Pre-Period Symptoms: What is Considered 'Normal'?
- Skye Sunderland
- Sep 5, 2024
- 10 min read
Updated: Mar 15
It’s common for women to feel different as they move through each phase of their menstrual cycle. Hormonal fluctuations across the cycle influence the brain, metabolism, and many physiological systems, meaning shifts in mood, appetite, sleep, and energy can occur at different points in the month.
However, the luteal phase—the time between ovulation and the start of menstruation—should not feel like a period of complete chaos. Mild changes in mood, energy, or water retention can occur as hormones rise and fall, but severe mood swings, emotional outbursts, intense cravings, debilitating fatigue, significant bloating, or feeling overwhelmed to the point it interferes with daily life are not symptoms that women simply have to endure.
Research shows that up to 90% of menstruating women report experiencing at least one premenstrual symptom during their lives. This means premenstrual symptoms are extremely common. However, common does not necessarily mean inevitable or unavoidable. For many women, these symptoms can be significantly improved—and in some cases largely prevented—through targeted lifestyle, nutritional, and behavioural interventions.
It is also important to recognise that some conditions affecting women’s reproductive health, such as Polycystic Ovary Syndrome, Endometriosis, and Premenstrual Dysphoric Disorder, involve more complex physiological mechanisms and may require additional medical support. However, the majority of premenstrual symptoms fall within the spectrum of premenstrual syndrome (PMS) and can often be meaningfully improved when the underlying drivers are addressed.
Understanding what is happening in the body before menstruation is the first step. By examining how hormonal shifts influence the brain and body, we can better understand why PMS occurs and, more importantly, what can be done to manage it effectively.
What is Considered 'Normal'
Feeling somewhat different throughout the menstrual cycle is entirely normal. The menstrual cycle is a dynamic neuroendocrine process involving coordinated changes in hormones, brain signalling, metabolism, and the reproductive system. These fluctuations support the possibility of pregnancy and reflect the remarkable physiological complexity of the female body.
Across the cycle, changing concentrations of estrogen and progesterone influence multiple systems in the body. These hormones interact with neurotransmitters in the brain, affect fluid balance and connective tissue, and influence metabolism and thermoregulation. As a result, it is normal for women to notice subtle variations in mood, energy levels, concentration, appetite, or physical sensations at different points in the cycle.
During the follicular phase, which begins after menstruation and continues until ovulation, estrogen gradually rises. Estrogen is associated with increased activity in several neurotransmitter systems, including dopamine and serotonin pathways, which can contribute to improved mood, cognitive clarity, and higher perceived energy levels.
After ovulation, the cycle transitions into the luteal phase, during which progesterone becomes the dominant hormone. Progesterone plays an important role in preparing the uterus for potential pregnancy, but it also influences the central nervous system. Many women notice subtle shifts during this phase, such as feeling slightly more fatigued, calm, reflective, or inwardly focused.
These changes are a normal part of menstrual physiology. However, some women experience heightened sensitivity to the hormonal changes that occur during the luteal phase, particularly the rapid decline in progesterone and estrogen in the days before menstruation. This sensitivity can lead to more pronounced physical or emotional symptoms commonly associated with PMS.
While mild premenstrual symptoms are common, severe symptoms that significantly disrupt daily functioning, relationships, or work are not considered typical and should not be dismissed as an inevitable part of womanhood. With appropriate strategies, many of these symptoms can be significantly reduced.
What is PMS?
Premenstrual syndrome (PMS) refers to the physical and emotional symptoms many women experience in the days or weeks leading up to their period, during the luteal phase of the menstrual cycle. Up to 90% of women report experiencing at least one premenstrual symptom at some point. However, this does not mean hormone levels are abnormal. Current research suggests PMS occurs because some women are more sensitive to the normal hormonal changes of the cycle, particularly the decline in progesterone and estrogen before menstruation.
For many women, symptoms are mild—such as slight bloating, temporary mood changes, or fatigue—and resolve once menstruation begins. For others, PMS can cause significant distress, interfering with daily life, relationships, and work.
Physical symptoms of PMS:
Cramps
Bloating and water retention
Headaches
Back pain
Constipation
Food cravings, particularly for sweets and carbohydrates
Tender breasts
Emotional symptoms of PMS:
Anxiety or low mood
Mood swings
Irritability
Fatigue
Trouble sleeping
Although these symptoms are familiar to many women, they do not have to control your life. Experiencing occasional premenstrual changes is common, but persistent or severe symptoms that disrupt daily functioning should not simply be accepted as inevitable. With the right lifestyle, nutritional, and behavioural strategies, many PMS symptoms can be significantly reduced.
