Premenstrual syndrome is a medical term and refers to a set of well-known and real symptoms for many women: abdominal swelling, cramps, sore breasts, acne, diarrhea or constipation, headaches and muscle aches, sensitivity to light and noise , and cravings for sweets. But in addition to these symptoms there are also alterations that can seriously affect the brain and mood.
Do we lack mental energy because we run out of neurotransmitters?
Symptoms appear sometime between five and eleven days before the start of menstruation, and usually go away on their own immediately afterward. It is considered that, on average, 48% of women of reproductive age suffer from premenstrual syndrome. Figures vary across countries, from a prevalence of 34% in China to 92% in Turkey.
Nevertheless, about 90% of women experience at least one of the above symptoms. In 3% of cases, the symptoms are so severe that they affect daily activities and social relationships, something called premenstrual dysphoric disorder (PMDD). In this case, the woman suffers much more important mental alterations:
- Depression, intense sadness, and crying spells
- Suicidal thoughts
- Panic attacks
- Anxiety, anger, or irritability
- sudden mood swings
- Lack of interest in daily activities
- trouble concentrating
- memory failures
Despite the fact that PMDD is included as a mental disorder in the DSM-5 psychiatry manual, it is underdiagnosed, and it is estimated that it could affect many women, who do not go to the doctor or seek help for fear of stigmatization. The usual explanation is that hormones are behind these disorders, but in recent years it has been seen that there is much more, and unfortunately, for such a common disorder, the information available is still scarce.
Progesterone, the forgotten hormone that brings you down
The general public thinks of sex hormones as simple: men have androgens (testosterone) and women have estrogens (estradiol). The reality is much more complex, since all humans have all the sex hormones with different concentrations. In addition, the third group of sex hormones is often forgotten: progestogens, specifically progesterone.
If the name sounds like pregnancy, it is logical, because this hormone is more related to reproduction, rather than sex. In women, progesterone regulates the menstrual cycle, the maintenance of the placenta and pregnancy, and the preparation of the mammary glands for lactation. In men, it participates in the production of sperm.
In general, low estrogen levels, for example during menopause, are associated with depressed mood. The estrogen supplementation improves symptoms, just as testosterone supplementation also improves mood in men. Both hormones increase levels of serotonin, the neurotransmitter associated with happiness.
In fertile women, the first phase of the period, estrogen levels increase, and with it their mood and mental energy. This makes evolutionary sense: it is when ovulation occurs and when the woman’s body must be more active for sex. On the contrary, in the last phase of the cycle, before bleeding, estrogens decrease. Instead, it raises progesterone. The effect is a depressed mood.
Progesterone has an effect on the brain opposite to that of the other sex hormones. High levels of progesterone activate the amygdala, the part of the brain that triggers alertness, fear, and anxiety. This would explain why women with PMS can feel very stressed for no apparent reason. But in addition, progesterone, when metabolized, activates the GABA A circuit, the main inhibitory neurotransmitter in the brain. That is, it has a depressive effect, similar to that of alcohol or sleeping pills.
progesterone as well increases insulin resistance and worsens the highs and lows of blood glucose, which has a very negative effect on cognition, mood and bad mood.
These depressant effects of progesterone could also explain the mental health side effects of contraceptive use hormonal. Certain birth control pills are made up of progestin only, a synthetic progestogen. They are the ones that do not require monthly rest. Side effects of these pills include mood swings, panic attacks, anxiety and depression, abdominal cramps, and weight gain. In contrast, low doses of combined (estrogen and progestin) contraceptives seem to help in some cases, perhaps because of the counteracting effects of estrogen.
Deficiencies and Supplements for PMS
Deficiencies of certain nutrients can affect the production of neurotransmitters such as dopamine and serotonin, which in turn affects mood. Diet deficiencies may partly explain why there is a higher incidence of PMS in modern society.
