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Is Your PMS "Normal"?

Ah, the period experience. How do you know when your symptoms warrant further investigation

and support? The short answer… when you suspect there is something bigger going on. Of course this can be hard to tease out since menstrual pain and mood shifts are almost considered a right of passage for those of us with a uterus. However, any major shifts or symptoms warrant a bigger conversation with a health care provider… If your periods are causing significant impairment in your day to day life, you deserve a proper assessment. So where can you start?

Monitor for symptoms such as:

  • Extreme cramping

  • Severe mood swings

  • Significant bloating

  • Depression or anxiety

  • Migraines

Keeping a symptom diary can be extremely helpful. This gives you a better idea of symptom

timeline and allows you to track intensity. You’ll want to track symptoms for at least 2-3 cycles.

But not to worry- supports can be put into place WHILE you work on consistent symptoms

tracking and further assessment.

Once you have a clear idea of your symptom calendar, it becomes easier to differentiate

between menstruation, premenstrual syndrome, premenstrual exacerbation and premenstrual

dysphoric disorder.

Premenstrual Syndrome


Premenstrual Exacerbation


Premenstrual Dysphoric

Disorder (PMDD)

Physical symptoms and

mood changes which occur

before the menstrual period

(and disappear after the

onset of the period)

Symptoms of an underlying

condition (depression,

anxiety) that gets WORSE

during premenstrual stage

Severe, sometimes disabling,

extension of PMS, with a

tendency towards extreme

mental health symptoms.

Work impaired >3 days/month

Social/Family life impaired >5 days/month

Still unsure where you fit? Don’t worry, there are practitioners who specialize in the nuances

between these conditions. Consider booking in with one of our Naturopathic Doctors for a full

assessment and to discuss the best next steps for you.

So what causes these monthly frustrations? There are a few suggested theories, but you likely

won’t find extensive hormone testing on your assessment plan. Research suggests PMS/PMDD

is not actually related to altered hormone levels. Meaning you won’t necessarily find inappropriate estrogen or progesterone on your lab work. Instead we are finding that PMS/PMDD is more accurately an inappropriate nervous system response to normal cycle changes. In other words, your body is viewing your natural shift in hormones as a threat.

That being said, some labs should be run in order to rule out potential PMS lookalikes. These

would include, but not be limited to:

  • Thyroid stimulating hormone

  • Cortisol

  • Follicle stimulating hormone and luteinizing hormone (Day 3)

  • Prolactin

  • Vitamin D

  • Ferritin

So where does this unfavorable association between our stress response and our monthly cycle

stem from? Evidence suggests PMS and PMDD can both be linked to past traumatic events,

such as childhood trauma, neglect and/or abuse. Young competitive athletes also tend to have

an increased risk for PMS. These associations suggest an inappropriate marriage of sorts,

between our stress hormones and our monthly sex hormone fluctuations.

Most importantly, there is nothing wrong with you. And there’s a good chance there is nothing

“wrong” with your hormones either. But missing out every month just because you ovulated…

That’s not normal, and there are solutions. Consider booking in with one of our naturopathic

doctors to discuss your treatment options.


  1. Azoulay, M., Reuveni, I., Dan, R., Goelman, G., Segman, R., Kalla, C., Bonne, O., & Canetti, L. (2020). Childhood Trauma and Premenstrual Symptoms: The Role of Emotion Regulation. Child Abuse & Neglect, 108, 104637.

  2. Czajkowska, M., Drosdzol-Cop, A., Naworska, B., Galazka, I., Gogola, C., Rutkowska, M., & SkrzypulecPlinta, V. (2020). The impact of competitive sports on menstrual cycle and menstrual disorders, including premenstrual syndrome, premenstrual dysphoric disorder and hormonal imbalances. Ginekologia Polska, 91(9), 503–512.

  3. Dean, B. B., Borenstein, J. E., Knight, K., & Yonkers, K. (2006). Evaluating the Criteria Used for Identification of PMS. Journal of Women’s Health, 15(5), 546–555.

  4. Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American Family Physician, 94(3), 236–240. Ito, K., Doi, S., Isumi, A., & Fujiwara, T. (2021). Association between Childhood Maltreatment History and Premenstrual Syndrome. International Journal of Environmental Research and Public Health, 18(2).

  5. Yen, J.-Y., Lin, H.-C., Lin, P.-C., Liu, T.-L., Long, C.-Y., & Ko, C.-H. (2019). Early- and Late-Luteal-Phase Estrogen and Progesterone Levels of Women with Premenstrual Dysphoric Disorder. International Journal of Environmental Research and Public Health, 16(22).

  6. Yonkers, K. A., O’Brien, P. M. S., & Eriksson, E. (2008). Premenstrual syndrome. Lancet, 371(9619), 1200–1210.

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