Why PMS is Ruining Your Life and How to Stop It

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75% of women in their reproductive years suffer from premenstrual headaches, mood swings, bloating and more. And in about 20% of these women, their symptoms can get so severe they threaten their relationships, their work life and their well being. But just because these symptoms are common doesn't mean you have to live with them. The real fact is that the suffering related to menstrual cycles is absolutely unnecessary and not caused by bad luck or bad genes, but by a bad diet, environmental toxins, changes to the microbiome, nutritional deficiencies and stress. And a few other things we'll talk about. Of course the drug companies don't want you to know that. So the conventional treatments for PMS range from the over the counter non steroidal anti inflammatory drugs to birth control pills. I mean, Pharma has even rebranded Prozac as Serafem. What a nice name, right? Serafem to treat pms as if PMS was a Prozac deficiency. Nonsense. So what's wrong with this picture? Hi, I'm Dr. Mark Hyman and welcome to Health Hacks.

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That the symptoms of PMS are an inevitable part of being a woman and require medical intervention with sometimes serious medications to correct them. Now to think that 75% of women have a design flaw that requires medical treatment just to live a normal life is just absurd. PMS is not a normal consequence of being female. If you're one of the many women who do suffer from pms, you don't have to suffer from PMS every month. Enduring mood swings, breast tenderness, fluid retention, migraines, bloating, or heavy painful periods. While medications may sometimes be helpful, they can have pretty significant side effects. And the good news is you can balance your hormones without them and without their potential side effects. Many young women are becoming increasingly aware of the potential harms of birth control. Not because their conventional gynecologist is explaining it to them, but through their own personal experience. They're on a journey to educate themselves, and they want a more nuanced, personalized approach to hormonal health. So today we're going to discuss what you can do to support your menstrual cycle through your diet and a comprehensive functional medicine approach to get rid of PMS for good and feel great all month long. But first, I want to tell you a story of a patient of mine with severe PMS who. Who was barely able to work or function and had a radical turnaround after using functional medicine. Now, this woman was 37 years old, and by the way, many women feel worsening PMS or premenstrual syndrome, as they get into their later reproductive years. She was severely depressed. She was so tired, she was anxious. She suffered severe food and sugar cravings. Sound familiar? And that led to overeating and weight gain. She also had joint pain, breast tenderness, heavy bleeding, hot flashes, dry skin, acne, hair problems, memory loss, poor sleep, gas, and bloating, and no sex drive. Sounds like a bunch of fun, doesn't it? Well, what was her diet like? Well, she didn't drink alcohol, but she was a big coffee drinker. She started the day with a bagel and cream cheese. She ate a cafeteria lunch. She snacked on chocolates in the afternoon, had a healthy dinner, but then binged on ice cream, chips, and Cheerios. She also ate a lot of conventional dairy products, which are very problematic for hormonal health. The key to solving this type of problem is getting to the root cause of the symptoms. Now, I hear this story all too often, but the good news is that there are simple solutions that don't involve taking medication. We know what causes hormonal imbalances. Sugar, caffeine, alcohol, stress, a lack of exercise, and environmental toxins all contribute to hormonal imbalance and and worsening of pms. Even changes to your gut microbiome can affect your hormonal health. Now, one of the biggest drivers of hormonal imbalance is dairy. There are over 60 hormones naturally occurring in cow's milk, and even more, they're added to boost milk production. I had this woman change her diet. I had her take a few key supplements and herbs. I had her start exercising. And within just one cycle, her symptoms revolved. She lost weight, her energy dramatically increased, her mood stabilized, her acne and dry skin cleared up. And the approach I use to treat this patient is called systems based medicine, also known as functional medicine, which is a framework for understanding disease by looking at root causes and the interconnectedness of your biological systems. Rather than each part in isolation. Now we try to identify the imbalances that are unique to each person. In this case, this woman had severe hormonal imbalances. And we try to address the root causes which are often our diet, lifestyle and we help the body repair and regain balance. Now once this is done, the body's natural intelligence takes care