It also counts the fact that today’s women have more periods throughout their lives, which increases the number of times they suffer from PMS. Two or three centuries ago there was more malnutrition, and women began to menstruate later, around 18 years old, and reached menopause at 40. In between they had multiple pregnancies, so in total they could have only a couple of dozens of periods in his life.
Today the problem is not malnutrition, but malnutrition. The modern diet is very high in calories, but it is also is deficient in certain essential nutrientssuch as protein, vitamins, minerals, and fiber. Also, be aware of known risk factors that increase your chances of PMDD:
- Alcohol, tobacco or drug use
- thyroid disorder
- Being overweight
- Family background
- Lack of exercise
The usual treatment for PMDD is usually SSRI-type antidepressants, which theoretically increase serotonin levels and reduce symptoms of depression, although its effectiveness is in question. However, the researchers suggest that there may be an influence of nutritional deficiencies and lifestyle that, once resolved, improve symptoms. These are the most common:
Calcium: Calcium is not only for the bones. Calcium ions are essential in the transmission of signals between neurons, and a calcium deficiency has effects on the brain. The symptoms of PMS resemble those of calcium deficiency, and it has been shown that improve with calcium supplements.
Vitamin D: This vitamin has very important effects on the immune system, inflammation and mood, as has been proven during the pandemic. Lack of vitamin D is associated with premenstrual syndrome, and it has been shown that high dose supplementation (over 7,000 IU daily) reduces pain, dysmenorrhea, and improves mood.
What about the most common supplements? Many Internet sites talk about the benefits of vitamin B6, zinc, magnesium or evening primrose oil (a source of fatty acids alpha and gamma linoleum). However, in a recent review of data did not find enough evidence. Instead, it appears that iron and vitamins B1 and B2 from the diet (not supplements) decrease the incidence of PMS, while a high intake of potassium increases the problems.
A common supplement in herbalists is chasteberry This Mediterranean native shrub (Vitex agnus-castus) is traditionally used for these discomforts, but in addition, in (small) controlled studies it has been proven that it really can reduce symptoms of irritability, moodiness, headaches, swelling and other discomfort.
As in many other physical and mental disorders, PMS also improves when the two pillars of health are addressed: diet and exercise. Sugar consumption is associated with more accentuated symptoms of PMS, as well as junk food consumption. Similarly, tobacco and alcohol increase the symptoms of PMS and TDMP, while exercise reduces its incidence.
What is all this based on?
- premenstrual syndrome. Premenstrual syndrome.
- Estrogen Impacts on Emotion: Psychological, Neuroscience and Endocrine Studies. Impact of estrogens on emotions: psychological, neuroscientific, and endocrine studies.
- The role of progesterone and GABA in PMS/PMDD. The role of progesterone and GABA in PMS/PMDD.
- Progesterone increases blood glucose via hepatic progesterone receptor membrane component 1 under limited or impaired action of insulin. Progesterone increases blood glucose through hepatic progesterone receptor membrane component 1 under limited or impaired action of insulin.
- Progesterone – Friend or foe? Progesterone: friend or foe?
- Formulation of the Total Western Diet (TWD) as a Basal Diet for Rodent Cancer Studies. Formulation of the total western diet (TWD) as a basal diet for cancer studies in rodents.
- The Association between the Risk of Premenstrual Syndrome and Vitamin D, Calcium, and Magnesium Status among University Students: A Case Control Study. The association between risk of premenstrual syndrome and vitamin D, calcium, and magnesium status among college students: A case-control study.
- Micronutrients and the premenstrual syndrome: the case for calcium. Micronutrients and premenstrual syndrome: the case of calcium.
- High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. High-dose vitamin D supplements may improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents.
- Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. Treatment of premenstrual syndrome with agnus castus fruit extract: a prospective, randomized, placebo-controlled study.
- Micronutrient Intake and Premenstrual Syndrome. Micronutrient intake and premenstrual syndrome.
- Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE. PMS is associated with dietary and lifestyle behaviors among university students: A cross-sectional study in Sharjah, UAE.
- Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomized controlled trials. Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomized controlled trials.