Dr Sayyada Mawji:
Have you ever considered how your diet can impact your menstrual cycle? Can a change in your diet help to ease the symptoms of premenstrual syndrome (PMS) and if so what are these dietary changes? In this article, I will share nutritional tips to combat PMS and the science behind this.
First, a quick overview of the menstrual cycle and the hormones involved
The menstrual cycle can be split into three stages: the first half is the follicular phase, the second half the luteal phase and ovulation in between these two phases.
During the follicular phase, the levels of the oestrogen and progesterone hormone are initially low which causes the lining of the uterus to be shed (i.e. a period), this is the start of the cycle. After menstruation around day 5-8, the level of oestrogen starts to rise and peaks mid-cycle which leads to ovulation (release of an egg).
During the second half or luteal phase of the cycle, the level of oestrogen remains high and progesterone also begins to rise, this prepares the body and uterus for pregnancy. When the egg is not fertilised, both hormone levels drop, the uterus lining breaks down, and your period starts again (the cycle re-starts).
The menstrual cycle is primarily regulated by the hormones oestrogen, progesterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH) as well as other hormones in the body. The levels of these hormones fall and rise through the different phases of the cycle.
It’s important to note that these hormones are not only involved with reproduction but also play a role in regulating other systems of the body and can impact our appetite, metabolism and affect organs such as the brain, heart, muscle and bones.
What is premenstrual syndrome (PMS)?
Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms that can occur one or two weeks before the start of the period (during the luteal phase). It can include a wide range of symptoms to varying degrees of severity such as: fatigue, changes to mood, difficulties sleeping, feeling bloated, breast tenderness, changes to libido, and changes to appetite.
The exact reasoning behind why we experience PMS is not fully understood but it is thought to be linked to the fluctuations in the levels of hormones and brain chemicals that occur during the menstrual cycle.
Can dietary changes help to ease the symptoms of PMS?
Healthier lifestyle choices such as regular exercise, eating a healthy balanced diet, improving your sleep quality and avoiding unhealthy behaviours can all contribute to improving PMS symptoms. So what does the research suggest when it comes to our diet; what foods should you consume and what should you avoid to help ease PMS symptoms?
Increase complex carbohydrates
Food consisting of complex carbohydrates such as whole grain foods, cereals, vegetables, and beans release energy slowly, which helps to stabilise blood sugar levels, keeping our mood stable, as well as helping with cravings by making you feel fuller for longer.
Complex carbohydrates also provide vitamins, minerals, and fibre which are an important part of a healthy diet. One study found that the consumption of whole grains (a complex carbohydrate) in place of refined grains (a simple carbohydrate) contributed to improvement in PMS symptoms with a significant decrease in general mood, physical, and emotional symptoms of PMS.
Foods high in fibre such as fruits and vegetables can be protective against psychological, physical, and overall PMS symptoms. A study conducted into PMS and its association with dietary and lifestyle behaviours found that this was likely attributed to the anti-oxidant and anti-inflammatory properties of plant foods. Try and eat a variety of fruits and vegetables especially leafy greens which are high in fibre and nutrients.
Increase omega-3 intake
Omega-3 fatty acids are essential fatty acids found in oily fish such as salmon, sardines, and mackerel as well as in walnuts, chia seeds, and flax seeds. Research suggests that omega-3 fatty acids could reduce the severity of PMS as they have anti-inflammatory properties which can help to alleviate PMS symptoms such as cramps and mood-related symptoms.
Stay well hydrated
Drinking plenty of water is essential for good health, it can also help to reduce PMS symptoms of bloating, constipation, and general fatigue. During the luteal phase when oestrogen and progesterone levels are low, the body can retain water which leads to feeling bloated and experiencing cramps, so staying well hydrated can alleviate these symptoms. Aim to drink 8 glasses of fluids daily.
Vitamins and minerals
When it comes to vitamins and minerals; calcium, magnesium, and vitamin D could have a role to play in alleviating PMS symptoms. These vitamins and minerals are essential for many bodily functions including muscle and nerve function, mood stability, and maintaining bone health. So boosting these in your diet could contribute to improving your symptoms.
Magnesium-rich foods include spinach, avocados, dark chocolate, and almonds . Additionally, one study found that low levels of calcium and vitamin D during the luteal phase of the menstrual cycle were found to cause or exacerbate the symptoms of PMS, so boosting your dietary sources could support your PMS symptoms. Try adding some of the following foods into your diet to boost your levels: dairy products, leafy green vegetables, tofu, sardines, or salmon.
Reduce sugar and salt
The change in hormone levels during the luteal phase before your period starts also causes a drop in sugar levels in the body and a drop in serotonin levels in the brain (the “happy” hormone). This is why so many women experience sugar cravings. Don’t feel guilty for indulging in the occasional treat, however consuming too much sugar can exacerbate PMS symptoms. Instead consume protein-rich foods such as fish, eggs, pulses, nuts, seeds, and complex carbohydrates to stabilise the sugar levels.
Increased salt in the diet can exacerbate symptoms of bloating and breast tenderness due to water retention, so try and limit your salt intake.
Reduce alcohol and caffeine
Research has shown that PMS symptoms were higher in women who reported drinking alcohol . Limiting alcohol can help reduce symptoms of mood swings, irritability, and cramps.
When it comes to caffeine intake the evidence varies on the exact amounts we can take, but on the whole, experts advise that reducing coffee intake can help to reduce PMS symptoms. It’s also worth remembering that alcohol and caffeine can impact sleep hygiene which can worsen PMS symptoms.
Take home message
The above nutritional tips are a useful guide, however, more research is needed in this area to draw firm conclusions on the impact of nutrition on PMS and the menstrual cycle. Most importantly, aim to eat a healthy balanced diet, listen to your body, and also focus on improving the other lifestyle factors which can play a role.
Remember, PMS can impact women in different ways with varying degrees of severity and there are different treatment/management options, so if you find these symptoms are impacting you it’s important to speak to your doctor.
Dr Sayyada Mawji is a London-based family physician and health & wellbeing expert. She is passionate about increasing health awareness, with a special interest in women's health and also works to tackle health misinformation online through her platform @doctorsayyada. Dr Sayyada regularly contributes to national and international media outlets, is a TEDx speaker and is a health expert panellist for Women's Health Magazine. Dr Sayyada was recognised on the 2023 New Year Honours list and awarded the British Empire Medal for her services to healthcare.
 Complex carbohydrates - medlineplus.gov National library of medicine
 Diets enriched with whole grains reduce premenstrual syndrome scores in nurses: an open-label parallel randomised controlled trial Mozhgan Esmaeilpour et al
 Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviours among University Students: A Cross-Sectional Study from Sharjah, UAE
 Effect of omega-3 fatty acids on premenstrual syndrome: A systematic review and meta-analysis https://obgyn.onlinelibrary.wiley.com/doi/10.1111/jog.15217?af=R
 Effects of Magnesium and Vitamin B6 on the Severity of Premenstrual Syndrome Symptoms https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161081/
 Effect of magnesium supplementation on women's health and well-being https://www.sciencedirect.com/science/article/pii/S2352364621000079#bb0010
 A systematic review of the role of vitamin D and calcium in premenstrual syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422848/
 Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis