Premenstrual syndrome (PMS) is characterised by recurring physical and psychological symptoms during the late luteal phase of the menstrual cycle. The luteal phase begins after ovulation on day 14 then finishes the day blood flow begins.

PMS symptoms usually dissipate a few days after menses begins; they can be mild or severe and some months can be worse than others. Around 85 per cent of women experience PMS and seven per cent suffer from severe symptoms. Women who experience severe and debilitating PMS are said to have premenstrual dysphoric disorder (PMDD).

Painful menstrual cramps (dysmenorrhea) are experienced by many women each month and can range from mild and uncomfortable to extremely painful and incapacitating.

Common psychological symptoms associated with PMS include mood swings, irritability, crying, anger, anxiety, depression, dysphoria, inability to cope with stress, loss of control, poor concentration, forgetfulness, loneliness, low self-esteem, aggression and social withdrawal. Some women with severe PMS have undiagnosed depression.

Painful menstrual cramps (dysmenorrhea) are experienced by many women each month and can range from mild and uncomfortable to extremely painful and incapacitating. Menstrual cramps are caused by the uterine smooth muscle contracting, causing pain and cramping. Women who experience significant pain should consult their doctor as it may be a sign of some underlying condition such as endometriosis, uterine fibroids, ovarian cysts or pelvic inflammatory disease.

Other common physical symptoms associated with PMS include fluid retention, swollen and tender breasts, bloating, headaches, weight gain, swelling of the extremities, nausea, vomiting, heavy menstrual bleeding, stiff joints, change in bowel habits (constipation or diarrhoea), low libido, sugar and carbohydrate cravings, increased appetite, acne, weakness and dizziness.

Fortunately, nutritional and herbal medicine is very effective at resolving PMS complaints. However, it is important to first identify the root of the problem.

Causes of PMS

Hormonal imbalance

Hormonal imbalance, especially oestrogen dominance, is a major cause of PMS. Oestrogen dominance doesn’t necessarily mean the body is producing excessive amounts of oestrogen; it usually means that oestrogen levels are higher in proportion to progesterone that helps keep things in balance.

Oestrogen is a steroid hormone primarily produced by the ovaries and to a lesser degree by the adrenals and fat tissue. During the first half of the menstrual cycle, or follicular phase, oestrogen grows and matures the uterine lining, which is shed during menstruation. Oestrogen helps the ovaries produce an egg, which is released during ovulation. Oestrogen levels should be dominant during the follicular phase.

Oestrogen and progesterone usually work together harmoniously to maintain the perfect environment for a fertilised egg to implant and develop if conception occurs.

Progesterone’s job is to balance the effects of oestrogen. Progesterone is produced after ovulation occurs by the corpus luteum, the sac the egg comes out of. Progesterone levels should be dominant during the second half of the menstrual cycle, or luteal phase.

Good bowel health is also important as the gut microbiome helps to control oestrogen levels.

Progesterone’s main job is to build and maintain the uterine lining in case a pregnancy takes place. If a pregnancy doesn’t occur, progesterone levels will drop and menstruation begin as the uterine lining starts to shed. Progesterone also prevents uterine tissue and breast tissue from overgrowth; it acts as a natural diuretic, boosts metabolism and balances blood-sugar levels.

Progesterone also helps promote healthy sleep patterns, reduces anxiety and depression and improves libido. Low progesterone levels are often due to irregular ovulation and are commonly seen in premenopausal women, when PMS symptoms often worsen.

Poor liver detoxification can contribute to oestrogen dominance. The liver filters out toxins and hormones from the bloodstream. It is the liver’s job to deactivate oestrogen so it can be excreted safely from the body.

Good bowel health is also important as the gut microbiome helps control oestrogen levels. If pathogenic bacteria outnumber the beneficial bacteria in the gut, oestrogen can be reactivated in the bowel and reabsorbed into circulation, which can lead to oestrogen dominance. Poor fibre intake and constipation are also contributing factors.

High circulating levels of oestrogen can increase prolactin levels. Prolactin is a hormone that normally increases during pregnancy, enlarging women’s breasts and stimulating the production of milk after giving birth. Prolactin levels can also be raised in women who have polycystic ovarian syndrome or hyperthyroidism or are stressed or taking certain medications. Fluctuations in prolactin levels will lead to imbalances in progesterone.

If you suffer from PMS it is a good idea to have your sex hormone levels checked (female hormonal panel) first, along with thyroid hormones. Multiple sample testing over the course of the menstrual cycle is also recommended if possible. This way you get a better idea of what’s happening with oestrogen and progesterone levels at different times throughout the cycle, not just on the single day of sampling. Having prolactin levels checked is also recommended to get a more accurate result of oestrogen levels. Prolactin levels increase in proportion to oestrogen tissue levels, which are usually a lot higher than blood oestrogen levels.

Keeping a diary record of your cycle — including basal body temperature (your temperature before you get out of bed in the morning), cervical mucous and PMS symptoms including mood, cramping, fluid retention, cravings, bowel changes and headaches — can be extremely helpful for recognising patterns in the menstrual cycle. There are also apps available to help you track your PMS symptoms. Doing this will help women develop a greater awareness of where they are during their menstrual cycle, which will allow them to prepare for any changes and acknowledge their emotional shifts.

Charting your basal body temperature can be beneficial for identifying whether you are oestrogen dominant or not. Oestrogen is a cooling hormone; progesterone is warming. Normally, your body temperature will rise after ovulation when progesterone should be more dominant. If there is no change in temperature, this could be a sign that your hormones are out of balance.

Aldosterone increase

Aldosterone is another hormone that can contribute to PMS symptoms. Aldosterone is produced by the adrenal glands situated just above the kidneys.

Aldosterone controls the retention and excretion of fluid in the body. When progesterone levels are low and oestrogen is dominant, aldosterone levels increase. This signals to the kidney to hold onto sodium, which in turn retains fluid. Stress and a deficiency in magnesium can also increase aldosterone. PMS fluid retention causes tender, swollen breasts and swollen feet and ankles. Women often feel uncomfortable around this time of the month, as though they’ve put on weight.

Low serotonin

Fluctuating levels of the neurotransmitter serotonin is thought to contribute to PMS symptoms. Low serotonin has been linked to worsening mood swings and premenstrual depression as well as fatigue, food cravings and sleep problems.

Serotonin is important for regulating mood: it makes us feel calm and happy and helps us sleep (serotonin is a precursor to melatonin). People with low serotonin levels are more emotionally sensitive, irritable and easily angered. They are more likely to have problems with sleep, anxiety, poor memory, headaches, fatigue and depression.

There is also a link between low serotonin production and carbohydrate cravings. When we consume carbohydrates, it allows the amino acid tryptophan to become available, which is then converted into serotonin. There is also an association between low serotonin levels and decreased pain tolerance. Managing pain can be difficult for people with low serotonin levels.

A large percentage of our serotonin is produced in the gut; therefore, promoting good gut health is vital for improving serotonin production and reducing PMS symptoms associated with low serotonin levels.

Poor adrenal function

Adrenal hormones play a major role in regulating the menstrual cycle. The adrenal glands are involved in producing sex hormones including oestrogen and progesterone. When the adrenals are underfunctioning, the production of these hormones will be reduced.

Many women with adrenal fatigue suffer from PMS. Chronic long-term stress is a major cause of adrenal fatigue. Signs that your adrenals might be running below par are extreme fatigue (especially in the morning), inability to cope with stress, lowered immunity and PMS.

A saliva cortisol/DHEAS test, which measures adrenal hormones throughout the day, can determine whether adrenal fatigue is an underlying issue.

Poor diet & nutritional deficiencies

The standard Western diet high in refined carbohydrates and processed foods is deficient in important nutrients, amino acids and dietary fibre needed for balanced sex hormones and healthy serotonin production. Deficiencies in B vitamins (especially B₆), vitamin E, magnesium and calcium will intensify PMS symptoms.