of the rest. So what would conventional medicine docs do for PMS? Well, they give you NSAIDs or things like ibuprofen, birth control, they might give you Seraphim or Prozac, in other words, but they don't get to the root cause of symptoms and they inhibit your natural cycle, your in Fredian rhythm. And the birth control pill often has significant side effects with long term use, including mood and gut issues. Dysbiosis. Taking the pill depletes folate, vitamin B2, B6, B12, vitamin C and E, magnesium, zinc, selenium, all important by the way, for fertility. There's also an association between hormonal birth control and depression. In fact, a nationwide prospective cohort study of over a million young women in Denmark reported an increased risk for antidepressant use in women prescribed hormonal contraceptives. And the results were published in JAMA Psychiatry. And their risk was highest in the adolescents who were aged 15 to 19 years old. So we don't want to be giving these teenagers antidepressants and the pill and just medicating side effects of medication. It's crazy. So you have to look for what are the real underlying causes of pms? Well, it's hormonal imbalance and there are a lot of causes for hormonal imbalance. So it's important to understand what they are and, and how to deal with them. The main problem is something called estrogen dominance, which means that your estrogen levels are too high and your progesterone levels are too low. Now this may be an absolute increase, in other words, a very high estrogen, low progesterone, or it may be a relative dominance of estrogen over progesterone. And unfortunately this is not something well recognized by traditional medicine. And you can measure this? Right. The fluctuations in estrogen in relation to progesterone can cause all sorts of problems, including neurotransmitter signaling and lots more. Because estrogen in part regulates serotonin levels in the brain and that can contribute to PMS symptoms. Things like mood swings, depression, irritability, and an absolute or relative excess of estrogen in relation to progesterone drives most of the symptoms of PMS and menstrual problems like fluid retention, breast tenderness, migraines, mood swings, heavy bleeding, cramps. All that is really related to this excess estrogen and inadequate progesterone as women get through their later cycles in life. So what causes these hormonal imbalances? Well, there's a lot of causes, right? It's not just one thing. Inflammation is a big one, which can be from many, many sources. Insulin resistance, another big cause. This is the pre diabetes metabolic dysfunction. This comes from eating a high sugar refined carb diet. Also, caffeine is not necessarily great for this. A lot of women really are sensitive to caffeine. So too much caffeine can actually cause pms. Obviously high stress. A lot of stress is a big factor in dysregulating hormones. You know, I mean, often women are just working hard on the go. They're trying to maintain their relationships, deal with their kids, deal with their housework, build their career, deal their aging parents. It's like a lot. And that affects your hormones. Poor diet is certainly a big factor. And when you clean up the diet, a lot of hormonal stuff just gets sorted out. And then there's a lot of unfortunately, hormones in conventional meat and dairy products. So I encourage you to eat regenerative or organic products. And particularly dairy might not be your best friend. If you're having a lot of female hormone issues, I'd encourage people to just quit dairy as an experiment to see what happens. There are also environmental toxins that play a big role in hormonal health. And unfortunately, a lot of these petrochemical toxins are also endocrine disruptors. They act as hormonally active compounds in the body, even at low doses. And in fact, there's a word for them. They're called xenoestrogens. Foreign. Xeno means foreign. And obviously estrogen means estrogen. So foreign estrogens, they come from pesticides, plastics, many personal care products, skincare products. I mean, these petrochemical products act as a toxic foreign estrogen like molecule that drives hormonal imbalances and most female cancers like breast, uterine, ovarian cancer. So toxins are a big factor and you have to reduce your exposures. A lot of nutritional deficiencies also affect hormone function, particularly magnesium, vitamin D and also iron, alcohol. Alcohol is another big one. If you want to kind of regulate your hormones, you got to get off alcohol. And alcohol affects your hormones in many ways. It slows the metabolism and the excretion of estrogen from your body so you accumulate more Estrogen, so you get more estrogen dominance. And drinking literally will raise your estrogen levels. I mean, drinking alcohol, not enough sleep, Also a big factor, constipation and imbalances in the gut flora. Dysbiosis, your gut flora play a big role in your hormonal health. So it's really important to keep your gut healthy. And