How Does PMS Occur?
One of the most important things to understand about PMS is that it is not caused by abnormal hormone levels. Most women who experience PMS have estrogen and progesterone levels within normal physiological ranges. Instead, current research indicates that PMS occurs because some women are more sensitive to the normal hormonal changes that occur during the menstrual cycle—particularly the rapid withdrawal of progesterone and estrogen in the late luteal phase.
After ovulation, progesterone rises as the body prepares the uterus for potential pregnancy. If pregnancy does not occur, both progesterone and estrogen decline rapidly in the days before menstruation. For many women this shift causes little disruption, but in others the brain and nervous system respond more strongly to this hormonal withdrawal.
A key factor involves allopregnanolone, a neuroactive metabolite of progesterone. Allopregnanolone interacts with GABA-A receptors, which are responsible for calming neural activity in the brain. During the luteal phase, higher progesterone increases allopregnanolone levels. As progesterone rapidly declines before menstruation, this calming signal is suddenly reduced. In women who are sensitive to this change, the result can be irritability, anxiety, mood instability, and emotional dysregulation.
At the same time, hormonal withdrawal can influence serotonin activity, a neurotransmitter involved in mood regulation, appetite, and sleep. Reduced serotonergic activity during the late luteal phase is one of the reasons symptoms such as carbohydrate cravings, fatigue, and low mood are commonly reported before menstruation.
For this reason, PMS is best understood not as a hormone imbalance but as a neuroendocrine sensitivity to normal hormonal fluctuations. Two women may experience the exact same hormonal pattern across the cycle, yet one may feel relatively stable while the other experiences significant symptoms.
This understanding has shifted how PMS is approached clinically. Rather than attempting to “fix” hormone levels, many effective strategies focus on supporting neurotransmitter balance, reducing inflammation, stabilising blood glucose, and improving nervous system resilience, all of which can reduce symptom severity.
PMS vs. PMDD
Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS that affects about 3-8% of menstruating women. While PMS can be uncomfortable, PMDD can be downright debilitating, causing severe emotional and physical symptoms that interfere with daily life.
PMDD symptoms include:
Severe mood swings
Depression and feelings of hopelessness
Anxiety or tension
Extreme irritability or anger
Lack of interest in daily activities
Difficulty concentrating
Severe fatigue
Insomnia or sleep disturbances
PMDD is a serious condition, but even for women suffering from PMDD, certain lifestyle changes and nutritional interventions can alleviate some symptoms.
A Brief History of PMS: From Hysteria to Understanding
Historically, women’s health—particularly menstrual health—has been poorly understood, and to some extent, it still is. For centuries, women’s cyclical mood changes were dismissed as ‘hysteria’ or attributed to some vague, mysterious feminine imbalance. In fact, the term ‘hysteria’ comes from the Greek word for uterus, reflecting the long-standing association of women’s reproductive systems with mental instability.
It wasn’t until 1993 that the National Institutes of Health (NIH) mandated that women be included in clinical trials, meaning research specifically focused on women’s health is relatively recent. And despite this progress, an analysis of over 5,261 scientific publications from 2006 to 2016 found that only 6% focused solely on women, with just 1% designed to study the impact of the menstrual cycle. Because of this research gap, many women are still left confused, frustrated, and unsure where to turn for reliable advice.
Although research on women's health is still in its early stages, the good news is that emerging evidence is finally shedding light on effective ways to manage PMS symptoms. However, because this knowledge is so new, it is not yet widespread, leaving many women unaware of the solutions now available.
Managing PMS: What Has Been Proven
The good news is, while PMS is real, it doesn’t have to be something you simply suffer through. Several strategies have been shown to help alleviate symptoms, and they are backed by scientific research. Here are some of the most effective ways to manage PMS naturally:
Magnesium
Magnesium is a vital mineral that plays an essential role in over 300 biochemical reactions in the body, many of which are directly linked to the management of PMS. It is crucial for muscle relaxation, which helps reduce cramps, and it also assists in regulating neurotransmitters like serotonin, which influence mood and stress levels. Additionally, magnesium helps control water retention by balancing electrolytes, thereby reducing bloating and swelling.
Research shows that magnesium supplementation can significantly reduce PMS severity. For instance, a study titled Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome found that magnesium, both alone and in combination with vitamin B6, can relieve symptoms such as anxiety, mood swings, and menstrual cramps. This is because magnesium helps relax muscles, calms the nervous system, and reduces inflammation, which can ease both physical and emotional PMS symptoms.
Dark leafy greens (spinach, kale), almonds, pumpkin seeds, black beans, avocados, and dark chocolate.