Thyroid problems

Thyroid hormones regulate our metabolism, including the rate at which sex hormones are produced and broken down in the body. If your thyroid is sluggish, you will suffer from low energy levels and find it difficult to lose weight. People with an underfunctioning thyroid are more susceptible to PMS.

Stress can also affect thyroid function by reducing the production of thyroid-stimulating hormone (TSH), which signals to the thyroid to produce more thyroid hormone.

Allopathic treatment

A number of pharmaceutical drugs are commonly prescribed by doctors to alleviate and manage severe PMS symptoms. Antidepressants (selective serotonin reuptake inhibitors or SSRIs) such as Zoloft and Prozac are used to treat women with premenstrual depression. Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended to treat menstrual pain and cramping.

NSAIDs come with unwanted side-effects including damage to the gut lining. Diuretics are prescribed to alleviate fluid retention and sore breasts associated with PMS. The oral contraceptive pill is often recommended to stop ovulation, which can bring relief for some women with severe PMS symptoms.

Before using conventional medications to manage PMS, there are plenty of highly effective natural treatments available that not only alleviate PMS symptoms but help address hormonal imbalances, adrenal or thyroid insufficiency and correct dietary deficiencies that may be causing PMS symptoms.

Natural treatment

To promote balanced hormone levels and a healthy menstrual cycle, it’s important to eat a wholesome diet rich in essential nutrients the body needs to produce sex hormones and neurotransmitters as well as support thyroid and adrenal function.

B vitamins

B-complex vitamins are essential for supporting healthy energy levels and the body’s response to stress. B vitamins are required for neurotransmitter and sex hormone synthesis and are involved in supporting adrenal function. The oral contraceptive pill decreases several B vitamins so supplementation is recommended.

B₆ (pyridoxine) is well known for its ability to relieve PMS symptoms. It helps modulate the production of neurotransmitters GABA and serotonin, both of which play a key role in regulating mood. Supplementing with B₆ can help alleviate pain, anxiety and depression and may assist in reducing fluid retention associated with PMS. An activated B-complex vitamin containing B₆ is recommended.

Some of the best food sources of B vitamins are legumes, dark green leafy vegetables, wholegrains, grass-fed organic meat and poultry and wild fish.

Calcium

Low calcium levels are associated with a range of symptoms to do with PMS. Supplementing with calcium 1000mg daily for at least three months is beneficial for reducing symptoms including change in appetite, depression and fatigue in women with PMS compared to placebo. Calcium amino acid chelate is a better-absorbed form of calcium than calcium carbonate.

Good calcium-rich foods to include in the diet include kale, broccoli, the soft bones of tinned fish (wild sardines and salmon), tahini (sesame seeds), almonds (almond butter) and organic yoghurt and kefir.

Magnesium

Low magnesium levels are often reported in women who suffer from PMS. Magnesium assists with fluid retention associated with PMS and is useful for reducing anxiety-related PMS symptoms (nervous tension, mood swings, irritability, anxiety), sugar cravings and menstrual cramps. Supplement with 400–800mg daily to help reduce PMS. It has been shown that low magnesium levels can increase the release of aldosterone from the adrenal glands, worsening fluid retention.

Foods rich in magnesium that should be included in the diet include spinach, kale, hemp and flax seeds, raw cacao, almonds, legumes, avocado, yoghurt or kefir and bananas.

Fatty acids

Supplementing with omega-3 essential fatty acids — docosahexaenoic acid DHA, eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) — can help control inflammation by enhancing the production of anti-inflammatory prostaglandins (E1 and E3) and reduce pro-inflammatory prostaglandins (E2).

Omega-3 essential fatty acids (DHA and EPA), found in high levels in oily fish like wild salmon, sardines and anchovies, have been shown to be effective in treating menstrual pain and cramping due to their potent anti-inflammatory properties. Plant-based sources of omega-3 fats include walnuts, chia and flaxseeds as well as dark green leafy vegetables.

