A Brief History Of PMS
In 1931, gynecologist Robert Frank first introduced the concept of premenstrual syndrome (PMS) to the medical literature. He noted, "These patients complain of unrest, irritability, 'like jumping out of their skin' and a desire to find relief by foolish and ill-considered actions. Their personal suffering is intense and manifests itself in many reckless and sometimes reprehensible actions. Not only do they realize their own suffering, but they feel conscience-stricken toward their husbands and families, knowing well that they are unbearable in their attitude and reactions. Within an hour or two after the onset of the menstrual flow, complete relief from both physical and mental tension occurs."
I will admit to a few "ill-considered actions" of my own when thinking about Frank's solutions - either removing the ovaries or radiation "therapy." Awesome, dude. Way to knock it out of the park.
It wasn't until the 1980s that the concept of PMS entered popular culture in quite a spectacular way. Two women, separately found guilty of murdering men, mounted a "PMS defense" whereby their actions were explained through the lens of PMS symptoms. Suddenly, PMS was a social problem that needed to be managed. We still see the effects of this in pop culture - the "once-a-month-witches" of a century ago are still present, albeit clothed in a slightly different language. Commonly used memes describing PMS vary from relatable to downright misogynistic.
Ultimately, 90% of menstruators do experience some changes prior to their periods. Sometimes, these rise to the level of "symptoms" - headaches, moodiness, sore breasts, and discomfort. However, it feels important to remember that these changes are normal. Why? Because there is no better clickbait than teaching people that their periods are problematic and that there is a solution for these NORMAL body shifts that happen during a cycle.
Need an example? Let's look at one of the most common complaints - PMS "cravings'. During the follicular phase, the rise in estrogen leads to a decrease in hunger cues and often results in a decrease in food intake. During the luteal phase, the rise in progesterone contributes to an increase in food intake. So, in any given cycle, people are likely to experience changes in hunger cues and food intake - all very normal.
Except, that's not how it seems in pop culture, as evidenced by a simple Google search for PMS cravings. You'll find articles asking, "Is PMS sabotaging your diet? How to cope with food cravings and lose weight." and "Do you get PMS food cravings? Here's how to deal with it."
We've turned a very normal cyclical pattern of the human body into a pathologized problem that needs to be fixed.
Folx, it's normal to sometimes feel more hungry and sometimes feel less hungry. It's normal for your food intake to change regularly, especially just before menstruation. We aren't robots, and our bodies don't respond to food the same way every day.
And guess what - we can also feel bloated during PMS (which is also normal). During the premenstrual window, changes in progesterone and estrogen levels tell the body to retain more water and salt. When this happens, cells become swollen with water, causing the sensation of bloating.
For many people, the sensation of bloating is triggering and comes with a boatload of negative self-talk. It's remarkable to me how many of my clients have feelings of shame every month that come from their experience of bloating during PMS. Why is it that we're taught to feel shame about a normal body process? Heck, if I know.
If we didn't perceive bloating or intermittent food cravings as problematic, would we still suffer in the same ways? Does pathologizing the premenstrual period contribute to the perception of symptoms?
In many of my clients, particularly those with disordered eating or body image challenges, every period is a problem. Each month, premenstrual changes bring an agonizing awareness to the body, particularly the abdomen. The desire to have a perfectly flat stomach, as seen in (often adulterated) social media images, is intense. Every food craving is perceived to be the start of an endless binge, which will result in even more weight gain than the bloating itself brought. These thoughts and feelings are eventually relieved, only to return the next month with a vengeance, all the while reinforced by pop culture references.
So what's a menstruator to do?
Reframing period "cravings" and premenstrual bloating as normal is a great start. A study in 1999 sought to positively reframe perceptions of the menstrual cycle using group education, and guess what? Negative PMS symptom reports decreased! Let's say that again for the folx at the back. Understanding normal menstrual rhythms and reframing negative perceptions resulted in decreased PMS symptoms.
I'd love to suggest an approach going forward. First, if you're having a challenging time with premenstrual symptoms such as anxiety, depression, irritability, insomnia, headaches, poor concentration, breast tenderness, or acne, let's talk. There are absolutely approaches we can take with food and supplements that will lessen these symptoms and get you back to feeling like yourself.
Likewise, if you feel super uncomfortable with changes in appetite or abdominal bloating each month, talk with a licensed nutritionist. We can help you better understand what is normal for YOUR body and come up with a plan to feel more comfortable and confident going into the premenstrual window of time.
What does this plan look like? Right at the moment, I have zero idea.
I know, you've probably read 10,000 articles about the "top 10 ways to decrease PMS food cravings" or the "biggest bloat busters." And yes, there are evidence-based ways to decrease PMS symptoms for sure.
But at Nutrition Hive, we don't get caught up in gimmicky approaches that promise the moon but don't actually work in your life. We spend the time to get to know you and co-create experiments with you to determine not only what approach works but what is sustainable and nourishing for you.
One thing I'm absolutely sure about? I'm not going to suggest radiating your ovaries as a solution.