there's a lot of ways. We've talked about that on the podcast. And when in fact you have bad bugs in the gut, it can lead to reabsorption of estrogen metabolites and that leads to this sort of recycling of estrogen and estrogen toxicity. So the microbiome is key to hormone balance. And most of us have dysbiosis or imbalances in our gut flora. So you need to do some work to get your gut healthy. Also, being sedentary, big factor, no, Your body needs exercise to balance your blood sugar and your hormones. So if you're not moving your body enough, it's likely part of your problem as well. Now, so there's a lot of variables. We look at all of them, we dig deep into all of them, we get tested, we know what's going on, then we can help personalize the approach. Test, don't guess, you know, check your levels. So you can check basic things to help regulate hormones like magnesium, vitamin D, vitamin D, iron, zinc, omega 3s, and sex hormones. Really important to check your FSH, LH, your estradiol level, your progesterone level, testosterone level. And you do this best in the luteal phase of your cycle, which is about day 19 to 22 of a 28 day cycle. Really important to know your numbers because we can see, for example, I had a patient yesterday who had extremely high estrogen, very low progesterone, very severe PMS symptoms. So it was really clear what's going on. And you can get all these tests done through a company I co founded called Function Health that allows you to get access to over 110 biomarkers, 499 a year as a membership. It's quite incredible. And you can get a deep dive into all your hormonal health and metabolic health and nutritional health, all the things that are going to be affecting your PMS and many other things. Obviously you just go to functionhealth.com for forward/ mark. You can skip the wait list. There's 200, 000 people on the waitlist. You might want to do that. It's functionhealth.com forward slash mark. What else should we be doing? For PMS or premenstrual syndrome, how do we get you back in balance and so you don't have to suffer and be really struggling your whole life? Because I just, I just don't think that is something that women should accept. It makes me actually quite angry that the conventional medicine system doesn't really take this seriously or just tries to medicate it instead of dealing with it from the root cause. So the first thing is food. Food is medicine. It's information. It controls every function of your body and mind, including your hormones. And it connects us to almost everything that matters in our lives. So you have to know that what you put on your fork is the most important thing you do every day for your health. So the first step to do with your diet is to cut down inflammation because inflammation will mess up your hormones. So first get rid of the junk, right? Then get rid of the junk and then add in the good stuff. So take out the bad stuff, add in the. And the good stuff. What's the bad stuff? Well, our current diet is really high in sugar and starch and that drives insulin resistance and that leads to belly or visceral fat. And here's something most people don't know. It's not just your ovaries that produce estrogen. Your belly fat is also an estrogen producing factory. Right? So all those belly fat cells in there aren't just holding up your pants, they're actually spewing out hormones. And there's something called aromatase also that increases estrogen production. That's found in fat tissue. So, you know, having more estrogen is not necessarily a good thing, especially when it comes from your visceral fat. So what are the things you should eat and not eat to eliminate PMF symptoms? Right. Eat real food. Right, Real food. You know what that is, right? My joke is if God made it, eat it. If man made it, leave it. Did God make an avocado? Yeah. Did God make Doritos or Twinkie? No. Right. Just don't eat that. So also, you want to reduce fast absorbing carbohydrates, right? Any flour products, sugar, quickly absorbed sugars like flour, instant oats, white rice, potatoes, or not all potatoes like the small fingerling potatoes may be okay, but the big starchy potatoes we all eat are a problem and they can spike insulin and that leads to insulin resistance and inflammation. And that can cause pms, can cause pcos. It can increase risk for all chronic diseases. Also, you want to really limit caffeine or get rid of it entirely for a while to See how it affects your hormones and for sure, alcohol. Alcohol, it will screw up your estrogen and make you estrogen toxic. Ultimately, these really make hormone imbalances worse. Also, I would encourage you to do a full dairy elimination for eight weeks. It's often a huge factor in PMS and many menstrual and hormonal issues. Next, I want you to avoid ultra processed foods, right? Starch, empty carbs, grains, sugar, sugar, sweetened beverages, energy drinks, teas, coffee. You know, I mean, think about it. Any, any coffee or frozen blended drink from Starbucks, Dunkin