The Infamous "Period" and PMS

Over the past few years, I have noticed a number of changes surrounding my menstrual cycle. I'm not sure if it's the fact that I use a hormone free IUD, or if it's my aging process (wine gets finer with time)...I'm pleading the fifth on the aging process...lol ;) So, I decided to dig a little into the actual pathophysiology behind my "Horrible Headaches" or H² surrounding my menstrual periods. Yes, I named them H²...I was a Math major and I'm a SUPER nerd!  

It is absolutely undisputed how miraculously our bodies function, and I'm always in awe of the many variations of beauty our body's represent.  A portion of the female body's beauty stems from its ability to manage stress, hormones, emotions, and reproduction with ease.  "With ease" is a bit of an under statement, when I actually think about the monthly process our bodies are subject to upon reaching our first menstrual cycle.  I remember entering middle school and all of my friends and female family members of my age group were all discussing their "period"... and I remember looking at them with my "shut the front door" face, thinking "it can't really be that bad...seriously...it's so bad that we have to have a full blown conversation instead of riding bikes"?  Anddddd 15 years later, I must confess that at least "MY" menstrual cycle needs/deserves/will occupy more than a full blown conversation...besides who would I be kidding if I didn't recognize that it basically runs things!  MY definition of running things doesn't exactly mean that I "bow down" to it...I just understand my body's natural process and I don't fight it nor do I attempt to agitate it because ultimately...my body WILL win (hands down) every time!  And I only know that my body's a winner because in my younger, not so in tune with my body self...I thought it was possible to live around my monthly cycle, as in not listening to my body and its needs during this very pivotal period of time.  However, my body had a way of ever so gently knocking me on my butt, at which point I had no choice but to listen.

In my younger days, I would battle with very painful cramping, but after child birth I started to notice a new pattern, and yet another pattern began after I started using a hormone free IUD.  So, I would go through periods of time where I thought I had my monthly cycles and symptoms all figured out, when in actuality just like any life long process my monthly cycles were evolving with my lifestyle environment.  In order to get in touch with and to understand my monthly cycles better, I had to call on my nursing background to research a few topics.  Mentally, I understand that my body is very complex, and it needs to be taken care of as such, but physically (in the real world) there are so many things that need to be taken care of in addition to "ME", which implies that my body may suffer from "I'm gonna start that next week" syndrome from time to time!  But, I'm human and this will occur from time to time, and I'm okay with that as long as I learn from my experiences and in turn share with you ;)

What is the "Menstrual Cycle" Exactly

In the most basic explanation, our menstrual cycle is a 4 week or 28 day cycle where our reproductive hormones participate in an automatic balancing act initiated by the hypothalamus to:

• mature an egg within one of our ovaries for release during ovulation, and to
• build a foundational endometrial lining along the wall of our uterus for future egg implantation1

The Hormones of Our Menstrual Cycle

1. Luteinizing Hormone (LH) - causes the complete maturation of follicles and pushes the follicles through ovulation.  It is also responsible for the development of the area on the ovum where the ovum exited during ovulation.  This exit area or ruptured follicle turns into a corpus luteum that excretes progesterone.
2. Estrogen - produced by the mature follicle, and suppresses the release of the FSH 
3. Progesterone - maintains the layer of the uterus that supplies blood circulation in preparation for fertilization and implantation for a developing fetus.  
4. Follicle-Stimulating Hormone (FSH) - stimulates the growth and maturity of the ovarian follicles necessary for ovulation1

For symptom identification reasons, I am going to focus on estrogen and progesterone along with serotonin.  Serotonin is a neurotransmitter that is involved with moods, emotions, and sleep; these levels are usually elevated in those with schizophrenia1

How Hormones & Neurotransmitters Affect Premenstrual Syndrome (PMS)

The fluctuations of our hormones has been mentioned by many as the foundation of our PMS symptoms.  Recently, I read a few articles that introduced a new variable to the PMS equation; the neurotransmitter serotonin.  In the Monthly Hormone Chart below, I have tried to illustrate the fluctuations of our key hormones (estrogen and progesterone), and serotonin with respect to our monthly menstrual cycle.

Monthly Hormone Chart.  Displays our typical monthly menstrual cycle from day 1 through day 31.  Where mensing (bleeding) or our "period" starts approximately on day 28 and continues through day 3 of our new cycle.  Each colored line represents a significant hormone and its fluctuation throughout our menstrual cycle.  Serotonin has two lines, where the green line represents its levels in women without PMS, and the purple line represents its levels in women with PMS.

In an ideal health situation, our serotonin levels remain steady (as seen with the green line) throughout our monthly menstrual cycle.  However, research has shown that women who experience PMS also experience a drop in their serotonin levels as their estrogen levels drop2 (as seen with purple line).  In my case, my PMS symptoms begin around the 14th day before my "period" starts.  Just for clarification, our menstrual cycle is a 4 week time frame that ends with a 3-7 day mensing interval.  This 3-7 day mensing interval is the portion of our menstrual cycle that we call or have come to know as our "period" because it's the most external evidence of our internal reproductive cycle.  At the end of our mensing interval or "period", our menstrual cycle starts again!  I felt the need to clarify this because at times we may forget that our body is ALWAYS in a menstrual cycle, but we tend to only acknowledge or pay attention to the portions of this continuous cycle that affects our activities of daily living (cramping, mood swings, bleeding, bloating, etc).

