Premenstrual Syndrome

by Christiane Northrup, M.D.

Menstrual Cycle

Premenstrual symptoms, often referred to as PMS, are very common. At least 60 percent of women suffer from PMS. It is mostly likely to occur in women in their thirties, though it can occur as early as adolescence and as late as the premenopausal years. Many women who suffer from premenstrual syndrome find that it intensifies as they get older. That’s because PMS and the escalation of symptoms that is so common during perimenopause are actions of our inner guidance systems, trying to get us to pay attention to the adjustments we need to make in our lives.

Everything from imbalanced nutrition to unresolved relationships can disrupt the normal hormonal milieu. Winenman1  The discomfort of PMS can be ignored only so long. By the time you reach perimenopause, PMS can become a real wake-up call. One of my patients described her perimenopausal symptoms as “PMS x 10.” This is particularly the case for women who hit the snooze button instead of heeding their monthly and seasonal wake-up calls.

PMS and Our Cultural Inheritance

Premenstrual symptoms have been known since ancient times. The term “PMS” was popularized in the 1980s by Family Circle magazine. The media soon grabbed hold of it and PMS became a nationally known problem and a household world. Reid2 Feminists argued that the diagnosis would be used against women. Doctors worried that it would become a “wastebasket diagnosis” that women or their families would use when no one could figure out what was going on.

Yet, even with an official diagnosis, and despite the fact that many women now approach their doctors wanting to understand PMS and get help, there is still a belief among conventional practitioners that these symptoms are strictly hormonal and have nothing to do with a woman’s life, and that they can be “fixed.” Rather than ask a woman about her relationships or her career, many doctors quickly prescribe oral contraceptives or Prozac for women with PMS to control symptoms along with their cycles and emotions.

Listen to Your Body

The truth is, if you ignore your cyclic nature, disconnect from your body’s wisdom and try to function as a linear being with the same drives, focus and aptitudes day after day, PMS will often be the result, no matter what you take to try to control it. If you don’t pay attention to the issues that come up premenstrually during the years when your periods are regular, it is likely that your symptoms will escalate during perimenopause. That’s why it is important to understand that every premenstrual issue is potentially related to a larger, deeper need that is not being met or that has been ignored for a long time. Having treated hundreds of women with PMS, I know that such a rethinking is needed. When we don’t acknowledge our needs, our bodies have to scream louder to get our attention.

Symptoms of PMS

A wide variety of symptoms can be present with PMS. Here are the most common:

  • Abdominal bloating
  • Abdominal cramping
  • Accident proneness, coordination difficulties
  • Acne, hives
  • Aggression, rage
  • Alcohol intolerance
  • Anxiety, irritability, suicidal thoughts
  • Asthma
  • Back pain
  • Breast swelling and pain
  • Bruising
  • Confusion
  • Depression, withdrawal from others, emotional lability
  • Edema
  • Exacerbation of preexisting conditions (lupus, arthritis, ulcers, herpes, etc.)
  • Fatigue, lethargy
  • Fainting (vasovagal syncope)
  • Food binges, salt cravings, sweet cravings
  • Headache, migraine
  • Heart palpitations
  • Insomnia
  • Joint swelling and pain
  • Nausea
  • Seizures
  • Sex drive changes
  • Sinus problems
  • Sore throat
  • Urinary difficulties

When making the diagnosis, however, the most important aspect is not the exact symptoms themselves, but the cyclic nature in which they occur. Women who chart their symptoms often begin to see a pattern emerge and are able to predict when their symptoms will start. Keeping a symptom journal can be a valuable tool when trying to uncover your premenstrual symptom triggers and the issues associated with them. If nothing is done to interrupt PMS, it often gets worse over time. A woman may begin by having symptoms just a few days before her period that stop abruptly as soon as her period begins. Then the symptoms gradually begin to appear one to two weeks before the onset of menses. Over time, a woman may have only two or three days of the month that are symptom-free. Eventually no discernable pattern of “good” days and “bad” days can be detected. She feels as if she has PMS all of the time.

