Understanding and
Managing PMS
Dr. Watson defines PMS and explains what happens in our bodies when it’s that time of the month. She advises how we can ease symptoms and provides different approaches to managing our body’s response to the hormone shifts.
With Dr. Polly Watson, MD, FACOG, NCMP
Crissy Fishbane (CF): We are very happy to be here today with Dr. Polly Watson. Dr. Watson is the founder of Hormone Wellness MD. She is a board-certified gynecologist. She is also a certified practitioner of the North American Menopause Society and the Institute for Functional Medicine.
She is a brilliant woman, basically! We get to pick her brain a bit today about something that is very interesting to me and to my husband in particular because about once a month he wants to kick me out and just send me away for a little while.
We are going to talk about PMS. I’m really excited to hear what Dr. Watson has to share with us about this today.
What is PMS?
Dr. Watson, break it down for us. What is PMS and what causes it? Why does a woman have to deal with this every month?
Polly Watson (PW): Before your period, your hormones are about to drop. The dropping of hormones, especially progesterone destabilizes the uterine lining and that causes you to have a period.
If we think about it really simply, estrogen is the hormone that makes us feel weepy and emotional and progesterone is grounding and solid, it represents calm and good sleep.
So a lot of times when we say “my sleep falls apart right before my period,” it’s because that progesterone is dropping.
This is an estrogen-dominant state. The progesterone is falling faster than the estrogen causing us to get weepy and emotional.
So we want to think about that, if you want to ease PMS naturally you have to ask how do we support the body in getting that extra estrogen out?
Unfortunately, a lot of the things we might really like to do when we are feeling lousy like eat garbage and sugar and have that extra glass of wine.
CF: Sit with a tub of ice cream!
PW: Right! That is actually a little counter-productive here.
CF: I was hoping you weren’t going to say that!
PW: This is a little bit of a geek dive, but bear with me for a minute.
Remember Thanksgiving and your mom would say you’re going to have some Tryptophan in the turkey and you’re going to feel sleepy. Tryptophan is a precursor to Serotonin which makes me feel calm.
But there is a dark side to Tryptophan. It can go the other direction and make something called Kyuric Acid. It basically makes a neurotoxin.
So as estrogen levels are falling and you’re about to have your period instead of making that wonderful feel-good hormone you’re going to make what is like a neurotoxin and feel a little grouchy.
What pushes that pathway towards a neurotoxin? Sugar and inflammation.
This is a time we really want to go to the gym and exercise.
It’s a time we really want to push a lot of soluble fiber to sort of bind up that estrogen and get it out of the body.
Things like broccoli. Broccoli is really great while you’re having PMS.
If it’s summertime and you have access to broccoli sprouts even better!
Have you ever had broccoli sprouts?
CF: I don’t think I have!
PW: North Hills Farmers Market in the summer! You can buy a flat of broccoli sprouts. Just cut them off and throw them in your smoothie. Fire up that estrogen!
Premenstrual mood disorders can be really severe in some people so we just want to empower folks, if you’re struggling and have tried some basic things at home on your own and you feel like you need to get help, please reach out and connect with a mental health professional.
Helpful Supplements
PW: During this time, there are some supplements that are pretty low-risk that can also be pretty helpful during PMS.
One is Magnesium. Magnesium is calming. 78% of Americans are deficient in Magnesium.
One is that we don’t eat enough vegetables.
Two is unfortunately our agriculture practices have robbed the soil of the nutrients in the soil. Even if you are eating the vegetables you’re not getting as much nutrition from them.
So, Magnesium is terrific for PMS.
You really want to dose around 400 milligrams, and some people can even do 400 milligrams twice a day.
I usually start with magnesium at bedtime because it can be sedating and help people sleep, but if you’re feeling really riled up it can help you calm down.
CF: Is that something you would take all the time the whole month through?
PW: I have not met a patient who — magnesium’s not going to hurt anybody. If they tolerate it, it’s fine. Magnesium can make you poop a lot. So if they have a really sensitive digestive tract and maybe they can only tolerate it for certain times of the month, or you just start with a lower dose, start with 200 milligrams.
