PMS - What is it & what can help?

PMS - What is it?

PREMENSTRUAL SYNDROME

PMS describes a wide range of "psychological, physical, and behavioural" symptoms, which occur in during certain stages of the menstrual cycle (Pearce et al, 2020). These typically occur during ‘Phase 4’ or the late luteal phase, approximately 5-11 days before your period arrives.

One study reviewed by Yesildere Saglam & Orsel (2020) states that "more than 300 physical, psychological, emotional, behavioural and social symptoms have been shown to be associated with PMS". Which is quiet a lot, when you think about it!

It is thought that up to 90% of women suffer from mild PMS symptoms throughout their life, whereas around 20% of women have symptoms that affect their daily life. Symptoms can vary, but the most common ones are

PMS Symptoms

• Lower back pain

• Cramps

• Breast tenderness

• Headaches

• Nausea

• GI distress

• Weight gain

• Fatigue

• Irritability & mood swings

PMS in Active & Exercising Women

A recent study by Gerogie Bruinvels et al in the British Journal of Sports Medicine, surveyed 6,812 women in 7 countries who were Strave app users.

The study looked at Menstrual Cycle Symptoms, so PMS, primary dysmenhorrea (pain while menstruating with no underlying cause) and ovulation pain.

They found that menstrual cycle symptoms were common amongst exercising women and "a cause for women to miss or change exercise training and competition, to be absent from work/lectures and to use pain medication for treatment."

The most prevalent symptoms were:

• Mood changes/anxiety (90.6%),

• Tiredness/fatigue (86.2%),

• Stomach cramps (84.2%)

• Breast pain/tenderness (83.1%)

MISSED TRAINING BUT NOT MISSED COMPETITIONS

What is interesting is that the paper found women were more likely to miss/change training or take pain medication than they were to miss work or a competition.

This suggests that women are likely to compete even with significant symptoms, further suggesting that women can "ignore or override" certain symptoms.

Nevertheless, the fact that so many women do suffer from significant PMS means that we should normalise the conversation amongst exercising women/athletes and coaches.

PMS - So what can you do?

1. TRACKING YOUR CYCLE & SYMPTOMS

One approach that I strongly believe in for myself and my clients, is that getting to understand YOUR cycle by tracking your menstrual cycle and symptoms can help you be more in tune with your body’s needs. It also empowers us to take ownership of our help and create a toolbox of strategies that we can have on standby when PMS hits.

The Bruinvels et al. paper suggestion is that exercising women should be screened for menstrual cycle symptoms and, if found to impact training/exercise, given support in "planning training and recovery accordingly".

This is something that I advocate for in my team seminars, both with active women but also with their coaches. Just as you would offer support if an athlete was struggling with sleep/nutrition/load management, the conversation should be extended to PMS symptoms & recovery too.

2. EXERCISE CAN HELP

Many therapies are recommended for managing PMS symptoms and exercise is one; for example, both the National Institute for Health and Care Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists (RCOG) suggest exercise as a "first- line treatment".

A recent meta-analysis by Pearce et al. reviewed 15 studies looking at the effect of exercise on PMS symptoms and all 15 studies reported that "exercise significantly decreased symptoms of PMS."

It seems like aerobic exercises, such as cycling, walking, swimming, as well as yoga are the most often studied but that any regular exercise can help reduce PMS symptoms.

The 'why' and the 'how' behind exercise as a potential ‘treatment’ for PMS symptoms regularly menstruating women is not yet clear and, Bruinvels et al. hypothesise that it may be linked to the cause of the specific symptom.

It could also be lined to the known-benefits associated with exercise: anti-inflammation, released endorphins, socialisation, reduced depression, improved overall wellbeing, and more balanced hormones*.

*Note: Over-exercising can actually be detrimental to your hormones. I personally prefer to drop the intensity of my training during PMS/first few days of bleeding as inflammation and stress can be high. I focus on lower intensity exercises which have been shown to reduce cortisol & inflammation.

3. ANTI-INFLAMMATORY FOODS

Inflammatory markers can be higher in some women during their premenstrual phase (just before their period). Inflammation can also be chronically high if you suffer from endometriosis, so eating a diet high in anti-inflammatory foods can help bring down some of that inflammation.