Soooo, back to these serotonin levels...serotonin levels tend to reach their lowest levels during the 2 weeks prior to mensing2.  Ultimately, women who experience this drop in serotonin also experience PMS.  And there lies the supposed connection...

The Infamous PMS Progression.  Displays the supposed relationship between hormones and PMS.  Granted it is not known what causes serotonin levels to mimic the decrease of estrogen levels.  However when serotonin does decide to follow the drop in estrogen, the decreased level of serotonin has been linked to PMS.

What Can We Do About It?

There are a number of options for limiting and alleviating symptoms related to PMS.

If you are anything like me, you want the justification behind as many of these options as possible.  So, here is my attempt at providing justification...

• Stress - this is problem if you are a person with great health, so imagine adding the element of stress to your body when it's in a state of imbalance...enough said!
• Avoiding caffeine and refined carbohydrates - this allows your body to minimize nervous system arousal.
• Increasing complex carbohydrates, high fiber, foods rich in vitamin B6, dairy, and poultry - these diet options are supposed to promote serotonin production.
• Exercise - enables the release of endorphins, which elevates your mood.  Aerobic exercises are especially good for relaxing the body.
• Calcium and magnesium - help with alleviating psychological and physiological symptoms.

Now for the "Happy" foods list...

• Sweet potatoes - loaded with folate, and B vitamins that increase serotonin and dopamine (neurotransmitters) levels, leading to better moods,
• Bananas - loaded with tyrosine, which is a building block for neurotransmitters,
• Eggs - have ideal proportions of fat and protein which will keep your blood sugar from jumping all over the place, preventing extreme mood highs and lows,
• Quinoa - (my favorite rice/noodle replacement) loaded with protein, B vitamins, magnesium, and iron, all of which regulate serotonin levels, evening out your moods,
• Tomatoes (cooked) - loaded with lycopene which prevents inflammation that can accompany PMS, leading to stress on your body...not to mention discomfort and pain,
• Avocados - loaded with healthy fat like Omega-3's which increases a positive mood,
• Coconut oil - (the only oil I use for cooking) loaded with medium-chain triglycerides which improves the brain's production of serotonin 3
• Chocolate, eggplant, pineapples, plantains, red plums, and walnuts - increase serotonin levels 5

After all of the information provided, I have to say that regular exercise, eating healthy, and taking a daily multi-vitamin seem to handle my mood swings and fatigue related to PMS.  I also take an iron supplement Floradix Iron + Herbs in order to prevent fatigue related to low iron levels due to heavy mensing.  It's perfect for me because it does not cause constipation or hard stools, however the taste isn't that great and I have to remember to take it 30 minutes prior to eating.  When my symptoms are severe and I'm experiencing migraines and severe cramping, I utilize Tylenol for cramping (because I can't take Ibuprofen...but if I could I would take an NSAID instead), Frova which is a prescription medication for migraines, and my old faithful heating pad ;) Frova works really well for immediate relief as soon as I feel a migraine coming on or after one has started.  The multi-vitamin I use is Ola Loa, and it comes in a powder form that you mix with water and drink.  I'd rather drink my vitamins in a powder form versus swallowing them in a pill form, as the pill forms can be inefficient and lead to additional free radicals roaming around in my system.  I'm also a heating pad snob, so I figured out the exact heating pads that work best for me and they happen to be made by Sunbeam.  You can find more information about the heating pads I use here, and here.  I also use a few applications to track my menstrual cycle and symptoms, they all have their strengths, it just depends on which is more comfortable for you.  My tracking apps are...

Period Tracker, by GP International LLC

I've been using this app the longest.

Period Calendar/Tracker by ABISHKKING
This app has grown on me, and it's presentation is really cute.

Period & Ovulation by SMSROBOT LTD

LoveCycles Menstrual Calendar by Plackal Tech

Another random note...there was also a study done recently that showed significant improvements in PMS with the usage of a medication named Fluoxetine (also named Sarafem and Prozac) in the place of Calcium supplements, please contact me for information if you can't find the article on the web4

In short, my monthly "horrible headaches" are related to PMS that has been linked to a decrease in my serotonin levels that happens to decrease with my estrogen levels prior to mensing!  As always, please consult with your physician prior to starting any new exercise regimens or prior to starting new medications or supplements.  This information has been provided for educational purposes, and I hope you find it helpful.  Please feel free to follow and share ;)  Until next time!

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¹  Dunn, J. (2015, March). Bad Moods, If you’re sometimes Ms. Grouchypants (and who new ways to head off downer feelings and bring. Health.com.

²  Lewis, S., Heitkemper, M., Dirksen, S., O'Brien, P., & Bucher, L. (2007). Medical Surgical Nursing Assessment and Management of Clinical Problems (Seventh ed.). St. Louis, Missouri, USA: Mosby Elsevier.

³  University of Minnesota Health Center. (2014). Understanding PMS and Your Cycle. Retrieved April 1, 2015, from University of Minnesota Health Center: http://www.uofmmedicalcenter.org/healthlibrary/Article/85704

⁴  Yonkers, K. (2014, January). Fluoxetine better than calcium in premenstrual syndrome. Journal of Clinical Psychopharmacological.

⁵   Leeuwen, A. M., & Poelhuis-Leth, D. J. (2009). Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications (Third ed.). Philadelphia, PA, USA: F. A. Davis Company.