February 22, 2016

What’s With all the Stress & How Does it Relate to My PMS?

anger frustration pain stress

Have you ever wondered how stress, anxiety and other emotional states of distress contribute to how our bodies feel physically?

We read about it all the time—stress creates an environment ideal for illness(es) and imbalances—but many of us do not entirely understand why or how this happens. We may give lip service to the mind/body connection and its importance but not truly grasp how complex this interplay really is.

This is certainly the case when it comes to discussing the relationship between chronic stress and PMS.

When we sit and really think about how delicate, complex, and individualized the cascade of hormones is in a women’s body it is pretty amazing. It’s no wonder that there is an epidemic of hormonal imbalances in our society, endorsed through the prevalence of PMS. If my private practice is a sample of the general well being of women between the ages of 22-65, it suggests that the vast majority of women feel tired, stressed, unbalanced and generally not so great physically or emotionally.

As I unravel their narratives, I am struck by how often their histories include both high levels of stress, acute anxiety, historical traumas and a chronic pattern of PMS.

Let’s define PMS so that we know we are talking about the same thing. The term PMS was coined in 1931 to describe a constellation of symptoms occurring in the luteal phase of a women’s cycle. The luteal phase happens from mid-cycle (ovulation) through to the onset of bleeding (menses).

According to the ARHP, between 43-55 million women experience uncomfortable symptoms during this phase of their cycle. Twelve to twenty-five million complain that the symptoms are severe enough to interfere with the quality of their life. The lifetime prevalence is estimated between 13-18%, most often occurring in the decades between 20-40. Average age of onset is 26. There is heavy overlay between women endorsing symptoms of PMS and the presence of PTSD, anxiety, and depression.

The causes of PMS are multi-determined, unique to each woman, and highly complex. A short list of possible causes include:

– Cyclic changes in hormones
– Chemical changes in the brain
– Depression
– Chronic stress
– Adrenal burnout
– Nutritional deficiencies

Those statistics are pretty staggering, both as a clinician and a woman. As a licensed psychologist, the area I spend most of my time exploring with the women I see in my practice is where stress, anxiety, trauma, grief, and depression interplay with our hormones and can wreak havoc on the precarious sense of balance.

Let’s explore how stress directly impacts our ability to produce, modulate and balance our hormones. The term Adrenal Fatigue, or Adrenal Burnout, is a hot topic of discussion right now. There is growing curiosity about the important role the adrenals plays in everything from hormonal production and distribution to how we respond and experience stress in our life. Our adrenal glands are located on top of each kidney and have a rather complex structure given their tiny size.

It’s beyond the scope of this essay to discuss the adrenal functioning in depth, but suffice it to say, they play a major role in hormone balance and are the hormonal epicenter of our fight-or-flight instinct.

One of the main roles of the adrenal gland is to release a stress hormone, cortisol, when danger is perceived. This hormone then sends messages throughout the body that indicate stress is on the horizon. From a Darwinian standpoint, this is a valuable and life saving response that has contributed to our ability to quickly regulate our response to our immediate and ever changing environment.

On the flip side, the adrenals can rather easily be tipped towards chronic or over production of this stress hormone, even in the absence of a true threat. When this occurs for an extended period of time, you can experience adrenal burnout, which then impairs your body’s ability to produce, regulate, modulate and balance other hormones important to our emotional and physical equilibrium, including DHEA, estrogen, progesterone, and testosterone.

We know from research examining the underlying physiological aspects of PTSD that chronic adrenaline and cortisol production creates a detrimental and unregulated pattern of fight-or-flight response, resulting in adrenal fatigue, emotional distress, and severe anxiety. When this occurs the result is often experienced as hormonal fluctuations that create unwanted and unsavory patterns of emotional distress throughout a woman’s monthly cycle.

The role of stress in our hormonal balance is a complex and nuanced dance between our brain, endocrine system, adrenals, liver, and our mind. It is no wonder so many things can go wrong when you think about how many systems need to be communicating with each other in an optimal way in order to achieve a sense of equilibrium. My experience has been that underneath the endorsement of PMS is a long history of emotional stress, trauma, anxiety, loss and often grief. The key is to help my patient’s create a relationship where they can better metabolize these experiences and collaborate on life style choices that will promote hormonal balance.

Here are steps we can take to better understand what our bodies are communicating through the language of PMS. These changes should be implemented for a minimum of 90 days in order to assess their efficacy.

Many of the suggestions are actually quite intuitive, but it does require from us a substantial degree of participation in a process of healing where responsibility falls squarely on our own shoulders.

Attempt to engage this 90-day process with a sense of wonder and curiosity.

1. Limit or avoid caffeine.

2. Avoid alcohol.

If you find that hard to do, be curious about the nature of that “partnership.”

3. Limit salt and avoid trans fats (fried food etc).

The latter is associated with hormonal disruption that over time will wreak havoc on your system.

4. Eat foods high in calcium and magnesium.

Try making a bone broth recipe and incorporating 1-cup daily to your regiment. My favorite recipe is on Kale and Kombucha. If you don’t like the idea of bone broth, consider taking supplements.

Please discuss with your physician about reputable brands.

5. Increase Omega-3 oil consumption.

Omega-3 fatty acids are found in wild caught salmon, flax, walnuts, sardines, etc.

6. Eliminate all processed foods.

All of them. Including and most importantly sugar…sorry, no way around it. The good news is that once you eliminate all processed junk, you are left with tons of real food you can eat. Vegetables, fruits, proteins, nuts and seeds, etc are all available for you to enjoy in bountiful amounts.

7. Get at least eight hours of sleep.

And let’s bring back nap time too if possible. Even 20 minutes once a day will help immensely.

8. Incorporate a daily mindfulness practice.

Preferably 10-15 minutes in the AM and PM. Create this space as a time to breath, observe your mind and body, and calm the central nervous system. Explore the various models of mindfulness that focus on calming and recalibrating the vagus nerve.

9. Exercise more days than not.

At least 30 minutes. Enough to sweat.

10. Work with a licensed psychologist.

To metabolize stress and trauma, process grief, create and tweak coping skills, and observe your interior world.




Author: Dr. Sarah Sarkis

Editor: Renée Picard

Photo: amenclinicsphotos ac at Flickr 

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