Supplementation with 6g of tryptophan daily, from the time of ovulation to the third day of menstruation, has been found to reduce mood swings, tension and irritability associated with PMS over a three-month period.

Evening primrose oil is a rich source of GLA and commonly used by women to alleviate PMS symptoms. It is thought that many women with PMS are deficient in GLA, which is necessary for prostaglandin formation. You need to take evening primrose oil for about six to eight weeks before you start to see results. Borage and blackcurrant oils are also good sources of GLA.

A study has shown that women who have diets high in saturated and trans-fats experience higher menstrual distress. Saturated and trans-fats found in processed and deep-fried foods, pastries, crisps and foods cooked in vegetable oil are highly inflammatory and should be avoided. Low-grade inflammation has been linked to PMS symptoms.

But not all saturated fats are created equal. Saturated fats found in natural foods such as ghee, grass-fed organic butter, full-fat dairy, organic eggs, grass-fed organic red meat and dark chocolate may be enjoyed in moderation.

Iron

Iron levels need to be checked and treated if women with PMS experience fatigue or long, heavy periods or are vegetarian. Iron deficiency or anaemia is likely to compound PMS symptoms such as fatigue and depression. Supplementing with 25mg or elemental iron daily is recommended if iron levels are low.

Foods rich in iron that should be added to the diet include grass-fed red meat, wild fish, legumes (especially lentils) and dark green leafy vegetables.

Vitamin E

Vitamin E is a fat-soluble vitamin that helps regulate sex hormone synthesis. A double-blind study showed that women who supplemented with 400IU/day of vitamin E over three cycles observed significant improvements in emotional PMS symptoms compared to placebo.

Vitamin E is found in foods such as raw nuts and seeds, wheat germ, avocado, olive oil, dark green leafy vegetables and wild salmon.

Tryptophan

Tryptophan is an essential amino acid needed to produce feel-good hormone serotonin as well as melatonin, which helps us sleep. Tryptophan is first converted into a compound called 5-HTP, which is converted into serotonin. Supplementing with either tryptophan or 5-HTP will boost serotonin and melatonin production. Tryptophan has also been found to help reduce carbohydrate cravings and control appetite.

Depletion of tryptophan has been shown to increase aggression in women during the premenstrual phase. Supplementation with 6g of tryptophan daily, from the time of ovulation to the third day of menstruation, has been found to reduce mood swings, tension and irritability associated with PMS over a three-month period.

The best sources of tryptophan are protein-rich foods such as organic eggs and poultry, wild salmon, spirulina, organic yoghurt, legumes, bananas, raw nuts, tahini, brown rice and grass-fed meat.

Brassica vegetables

Brassica vegetables such as kale, cauliflower, broccoli, cabbage and Brussels sprouts contain a phytochemical called indole-3-carbinol (I3C) that helps maintain healthy hormonal balance. I3C increases the metabolism of hormones including oestrogen in the body. It supports healthy liver detoxification and assists with the elimination of toxins and clearance of oestrogen from the body.

I3C is activated when Brassica vegetables are cut, chewed or cooked. Broccoli sprout powder added to veggie juices or green smoothies is another great way to consume I3C. You can also supplement with I3C at a dosage of 400–800mg daily. Brassicas are best eaten raw, lightly steamed or stir-fried.

Dietary fibre

Adequate daily fibre intake is required to help maintain good bowel health and healthy hormone levels. Fibre assists with the excretion of oestrogen by binding to oestrogen and removing it from the body via the bowel. Adults should be getting around 30g of dietary fibre daily from sources such as fruits, vegetables, legumes, nuts, seeds (chia and flax) and wholegrains.

Balanced blood-sugar levels

You need a constant supply of glucose from carbohydrate foods for energy to fuel your brain and body. When blood-sugar levels are too low, the adrenal glands release cortisol, which triggers glucose to be released from emergency glycogen stores in our muscles and liver. This normalises blood-sugar levels again and delivers glucose, most importantly to the brain, then to the rest of the body.

