PreMenstrual Syndrome: hormonal Roller Coaster month in, month out

This article is both for men and women. For women to understand and accept that they are not on their own, and for men to stop using it as a great joke theme. Guys, you have called a common cold – when it hits you- a man flu, for goodness sake. I would like to see you bleed for 5 days every month and not be bothered!

PMS is that crazy time before period, when a woman, in her childbearing age does not feel that great. Symptoms include:


  • bloating
  • acne (posh word for spots)
  • lower back pain
  • cramps
  • headache
  • constipation
  • sensitive breasts (not in a good way!)
  • fatty/sugar rich food cravings
  • water retention


  • stress
  • tiredness (sometimes caused by insomnia)
  • fatigue
  • mood swings (I would say more mood-drops…)

Some people would list losing interest in sex there as well, but after having even half of the above, is anyone really into faire l’amour??? It does have something to do with the hormonal change as well, but we will come to that later.

PMS can start even 2 weeks before the bleeding starts .

(I have actually used the word ‘bleeding’ on purpose – because women DO bleed for 3 to 7 days every month, and maybe it is not the best topic over business dinner, but it is good to remember. Things are the way the nature designed them, whether you are squeamish or not, so hopefully you are able to get over it so we can get to the heart of the matter)

In some shape or form PMS affects every woman in childbearing age on the planet. For around 1 woman in 20 it will be so overbearing that it will stop her from having a normal life. In medical terms they go one step deeper and suffer a premenstrual dysphoric disorder (PMDD). 1 in 20 or 5%.

We have covered WHAT now it is time for WHY.

Before I try to tackle the WHY a few words of explanation: this topic has been requested by a close friend a while back. I got really excited, as I realized I did not know much about the causes, knowing the results too well though. So I started my research and I could not believe that there is so little substantial information out there. When you think about it: half of the human population of the planet Earth is affected by a certain pattern of symptoms, which for 5% results in severe life disruption month in month out. On average every 28 days for lets say 30 to 40 years. And we are not fully certain why… I will leave it here, otherwise I will keep on rambling forever and you will be clicking on that tiny x to close the page 😉

So let’s have a look at what information we have got.

During the menstrual cycle there are many hormonal changes. Female body within a month matures and releases an egg from one of the ovaries. The egg travels to the womb waiting to be fertilized (well, it is not very patient to be honest because if there is no action it only lasts 24h). Fertilized or not, the body prepares for implantation of the embryo. During that cycle two main hormones significantly change their levels: estrogen and progesterone. Estrogen has a peak before ovulation, stays a bit higher afterwards and drops on its head before period. Progesterone is released after ovulation, keeps on going up to prepare the womb for a possible embryo implementation – and.. drops on its head before the period.

Here is a nice chart. Have a look at the black and blue lines (*estadiol is a form of estrogen):


When you try to find the reasons for PMS usually the first sentence is: not fully understood. However these two are obvious culprits to look at:

  • Progesterone – there seems to be an interaction between progesterone and serotonin. Serotonin is another hormone, managed by a different unit (brain), playing a key role in maintaining mood balance. Deficit of serotonin can lead to depression. High progesterone seems to be taking serotonin levels up with it. Another crucial piece of information is that low progesterone levels result in less efficient glucose delivery to the brain.
  • Estrogen –  very closely associated with general well being: good mood, regular sleeping patterns, sharp thinking and usual energy intake (appetite). Research shows a clear connection between a regular or even reduced food craving with high levels of estrogen and higher food demand when low. This is why just around ovulation we tend to feel at top of the world. The first drop of estrogen after ovulation is cushioned by rise of progesterone. However there is nothing to cushion the second drop at the end of the cycle.

To summarize: the two hormones are connected with well being: directly or by influencing other hormones. Both in its own way influence either appetite or fuel delivery: with high levels we eat regularly and fuel all parts of our body, with low levels our organism asks for more calories and it not very efficient with getting the sugar to the right places. Again: just before the period both hormones levels drop significantly.

How can we help minimize the impact of PMS?

Well, in the first place I think that understanding that we are not crazy helps. Getting our head around biology might enable us to see it coming and maybe take it with a bit of perspective, plan and not get ourselves overwhelmed. It is not always possible, but maybe sometimes we can move some stressful events in our agenda and get a space to breathe and chill. Eating regularly (even if alternating with chocolate 😉 ) helps to diminish the glucose delivery reduction to our brain and regular exercise helps to keep the machine in a good flow.

Just to put the record straight: I do not think PMS should be used as an excuse to explode. However my dear man: now that you understand that the woman by your side – partner, sister, friend – who is taken for a hormonal ride every month, maybe instead of making a joke about it, or getting irritated get her a cup of hot chocolate. Maybe offload the dishwasher and let her have a quiet moment on the sofa, while reading her favorite book. Let her breathe so she can live with it, not despite of it.

And I wish scientists would fine a better term for their scientific papers than ‘woman in reproductive age’ 😉






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