The type of magnesium you pick also determines how easy it is on your gut. Magnesium Citrate would be a really great first choice for a person who is constipated.
Magnesium Glycinate is a little more gentle on the gut. Two easy things you can grab at Whole Foods that can be helpful.
Another supplement that has terrific data behind it is Vitex or Chaste Tree Berry, which is an herb. There have been big-box, PubMed level studies that have compared Vitex to an SSRI and it works just as well.
So 400 milligrams of Vitex. That would be something you would take throughout the month. Vitex naturally boosts progesterone. It’s the “I feel calm. I’m okay” hormone.
Vitex and Magnesium are two supplements that would be great for PMS, in addition to paying attention to diet and exercise.
Conventional Approaches to PMS
CF: That’s fantastic! I’m really excited to learn all this. What is the conventional approach to PMS?
PW: A lot of times folks are put on birth control pills or antidepressants. I think it’s super important for us to respect wherever somebody is in their journey and not to demonize any particular pathway.
Certainly I want women to be educated about the pros and cons of serotonin and the serotonin medications and the pros and cons of birth control pills. Some people do really well with medicines and some people don’t.
I wish there was a little more of a nuanced discussion around initiating those two things. But I think it’s important to acknowledge that they can be helpful for some people. In our effort to promote more natural things we want to respect that some people may still benefit from a more conventional approach and respect the decisions that they’ve made. If that’s something that’s working for them, we want to support them where they’re at.
CF: Every woman’s journey is unique and we want to meet her where she is at. That is something HER Health Collective definitely stands behind.
How can we use diet and supplements to ease symptoms of PMS without drugs?
PW: Yes! We talked about that a little before with the Vitex and Magnesium. If you’re looking at Whole Foods, Gaia Herbs is a company that’s around Asheville, North Carolina. So they are a relatively local company. They have great quality controls.
A Vitex or Chaste Tree Berry is the other name for Vitex, I would definitely seek out a product from them. I feel like they have good quality control. I stand behind their products. I do not have a financial relationship with them. I just think they are good people!
CF: We love getting recommendations!
Big important question, I know a lot of women have tried different diets and supplements and sometimes they aren’t working. What if a woman has tried these things and they don’t seem to be working for her?
PW: That’s where sometimes the conventional approaches can be helpful. Sometimes folks getting away from that dip in hormones each month when they are on a continuous birth control pill might be an option for some people.
Another herbal product that some people find very helpful is Maca.
When I do Cochran database reviews the literature on Maca is kind of mixed. The product I’ve had the most success with is from Feminescence. Their product is called Maca Harmony. That’s another product you can get at Whole Foods. That would be another option for folks to try.
A Fixable Problem
PW: Premenstrual mood disorders can be really severe in some people so we just want to empower folks, if you’re struggling and have tried some basic things at home on your own and you feel like you need to get help, please reach out and connect with a mental health professional.
This can be a fixable problem. We don’t want people to crash every single month. Sometimes people will come in and say I lose a week a month or I lose two weeks a month. That’s no way to live.
If you’ve tried some basic things and you’ve really optimized your diet it might be time to reach out to a professional and get some additional support.
CF: Fantastic! Thank you so much Dr. Watson. Dr. Watson’s office is located right here in Apex. Make sure you check her out, give her a follow. She knows her stuff! She solves PMS!
Thank you so much, Dr. Watson!
Dr. Polly Watson is a board certified OBGYN who has been refining her practice of women’s medicine for almost 20 years. In 2007, she chose to focus solely on gynecology. Early in her career, she found that many women felt underserved in busy OBGYN practices which focused on delivering babies. Seeking to serve these women better, she concentrated her practice on menopausal medicine and became a North American Menopause Society Certified Practitioner in 2009. She sought to broaden her skills and attended training from International Society for the Study of Women’s Sexual Health in 2011. Dr. Watson completed the Institute for Functional Medicine Certificate Program (IFMCP) in 2019. She is one of about 1000 providers in the US who has obtained this certification.
Dr. Watson has a private practice called Hormone Wellness MD. She can be found on Facebook and Instagram.