If this pattern continues for too long, the adrenals will become worn out and this will disrupt the production and natural balance of oestrogen and progesterone in the body.

To best support your physical, mental and emotional health and make sure your menstrual cycle is balanced, you need to ensure your blood-sugar levels are stable throughout the day.

Common symptoms of low blood-sugar levels, also associated with PMS, include sugar cravings, fatigue, anxiety, depression, headaches, poor concentration, insomnia, irritability and mood swings. Low blood-sugar levels can occur when you skip meals or eat a lot of refined carbohydrates and sugary foods like white breads, pastries, convenience foods and soft drinks. Consumption of sugary foods has been associated with higher prevalence of PMS symptoms.

The best way to ensure that blood-sugar levels are balanced is to have a wholesome breakfast, eat some good-quality protein with each meal, avoid skipping meals (especially breakfast), choose fibre-rich complex carbohydrates over refined white carbs, avoid sugary and refined foods and choose nutrient-dense foods with a lower GI.

Foods with a low GI take longer to digest and they release glucose slowly into the bloodstream, which helps control blood-sugar levels. Balancing carbohydrates in a meal with some protein, healthy fats and fibre will lower the GI of that meal. This will leave you feeling full and less likely to overeat or crave sugars.

Chromium supplementation can be very beneficial for people who have severe carbohydrate cravings and difficulty balancing their blood-sugar levels. Taking a chromium supplement (600mcg/day) can significantly reduce carbohydrate cravings and help normalise blood-sugar levels by improving glucose metabolism.

Caffeine

Consumption of caffeine beverages has been strongly linked to an increased prevalence of PMS. Caffeine also increases calcium excretion and calcium has been found to be a beneficial mineral for ameliorating PMS symptoms. Caffeine-rich foods that should be avoided or limited include coffee, black tea, chocolate, cola soft drinks and energy drinks.

Sodium

A diet high in sodium will exacerbate fluid retention. Reducing salt intake is recommended to alleviate PMS-related fluid retention including swollen breasts, ankles and feet. Look out for high-sodium foods including processed foods, crackers, sauces, spreads, crisps, deli meats, breakfast cereals, canned foods (baked beans, soups) and foods you wouldn’t suspect like desserts and sweet biscuits. A little good-quality sea salt is healthy but avoid adding refined salts to meals. Use garlic, herbs and spices for extra flavour in meals.

Potassium is a naturally occurring mineral, found in bananas, green leafy vegetables and avocado, that helps eliminate fluid naturally from the body.

Celery, dandelion leaves, parsley, horsetail, green tea and hibiscus tea are natural diuretics that aid the clearance of fluid if PMS fluid retention is present. Celery and parsley make a great addition to vegie juices while dandelion leaves can be added to salads or drunk as a tea.

Drink 2L of filtered water daily (caffeine herbal teas are included). Contrary to what people think, having adequate water throughout the day won’t increase fluid retention — it helps stimulate your body to flush away toxins and remove excess fluid.

Probiotics

Maintaining a healthy balance of good bacteria in the gut is important for healthy oestrogen levels. Some of the best probiotic-rich foods to choose from include sauerkraut and other fermented vegetables, sugar-free yoghurt, kefir, kombucha, kvass, miso and kimchi. Including fermented foods in the diet is a great way to enhance gut health, help keep hormone levels balanced and improve serotonin production.

Herbal teas

Ginger and cinnamon are both great circulatory stimulants that increase circulation in the pelvic region and help relieve the congestion, pain and cramping associated with PMS. Ginger tea or a mug of warm almond milk with a good teaspoon of cinnamon can be very soothing. Historically, women would drink ginger beer to relieve menstrual pains. Chamomile, peppermint and raspberry leaf tea can also help soothe PMS cramps.

Xenoestrogens

BPA belongs to a group of chemicals called xenoestrogens, used to make pesticides, herbicides and plastics. Xenoestrogens act like oestrogen in the body. They interfere with normal hormonal signalling and can worsen PMS symptoms. Women should take measures to avoid these hormone-mimicking chemicals.

