More Than “Just Hormones” – Understanding PMS
For one to two weeks every month, you become a different person. Irritable, anxious, bloated, exhausted, craving sugar, and emotionally fragile. Then your period arrives and within days you feel human again – until the next cycle. Premenstrual Syndrome affects up to 80% of menstruating women to some degree, yet it is often trivialised as something women simply have to endure.
At our practice in Zürich Seefeld, I take PMS seriously. It is not a character flaw or an overreaction – it is a physiological response to hormonal fluctuations, and in most cases, it can be significantly improved.
What Causes PMS?
PMS is not simply caused by “too much oestrogen” or “too little progesterone,” though hormonal balance does play a central role. The current understanding is more nuanced:
Progesterone sensitivity: Some women’s brains are more sensitive to the normal fluctuations in progesterone and its metabolite allopregnanolone, which affects GABA receptors (your calming neurotransmitter system).
Oestrogen-progesterone ratio: Relative oestrogen dominance – oestrogen that is too high relative to progesterone – is common and worsens PMS symptoms, particularly breast tenderness, water retention, and mood changes.
Serotonin fluctuations: Oestrogen and progesterone modulate serotonin synthesis and receptor sensitivity. The luteal phase drop in oestrogen can reduce serotonin activity, contributing to mood symptoms.
Inflammation: Women with more severe PMS often have elevated inflammatory markers. Prostaglandin production increases in the luteal phase, contributing to pain, cramping, and mood disturbance.
Nutrient deficiencies: Magnesium, vitamin B6, calcium, and vitamin D deficiencies are all associated with more severe PMS symptoms.
Blood sugar instability: Insulin sensitivity changes across the menstrual cycle, and luteal phase carbohydrate cravings combined with blood sugar swings amplify mood and energy symptoms.
PMS vs. PMDD
Premenstrual Dysphoric Disorder (PMDD) is a severe form affecting 3-8% of women, causing debilitating mood symptoms – severe depression, anxiety, anger, or hopelessness – that significantly impair functioning. PMDD requires specific treatment and should be taken very seriously.
Our Diagnostic Approach
I ask patients to track symptoms across two to three cycles to establish the pattern. Blood work timed to the luteal phase (day 19-21) assesses progesterone, oestradiol, and the ratio between them. I also check thyroid function, iron, vitamin D, magnesium, B6, and inflammatory markers. Evaluating oestrogen metabolism can reveal whether oestrogen detoxification pathways are functioning optimally.
What We Do: Reclaiming Your Month
Magnesium supplementation: Magnesium glycinate (300-400 mg daily) has strong evidence for reducing PMS symptoms including mood changes, water retention, and cramping.
Vitamin B6: Supports progesterone production and serotonin synthesis. Effective at 50-100 mg daily.
Vitex (chaste tree berry): The most evidence-based herbal treatment for PMS, supporting progesterone production and reducing prolactin.
Blood sugar stabilisation: Eating regular, balanced meals with adequate protein and healthy fats, particularly in the luteal phase.
Oestrogen metabolism support: DIM, calcium-D-glucarate, and cruciferous vegetables to support healthy oestrogen detoxification.
Anti-inflammatory strategies: Omega-3 fatty acids and dietary modifications to reduce prostaglandin-driven symptoms.
Bioidentical progesterone: When progesterone deficiency is confirmed, luteal phase progesterone supplementation can be transformative.
Conclusion
PMS is treatable. You do not have to lose one to two weeks of every month to hormonal symptoms. A targeted approach based on your specific hormonal profile and nutrient status can make a dramatic difference. Book a consultation at our practice in Zürich Seefeld to get your cycle working with you, not against you.