Focus on the basics: Focus on eating a variety of whole foods that centre around colourful fruit and vegetables, complex carbohydrates, lean proteins, and a mix of different fats, will go a long way in helping you beat inflammation.

Focus on Fatty Acids: It seems that essential fatty acids can reduce PMS and reduce period pain. A study in 2011 found that a mix of polyunsaturated fats of ~2grams over 6 months reduce the severity of PMS symptoms (Rocha Filho et al, 2011). Another study found that dietary supplementation with omega-3 fatty acids can lead to noticeable pain reduction among young women with primary dysmenorrhea. (Rahbar, 2012)

Up the volume of anti-inflammatory foods: It is good to get a mix of anti-inflammatory foods throughout our cycle, but particularly in the lead up to phase 4 and menstruation. By tracking your symptoms you should get a sense of when you may need a lil pms-busting boost through your diet:

• Lots of Fruits & Vegetables : aim to get a variety, lots of different types (you can use frozen/tinned if fresh isnt in season or too pricey)

• Omega-3s: oily fish, flax seeds, walnuts, pumpkin seeds, chia seeds

• Green Leafy Vegetables: spinach, kale, pak choy, swiss chard

• Herbs & Spices:Turmeric, curicumin, ginger, garlic are all meant to have anti-inflammatory benefits.

4. OTHER SUPPORTS

TRYPTOPHAN-BOOSTING FOODS - Tryptophan is a key building block of serotonin, which is known as the happy chemical as it can regulate mood and sleep.

You can get tryptophan from chicken, eggs, milk, tofu, chocolate, pumpkin and sesame seeds.

Furthermore, eating a diet with complex carbohydrates (brown rice, potatoes, wholegrains) helps the amino acid tryptophan cross the blood brain barrier as well as lots of other great things, such as: fuels your body, increases fibre, has more micronutrients and helps stabilise blood sugars, Furthermore,

FOOD WITH VITAMIN B6 - B6 is important for forming neurotransmitters, steroid hormones, and for nervous system functioning. Being deficient can result in anxiety, sleeplessness, irritability and depression.

Foods that contain B6 include sunflower seeds, fish, spinach, poultry, chickpeas, and bananas

AGNUS CANTHUS (CHASTEBERRY) - Chasteberry it is a herb and is used as a herbal remedy. Some resesrch may suggest it helps with irritability, mood and depression.

TALK THERAPY - CBT or other talk therapies may help if you are suffering with anxiety and depression. Please speak to a healthcare provider and seek a referral if you need support and/or it is affecting the quality of your life.

Note: getting nutrients from food is always preferable. If you are going to supplement, please speak to a chemist or a doctor, esp. if your are taking other medicine as they can interact - eg. Tryptophan and SSRIs. Overconsumption of vitamins can also cause issues. Overconsumption of B6 can cause neurological symptoms and overconsumption of Tryptophan can result in muscle weakness difficulty breathing etc

Sources:

Aware.ie - Lecture Series - PMDD, July 10 2019, Dr Robert Daly

Bruinvels G, Goldsmith E, Blagrove R, et al. Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: a study of 6812 exercising women recruited using the Strava exercise app. British Journal of Sports Medicine Published Online First: 16 November 2020. doi: 10.1136/bjsports-2020-102792

Mind.org.uk @mindcharity - PMDD

Healthline - What is Tryptophan by Ana Gotter and medically reviewed by Alana Biggers, MD

Pearce, E, Jolly, K, Jones, LL, Matthewman, G, Zanganeh, M & Daley, A 2020, 'Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials', BJGP Open. https://doi.org/10.3399/bjgpopen20X101032

Rahbar N, Asgharzadeh N, Ghorbani R. Effect of omega-3 fatty acids on intensity of primary dysmenorrhea. Int J Gynaecol Obstet. 2012 Apr;117(1):45-7. doi: 10.1016/j.ijgo.2011.11.019. Epub 2012 Jan 17. PMID: 22261128.

Rocha Filho, E. A., Lima, J. C., Pinho Neto, J. S., & Montarroyos, U. (2011). Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reproductive health, 8, 2. https://doi.org/10.1186/1742-4755-8-2

Yesildere Saglam H, Orsal O. Effect of exercise on premenstrual symptoms: A systematic review. Complement Ther Med. 2020 Jan;48:102272. doi: 10.1016/j.ctim.2019.102272. Epub 2019 Nov 27. PMID: 31987230.