Vitamin B6
Vitamin B6 is essential for the production of neurotransmitters like serotonin and dopamine, which are key to regulating mood. During the luteal phase, when estrogen and progesterone levels fluctuate, the body may experience drops in serotonin, contributing to mood swings, irritability, and even depressive feelings. Vitamin B6 can help support the synthesis of serotonin, improving mood stability and emotional well-being.
When paired with magnesium, vitamin B6 becomes even more effective at targeting the emotional symptoms of PMS, such as anxiety and irritability. It also helps reduce physical symptoms like bloating and breast tenderness by regulating hormone levels. This combination of B6 and magnesium addresses multiple aspects of PMS, making it a powerful tool for symptom relief.
Poultry (chicken, turkey), bananas, chickpeas, salmon, potatoes, and fortified cereals.
Omega-3 Fatty Acids
Omega-3 fatty acids are well-known for their anti-inflammatory properties. In the context of PMS, omega-3s help reduce inflammation, which can lessen cramps, bloating, and discomfort. These essential fatty acids also support brain function, mood regulation, and hormone balance, making them particularly effective in managing both the physical and emotional symptoms of PMS.
A systematic review and meta-analysis titled Effect of omega-3 fatty acids on premenstrual syndrome found that omega-3 supplements can reduce PMS symptoms, including mood swings, cramps, and bloating. Long-term use of omega-3s has been shown to consistently alleviate symptoms by reducing prostaglandin production, which is responsible for inflammation and cramping during the menstrual cycle.
Salmon, mackerel, flaxseeds, chia seeds, walnuts, and sardines.
Calcium
Calcium is essential for muscle function, helping to regulate contractions and prevent cramps. It also plays a role in maintaining hormonal balance, which can improve mood and reduce irritability, anxiety, and depression. Additionally, calcium supports energy levels and may alleviate fatigue, another common PMS symptom.
A systematic review titled Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature found that calcium supplementation significantly reduced symptoms such as bloating, fatigue, changes in appetite, and mood disturbances. This is because calcium helps modulate hormonal fluctuations, particularly in the luteal phase, and supports overall physical and mental well-being.
Dairy products (milk, yogurt, cheese), leafy greens (kale, broccoli), almonds, and fortified plant-based milks.
Exercise
Exercise is another powerful tool in managing PMS symptoms. While some studies have been inconclusive, there is substantial evidence supporting the benefits of regular physical activity in reducing both physical and psychological symptoms of PMS. Exercise can alleviate pain, reduce fatigue, improve mood, and decrease water retention. It triggers the release of endorphins, the body's natural "feel-good" hormones, which help combat mood swings and emotional distress.
Despite these clear benefits, no research to date has definitively determined the most effective type or amount of exercise for PMS relief. However, maintaining a consistent exercise routine—whether it's strength training, cardio, yoga, or stretching—has been shown to contribute to overall symptom management.
Why You Can—and Should—Take Control
While PMS is real and can feel overwhelming, it’s important to understand that you don’t have to live with extreme symptoms. The research we have—though still limited—proves that many PMS symptoms can be managed or even prevented through lifestyle adjustments, nutritional changes, and proper supplementation.
The first step in alleviating these symptoms is acknowledging that they are not a fixed part of womanhood. We now have access to enough knowledge and tools to make real changes in how we experience our menstrual cycle.
Supplements and Lifestyle Shifts to Manage PMS
Effectively managing PMS involves a combination of targeted supplements, lifestyle changes, and stress management techniques. Here’s a guide to help you alleviate symptoms and promote overall well-being:
Supplements:
Magnesium: 300-500 mg daily.
Calcium: 1,000-1,200 mg daily.
Vitamin B6: 50-100 mg daily.
Omega-3 Fatty Acids: 1,000-2,000 mg daily.
Exercise:
Aim for at least 100 minutes of moderate-intensity exercise, such as brisk walking, cycling, or swimming each week, plus at least 2-3 strength or weightlifting training sessions each week.
Stress Management:
Practices like breath-work, specifically diaphragmatic breathing, can help reduce stress and promote relaxation.
Evening Primrose Oil and Chasteberry:
Evening primrose oil and chasteberry (Vitex agnus-castus) are often recommended for PMS, though research is limited. Evening primrose oil may help with breast tenderness and mood swings, while chasteberry is believed to balance hormones and alleviate PMS symptoms.
While it’s normal to feel different at various points in your cycle, it’s not normal for PMS to take over your life. With the right nutrition, lifestyle changes, and supplements, you can drastically reduce or even eliminate disruptive premenstrual symptoms. It’s time to stop accepting PMS as an inevitability and start using the knowledge we now have to feel better.
Take action today—your body and mind will thank you for it.
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