BPA is used to make hard, clear plastic containers (water bottles, microwave ovenware, eating utensils, milk and juice containers) and the plastic coating inside metal cans. Trace amounts of BPA can leach from these containers into foods and drink.

The best way to reduce your contact with xenoestrogens is to buy and store foods and beverages in glass or stainless-steel containers. Do not heat food in plastic containers or plastic cling wrap, since heating some plastics can cause xenoestrogens to leach out of the container into the food. Some plastic cling wrap is made from PVC (polyvinyl chloride) and contains xenoestrogens.

Invest in a good water filter and use stainless-steel or glass water bottles. Tap water can contain xenoestrogens from medications and agricultural and chemical pollution. Buy organic produce free from pesticides, herbicides and xenoestrogen residue.

Herbal medicine

Vitex agnus-castus (chastetree berry)

Vitex has been used for centuries for the management of gynaecological complaints and is one of the top botanicals prescribed by herbalists for the treatment of PMS and menstrual irregularities. Vitex helps balance the ratio of oestrogen to progesterone and is beneficial for women with oestrogen-dominant PMS. Vitex helps PMS by naturally raising the body’s progesterone levels, inhibiting the release of prolactin from the pituitary gland.

In a large study where 1634 women with PMS were given vitex for three months, 93 per cent observed a decrease in a number of PMS symptoms or had complete cessation of PMS. Vitex helps improve PMS-related irritability, mood swings, anger, headaches, breast tenderness and premenstrual acne.

Hypericum perforatum (St John’s wort)

St John’s wort has been used for thousands of years for its antidepressant action to alleviate nervous and mood disorders. This beneficial herb is commonly used by herbalists to treat mild to moderate depression and anxiety. St John’s wort helps improve mood by making serotonin and dopamine more available to the brain. This herb is beneficial for treating depression and mood swings associated with PMS.

Withania somnifera (ashwagandha)

Poor adrenal function as a result of long-term stress affects the production of sex hormones and can worsen PMS symptoms. Supporting the health of the adrenals is vital for keeping hormones balanced and PMS symptoms at bay.

Withania, known to Ayurvedic medicine as ashwagandha, is a highly effective adaptogen widely used by herbalists to improve the body’s resistance to stress. Withania supports adrenal health and calms the nervous system, making it beneficial for alleviating anxiety and aiding sleep.

Paeonia lactiflora (peony)

In traditional Chinese medicine, peony is used to treat various gynaecological problems including PMS associated with oestrogen dominance or elevated prolactin levels. Native American tribe the Chumash also knew of its health benefits for women: they would boil peony root and use it as a tea to help relieve menstrual cramps.

Peony exhibits analgesic, antispasmodic and anti-inflammatory properties. It helps ease PMS symptoms by increasing progesterone and helping balance hormone levels. Peony is often used in combination with other herbs to ease menstrual abdominal pain and cramping.

Essential oils

Essential oils can be a useful natural treatment for PMS. Certain essential oils can help ease menstrual pain and cramping and enhance circulation, soothing the nerves, improving sleep and lifting mood.

Clary sage is one of the most commonly used essential oils for relieving PMS symptoms. It has an antispasmodic and mild sedative effect, which helps improve anxiety, sleep and pain and cramps associated with PMS.

Other commonly used essential oils for relieving PMS symptoms include lavender, ylang-ylang, cypress, eucalyptus, bergamot, marjoram and geranium.

Add 5 drops of essential oils to 10ml of a carrier oil of your choice (evening primrose oil, grape seed, sweet almond or jojoba oil). Massage your blend into your lower abdomen and apply it to the base of your neck, temples and back of your head. Try adding 15-20 drops of essential oils to a relaxing bath or add essential oils to a warm compress, your favourite body lotion or balm, or to an inhaler or infuser.

DIY essential oil PMS blend

This PMS blend contains essential oils that help calm the nerves and lift the mood along with easing menstrual cramps.