Donuts. With flavor, it means tons of added sugar or glucose syrup. And lots of women drink these and they start their day with these drinks, not realizing it's a sugar bomb. Like a vanilla latte, mocha Frappuccino, even a matcha have tons of added sugar. I mean, a grande mocha frappuccino has almost 13 teaspoons of sugar. I mean, you've never put 13 teaspoons of sugar in your coffee in the morning. But if you're going to Starbucks for your morning fix, you're literally killing yourself. Also, avoid some of these quote, healthy nut milks or oat milks. They're, they're often blended starch, sugar and water, so be careful. Oat milk really spikes your blood sugar sometimes. There's also additional sugar from the flavoring too, like vanilla or chocolate, whatever, hazelnut. Just stay away from all that stuff. Drink black coffee, put a little almond milk in it. Ask for the unsweetened almond or coconut milk, although usually you don't have that. Also, I want you to avoid processed food, packaged food, all kinds of food with quote, health claims on the label. You know, plant based, vegan, keto gluten free, whatever. It doesn't mean it's healthy. And my rule is that if it has a health claim on the label, I guarantee you it's bad for you. So just don't, don't eat. It's a way of getting food marketers to kind of get you engaged, but it's often hiding something bad underneath. Get in the habit of reading ingredient labels, right? Just know what you're eating. If it has any food that you wouldn't have in your kitchen, like or non food, right? You don't have maltodextrin or butylated hydroxytoluene in your cupboard that you put in your recipes, right? Don't eat that stuff. I mean, the average American who's eating most of their diet is ultra processed food, which is about 60% to 70% of the diet of most Americans, they eat up to 22 pounds of, of food additives a year. 22 pounds? That's insane, right? Also avoid a lot of blended drinks, packaged protein drinks. A lot of these have sugar, artificial sweeteners, sucralose, gums, emulsifiers, things that really screw up the gut microbiome. And gut microbiome plays a huge role in hormonal health. So look for a protein powder that's sweet with monk fruit or stevia instead. That's got simple ingredients. And make sure you really focus next on balancing your blood sugar. So you've got rid of all the bad stuff. So what do you do adding the good stuff, Right? So you want foods that really balance your blood sugar. You want to focus on fiber, rich, low glycemic, non starchy veggies, low glycemic fruits. And fiber is really important because it helps balance out your hormones, it helps build a healthy microbiome, it helps prevent the reabsorption of estrogen that can cause estrogen toxicity. So you want to eat the rainbow. Aim for about 8 to 10 servings of colorful veggies daily for all their health benefits. Make sure you sort of eat every day something from the cruciferous vegetable family. Like that's the broccoli family. Broccoli, cauliflower, kale, collage, cabbage, brussels sprouts, arugula, bok choy. They're all important because they actually support estrogen detoxification and they help balance the estrogen and progesterone because they contain amazing phytochemicals such as glucosinolates or indole. 3 carbidal, diurnal, methane. All of these are big medical words, but they're essentially molecules that are in the broccoli family that help induce the expression of certain enzymes called CYP450, enzymes that enhance the metabolism of estrogen in the right way to produce beneficial estrogen metabolites, including, for example, they call two hydroxy estrone. And they reduce the formation of a toxic estrogen metabolite called 16 hydroxy estrone that's associated with heavy periods with breast tenderness, breast cancer, and, and DNA damage. So there's different ways your estrogen can be metabolized in your body to the good or bad metabolites. And the bottom line is if you eat more broccoli, you'll be shifting towards the good metabolites. So that's the take home, okay? But the science is there. It's quite fascinating. And I do measure in my practice the estrogen metabolites. And I can see what's happening with women's metabolites and whether they need more B vitamins or more support for glutathione or more. These chemicals from food, these phytochemicals like indole 3 carbonal or dandy methane. You also want to focus on slow absorbing and burning carbs. Sweet potatoes, yams, lentils, some whole grains are fine like quinoa, non starchy veggies. Protein to avoid the blood sugar spikes. Those are really important. Then you eat protein first as opposed to starch first. Eat about 4 to 6 ounces of protein per meal, roughly the size of your palm. Make sure you use high quality sources. Grass fed meats, pasture rich eggs, poultry. Poultry, I recommend Force of Nature. I love it. It's. I don't have any financial relationship but they have great regenerative sources of chicken and meat. Bison and venison, elk so forth. You actually need