living in the digestive tract—plays a role in several aspects of health. Researchers are exploring whether changes in the composition and diversity of the gut microbiome may be associated with PMS symptoms. The gut also communicates with the brain through what is known as the gut-brain axis. This complex relationship is one reason digestive health is of interest when considering mood, stress, and overall well-being.

Evaluating digestive health may be worthwhile when a woman experiences PMS alongside bloating, changes in bowel habits, or other gastrointestinal concerns. The goal is to understand whether digestive issues may be part of a broader pattern that deserves attention.

Environmental Exposures and Hormone Health

Another area of interest involves endocrine disruptors. These are substances in the environment that can interfere with normal hormone signaling. Depending on the substance and the level of exposure, endocrine-disrupting chemicals may affect aspects of the endocrine system. Researchers have explored whether environmental exposures may also be associated with PMS symptoms. Reducing unnecessary exposure to potentially disruptive substances is one practical consideration within a broader approach to wellness.

It’s important to remember that exposure alone doesn’t establish the cause of an individual’s symptoms. Instead, environmental factors may be one of several considerations when evaluating overall health.

How Functional Medicine Approaches PMS

Because PMS can involve several overlapping factors, a functional medicine approach begins with the individual. Rather than assuming that every woman has the same underlying issue, the goal is to explore her symptoms, health history, nutrition, lifestyle, and other relevant factors to determine where additional support may be appropriate.

Looking More Closely at Hormonal Patterns

When hormonal fluctuations are a concern, a healthcare provider may consider hormone testing as part of an individualized evaluation. Traditional blood testing provides information about hormone levels at a particular point in time. Other testing methods, including dried urine hormone testing, can collect samples across different days of the menstrual cycle. This broader sampling approach can help evaluate hormone patterns over time rather than relying on a single measurement.

For example, the DUTCH Cycle Mapping Test is designed to assess hormone patterns across the menstrual cycle. A provider may consider this type of testing when the timing of symptoms suggests that a closer look at hormonal changes could be useful. Testing should be selected according to the individual’s symptoms and clinical circumstances. No single hormone test can independently diagnose PMS, and results need to be interpreted in the context of the menstrual cycle and overall health.

Evaluating Nutritional Status

If nutritional deficiencies are a concern, a provider may recommend an appropriate assessment of vitamin and mineral status. The results can help guide individualized nutrition recommendations and determine whether supplementation deserves consideration.

A balanced diet that includes a variety of nutrient-rich foods is a useful foundation. Some women may also benefit from reviewing their intake of calcium, vitamin D, magnesium, and B vitamins with their healthcare provider. The objective is to address identified nutritional needs rather than assume that everyone experiencing PMS requires the same supplements.

Exploring Digestive Health

For women with digestive symptoms or other reasons to investigate gut health, a provider may consider whether further evaluation is appropriate. Depending on the clinical picture, this might include stool testing to assess aspects of the gut microbiome. The results may help identify issues that warrant additional attention, although the presence of a particular microorganism or a change in microbial diversity doesn’t automatically establish the cause of PMS. When digestive concerns are present, individualized nutrition and other measures to support gastrointestinal health may become part of a broader wellness plan.

Considering the Bigger Picture

It is important to also consider how nutrition, lifestyle, environmental exposures, and other aspects of health may fit together. Depending on a woman’s history and symptoms, this may include reviewing potential environmental exposures, assessing relevant aspects of liver health, and considering whether additional testing is warranted. The important distinction is that testing should answer a meaningful clinical question. More tests aren’t necessarily better, and not every woman with PMS needs an extensive laboratory workup. A thoughtful evaluation can help determine which areas deserve attention and which are less likely to be relevant.

Supporting Menstrual Health Through Everyday Choices

Laboratory testing is only one possible component of a functional medicine plan. Everyday habits can also provide a foundation for supporting overall health.

Build a nutrient-rich eating pattern. A varied diet that includes vegetables, fruits, whole grains, legumes, and other nutrient-dense foods can help support nutritional needs. A Mediterranean-style eating pattern is one approach that has also attracted interest for its potential benefits to gut health.

Pay attention to digestive health. If bloating, constipation, diarrhea, or other digestive symptoms accompany PMS, discuss them with your healthcare provider. Addressing persistent gastrointestinal concerns may be an important part of your overall care.

Review your nutrient intake. If your diet is limited or you suspect a deficiency, a healthcare provider can help determine whether dietary changes or appropriate testing may be beneficial.

Consider environmental exposures. Reviewing everyday products and potential sources of environmental chemicals may help identify opportunities to reduce unnecessary exposure. The Environmental Working Group is one resource for learning more about potential exposures in daily life.

Track your symptoms. A simple monthly journal can reveal patterns that are easy to overlook when you’re busy managing everyday life. Note the timing, severity, and duration of symptoms, along with relevant changes in sleep, diet, or stress.

Approach supplements thoughtfully. Herbs such as chasteberry (Vitex agnus-castus) and evening primrose oil have been explored for menstrual symptom support. However, the evidence and suitability of these products vary. Supplements can also interact with medications or be inappropriate in certain circumstances, so discuss them with a qualified healthcare provider before use.

These strategies aren’t a guaranteed solution, and there isn’t one universal plan for PMS. What proves helpful for one woman may not be appropriate for another. The value of an individualized approach is that recommendations can be guided by a woman’s symptoms, health history, nutritional needs, and clinical findings.

When PMS Deserves a Closer Look

It’s easy to dismiss recurring symptoms as something you simply have to live with. But when the days leading up to your period consistently leave you feeling physically uncomfortable, emotionally overwhelmed, or unable to maintain your usual routine, it’s worth having a conversation with a healthcare provider. Keeping track of your symptoms can help clarify the pattern and provide useful information for that discussion.

Although PMS is generally identified through its recurring pattern of symptoms rather than a specific laboratory test, additional evaluation may help explore other health concerns or contributing factors when appropriate. If symptoms are severe, persistent, or substantially interfere with your quality of life, seek professional evaluation rather than assuming they are simply PMS.

A More Individualized Approach to PMS

Premenstrual syndrome is complex, and its effects extend beyond the few days before menstruation. Hormonal fluctuations, nutritional status, digestive health, and other factors may all deserve consideration when a woman experiences recurring symptoms. Functional medicine offers a framework for exploring these connections and developing an individualized plan based on the person’s health history, symptoms, and clinical needs.

Dr. Tranchitella takes a comprehensive approach to health, looking at the factors that may be influencing how you feel rather than focusing on symptoms in isolation. If PMS is affecting your quality of life, you don’t have to navigate the questions alone. To learn more about working with Dr. Tranchitella and exploring an individualized approach to your health and well-being schedule a consultation today >> LEARN MORE