Ingredients

20mL evening primrose oil (or another carrier oil of your choice)

5 drops clary sage essential oil

3 drops lavender essential oil

2 drops bergamot essential oil

Method

Combine all ingredients in a small dropper bottle and shake well.

Use your blend 2–3 times a day massaged into the lower abdomen, temples, back of the neck and head.

Homeopathic remedies

Homeopathic remedies are beneficial for correcting underlying imbalances that lead to PMS symptoms. In studies from Hadassah Hospital in Jerusalem, 90 per cent of women treated with homeopathy over a three-month period reported an improvement in PMS symptoms.

The following are commonly prescribed homeopathic remedies for PMS.

Bryonia

Sore, swollen breasts with shooting pains that worsen with movement indicate the need for Bryonia. Women feel irritable and easily angered and prefer to be alone. Other common symptoms indicating this remedy include a dry mouth with thirst, constipation and headaches before periods start, symptoms that are worse for movement.

Chamomilla

This remedy is a good one for women who are very irritable, short-tempered and easily angered. These women are hypersensitive to pain and don’t want to be touched or spoken to. They experience painful menstrual cramps that come and go and are intensified by an emotional upset. The menses are commonly heavy, dark and clotted. PMS symptoms are usually worse at night but movement such as rocking and walking alleviates symptoms.

Lachesis muta

Women who suffer from a heavy flow, headaches, congestion and cramps that usually settle once their period starts do well on this remedy. These women are intense and outspoken and can be irritable and jealous. They hate anything tight around their waist or neck and symptoms are usually worse in the morning when they wake up.

Lycopodium clavatum

This remedy is recommended for women who have a ravenous appetite with cravings for sweets. Their periods are often delayed then followed by a heavy flow. These women commonly have digestive complaints (abdominal bloating and flatulence) and can be irritable, bossy and weepy before their periods. Their symptoms are generally worse between 4 and 8pm.

Nux vomica

This remedy is indicated for women with irregular periods who are extremely impatient and hot-headed with an explosive temper. These women desire stimulants like coffee, fatty foods and alcohol and often suffer from constipation. Their menstrual cramps are worse in the mornings and symptoms feel better for heat and rest.

Pulsatilla pratensis

This remedy is helpful for women who are very emotional, weepy and needy, who crave attention and sympathy. Their symptoms are changeable including mood, bowel movements and menstrual flow. No two menstrual cycles are the same. They can suffer from headaches before periods and symptoms are often better for fresh air.

Calcarea carbonica

Women who do well on this remedy have problems with fluid retention, sore and swollen breasts and weight gain. They feel overwhelmed, anxious and fatigued and suffer from digestive complaints, headaches and sweet cravings. They may feel chilly but have clammy hands and feet.

Natrum muriaticum

This remedy is prescribed for women who feel depressed and extremely emotional. These women are reserved and want to be alone and can get angry over minor things. Their symptoms feel better when they lie on something hard or push something hard into the painful area. They often crave salty foods and are thirsty.

Veratrum album

This remedy is useful for women who have menstrual periods that are very heavy with a lot of cramping. They feel cold and exhausted and vomiting and diarrhoea are common symptoms. Their symptoms feel worse at night and after exercise but improve when they are warm and covered up.

Lifestyle

Simple lifestyle changes can also help ease PMS symptoms. Exercising regularly is beneficial for physical and mental health and wellbeing. It can help improve PMS symptoms including fluid retention and mood swings. Yoga and Pilates are particularly good as they help improve circulation to the abdominal area.

Managing stress is critical for healthy hormone levels. Meditation, adequate sleep and allocating time for relaxation — reading a book, sipping on a calming herbal with a friend, having a warm bath with essential oils — are all important ways to alleviate physical and emotional PMS symptoms.

A warm bath with Epsom salts, a wheat bag or hot water bottle can help reduce menstrual cramps and pain by improving circulation and relieving congestion to the pelvic area.