protein by the way to make, to make hormones. So they're part of the building blocks and you good fats to make hormones as well. Make sure your diet's really nutrient dense. You want a lot of bioavailable micronutrients like iron, magnesium, B vitamins and so forth. Nuts and seeds are great for hormones. I, I, I bunch of science on how they regulate hormonal health, but things like flax seeds are my favorite. Almonds, chia seeds, hemp seeds, pumpkin seeds, sesame seeds, sunflower seeds. All these are rich in fiber, they're full of good fats. They have micronutrients like calcium, magnesium, zinc, iron, B6, phosphorus, which are all important for a healthy menstrual cycle and hormone balance. Right? Your body's just a big biochemical machine and you have to put in all the right ingredients to make the right things work. And what the problem is is most of our diet is depleted. Most of us are nutrition efficient at some level or other. Most of us are unhealthy microbiomes. Most of us are exposed to toxins. Most of us eat too much sugar. Most of us drink too much coffee, Most of us drink too much alcohol. Most of us don't exercise enough. No wonder we're having all these problems, right? So we really need to get our act together if we want to reset. And it doesn't take that long. One or two cycles of doing this for women really helps reset the whole system. One of the cool things you can do is use flaxseeds. Ground flaxseeds, about 2 to 4 tablespoons. It's great for your hormones. It's great for beneficial compounds that, that are helpful in regulating your hormones like lignans. And also it's great for bowel movements, right? So they really balance the hormones and they block the negative effects of some of the excess xenoestrogens. So if you're exposed to environmental toxic estrogens, you can actually reduce your exposure to them by having these flaxseeds. Also you want to increase the anti inflammatory fats in your diet. The Omega 3s, Epadha and my favorite sources obviously are sardines, herring, mackerel, anchovies. You can use small wild caught salmon sometimes there's omega 3 enriched eggs. There's plant based sources like walnuts, G and hemp. But they're not really moving the body into the EPA and DHAs. Only about 10% is converted. So you want to get the also the preformed EPA DHA from fish or from supplements. Now if you're a vegetarian or vegan, it's really important to supplement with omega 3 fats. Really will help your hormonal health. Also increase monounsaturated fats. These are avocados, olive oils, extra virgin olive oil, macadamia nuts, seeds. Really important saturated fat may not be bad for most people. You just have to watch your cholesterol and see what happens. But, but grass fed butter, ghee, coconut oil, actually saturated fat is a building block for your hormones, right? Your hormones are made out of fat. Also you want to decrease the inflammatory fats, right? Trans fat, hydrogenated fat, margarine, even vegan butters. They're actually not recognized as safe to eat anymore by the fda, but they're still lurking on the grocery store shelves. So be religious about never eating them. Also, you want to reduce your intake of vegetable oils. These refined highly processed oils, you know, if they're cold pressed, if they're organic, if they have high oleic levels, they may be okay, we need some, but the amount we're eating is just a pharmacologic dose. Sunflower corn oil, canola oil, safflower oil, not so great. Also stay away from processed meats. Stay away from like hot dogs. Stay away from weird processed cheeses. I mean you should be in there anyway. But Kraft singles, they can't call it cheese because it's not more than 51% cheese. That's just a bunch of chemicals. Obviously reduce your exposure to pesticides and hormones and antibiotics that are stored in some of these foods and you can use the clean 15 and dirty dozen guy from the environmental working class group to guide you on which are the least contaminated or the most contaminated foods and fruits and vegetables. So it's not always possible. But try to eat grass fed and organic. When possible, filter your water. I mean also support your gut. Really important to support your gut. Probiotic rich foods are key things like sauerkraut, kimchi, miso, natto, which may taste weird but it's actually really good for you. And prebiotic foods also like asparagus, artichokes, jicama and drew some artichokes. All great for your gut health. Because supporting your gut health really and having a healthy microbiome helps normalize estrogen metabolism. It's all connected. In fact, we do stool tests and we can see that some women have certain levels of bacteria that make them reabsorb estrogen and that causes estrogen toxicity, can lead to fibroids and many other things. Also try to stay in circadian rhythm. When we live irregular lives and waking and sleeping and eating all throughout different times, you know, it can be hard in our system. So eat regular meals throughout the day at, at the