Triggers and Contributing Factors Associated with PMS

Many events and other factors can contribute to or trigger PMS by resulting in hormonal changes in the body, including:

  • Onset of menses
  • Perimenopause
  • Discontinuing birth control pills
  • Amenorrhea
  • Childbirth, or termination of pregnancy
  • Toxemia during pregnancy
  • Tubal ligation
  • Unusual trauma
  • Decreased light associated with autumn and winter

Other Factors:

  • High consumption of dairy products Goci3
  • Excessive consumption of caffeine (soft drinks, coffee, chocolate) Rossignol4
  • Excessive consumption of high glycemic foods
  • A relatively high blood level of estrogen
  • A relatively low blood level of progesterone
  • Diet that leads to increased levels of the hormone prostaglandin F2
  • Excess body weight
  • Low levels of vitamins C, E, and selenium
  • Magnesium deficiency
  • Lack of exercise

Spiritual and Holistic Options

I recommend a balanced approach to healing PMS, instead of just treating the symptoms. Many women are given symptomatic treatments for their PMS that, in the long run, do not work. To treat a woman’s bloating with diuretics, her headaches with painkillers, and her anxiety with Valium is to ignore the underlying imbalance that leads to PMS in the first place. In addition, these treatments often have deleterious side effects of their own. And, while psychotherapy can provide insight about stress, it by-passes the nutritional and biochemical aspects of the disorder. Here is a program that can help you heal your PMS.

  • Follow the dietary approach I recommended for Menstrual Cramps and Pelvic Pain.
  • Take a good multivitamin-mineral supplement. In addition, get 400–800 mg per day of magnesium and 50–100 mg of most of the B-complex vitamins. Take these all month long, not just premenstrually.
  • Eliminate caffeine. Even if you only drink one cup of coffee per day, eliminating caffeine can make a huge difference for some women.
  • Get enough essential fatty acids in your diet. You can get EFAs in nuts and seeds, cold-water fish, such as salmon and sardines, and many plants. Fish oil supplements are also a good option. Generally, 500 mg of fish oil, three to four times per day is recommended. Flax seed and DHA derived from algae are two excellent plant sources.
  • Reduce stress. Women who practice meditation or other methods of deep relaxation are able to alleviate many of their PMS symptoms. Relaxation of all kinds decreases cortisol and epinephrine levels in the blood and helps to balance your biochemistry, including the reduction of inflammatory chemicals. There are numerous types of meditation that work. Each woman should choose the type of meditation that she feels most drawn to and incorporate this discipline into her daily routine. The relaxation response suggested by Dr. Herbert Benson has been shown to significantly relief MS within three months of regular practice. Goodale5
  • Exercise. Get at least 20 minute of aerobic exercise three times per week. Brisk walking is all that is necessary.
  • Try reflexology. This treatment, involving massage of specific pressure points on the ear, hand, or foot, has been shown to relieve PMS. Oleson6
  • Get more natural or full-spectrum light. Expose yourself to sunlight. During the autumn and winter months, use a full-spectrum light box each morning or each evening.
  • Try bioidentical progesterone. Natural progesterone, in combination with lifestyle changes, often produces profound improvement in PMS symptoms. Rapkin7

Learn More — Additional Resources


  1. Winenman, E.W., 1971. Autonomic balance changes during the human menstrual cycle, Psychophysiology, vol. 8(1):1–6.
  2. Reid, F. L., Yen, S. S., 1981. Premenstrual syndrome, American Journal of Obstetrics and Gynecology, vol. 139:86.
  3. Goci, G.S., Abraham, G.E., 1982. Effect of nutritional supplement on symptoms of premenstrual tension, Journal of Reproductive Medicine, vol. 83 (1982), pp. 527–31.
  4. Rossignol, A.M., 1985. Caffeine-containing beverages and premenstrual syndrome in young women, American Journal of Public Health, vol. 75(11):1335–37.
  5. Goodale, I., Domar, A., Benson, H., 1990. Alleviation of premenstrual syndrome symptoms with the relaxation response, Obstetrics and Gynecology, vol. 75(4):649–89.
Last Updated: February 26, 2007

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Minette gargurevich
    5 years ago

    Hi can my 13 year old daughter use progesterone cream by emerita. She becomes very moody , depressed, and angry before monthly cycle. I would say that she is experiencing this quite often now since puberty began. Thank you

  2. Melissa Cunningham
    7 years ago

    Hi Dr. Northrup.
    I just had a baby on 5/17/17. I had my 6 week postop appointment today. At my visit i informed my doc that I would like to do tubal ligation and she told me to do IUD. She gave me to packets one for Mirena and one for Paragard. Which one if either would you recommend to do?
    Thank you

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