right times. Don't skip meals. Don't get hangry, don't make hangry. Bad choice food choices. I know if I'm hangry, I'll eat bad stuff, right? Also, you may want to just make sure you don't eat overnight. Like basically 12 hours. It's called that breakfast, right? We call it time restricted eating now or fasting or whatever. It's basically just don't eat between, let's say seven at night and seven in the morning, right? It's 12 hour fast. That's going to help maintain insulin sensitivity, reduce inflammation. And you can do this during the first phase of your cycle even more than the second. It can be better. Don't eat within three hours of bedtime. Don't fast for too long. Actually can be problematic for women. And start your day with a nutrient dense food. Right? Protein, fat and fiber. Think protein, fat and fiber. Not the typical breakfast. We have cereal, muffins, bagels, you know, sugared coffee. I mean French toast, pancakes. I mean the American breakfast is the worst and you do not want to start your day with that. You want protein and fat and fiber for breakfast. So you have eggs, spinach, peppers, olives, maybe some feta cheese from sheep, an omelet with avocado protein shake. Also stay hydrated. At least eight glasses of water a day. Sometimes I use electrolytes are important. I like E Lite. Lots of really important things around nutrition. But getting your nutrition straight can really help regulate your hormones. And you also need potentially some supplements. A number of supplements been shown to really help ease PMS symptoms because they improve metabolic health, hormonal metabolism, and here's the superstars. Magnesium glycinate, 400 to 600 a day. Calcium, sometimes helpful. It's calcium citrate, about 600 a day. Vitamin B6, really important for estrogen metabolism, 50 to 100 milligrams a day. And folate, especially a preformed form called methylfolate, about 800 micrograms a day. Vitamin B12 in the form of methyl cobalt balm in about a thousand micrograms a day and evening. Primrose oil, that works really well. Take 500 milligram capsules, one or two twice a day. Take fish oil, omega 3s, EPA, DHA, about a thousand milligrams, one or two a day. Taurine, also really important for hormone metabolism. It's an amino acid, about 500 milligrams a day. Helps liver detox and a good multivitamin. All these things work together. And the good news is there's also a lot of herbs and phytochemicals that can really help, including chase berry. Also, Vitex is known as Vitex, but Chase berry fruit extract is very good for regulating menstrual cycles and helping with pms. Milk thistle dandelion root also is great. Certain isoflavones from soy, red clover, kudzu root help improve estrogen detoxification because they boost some of the metabolism enzymes that you need to properly regulate estrogen. And they can be taken as supplements or in the diet. Also keeping your gut healthy. I do recommend probiotics to help normalize estrogen and hormone metabolism. Maybe five to 10 or even more billion organisms a day in a probiotic supplement. And so what if all that stuff doesn't work completely? Or maybe you're better, but not 100% better. What else can you do? Well, one of the things that you can do is to mitigate some of this estrogen excess by giving a little bit of topical natural bioidentical progesterone. And I usually do that in the last two weeks of the menstrual cycle. Usual dose is about 20 milligrams, 20 to 40 milligrams applied at night to the thin skin areas, maybe your forearms, inner thighs, your belly for the last two weeks of the menstrual cycle. And that often can help with many of the symptoms, like premenstrual migraines, the mood changes, the heavy bleeding, the clotting Next, you want to make sure you exercise. Exercise is so important for balancing your hormones. You want to aim for about 30 minutes of aerobic exercise four to five times a week. Really important in regulating hormones, obviously, stress, you know, managing stress, dealing with stress is so critical. You want to take a hot bath at night, get a massage, try yoga, learn deep breathing or breath work, meditation. There's lots of techniques out there and many others that can help balance your hormones. So you want to make sure you really attend your diet, your lifestyle, your sleep, stress level, your microbiome, optimizing nutrition, taking the right herbal support, maybe a little progesterone that can help balance your hormones. And really we can help reduce this whole phenomena of estrogen dominance that's leading to so much of the suffering that women have around their periods, including pms, heavy bleeding, clots and mood changes, and migraines, and you name it. Now remember, women are not defective. PMS is not a natural condition of being female. You can thrive and be healthy by paying attention to a few natural laws of biology and don't need drugs to survive. You just have to learn how to balance your hormones with some simple changes in your diet, lifestyle and supplements.