Premenstrual syndrome, commonly referred to as PMS, describes a collection of physical, emotional, and psychological changes that can occur in the days or weeks leading up to menstruation. For some menstruating people, symptoms may appear a few days before bleeding begins. For others, they may last up to a full week or longer.
In some cases, individuals experience more intense emotional symptoms such as anxiety, irritability, or low mood in the one to two weeks before menstruation. This is sometimes described as premenstrual dysphoric disorder (PMDD), a more severe presentation that can significantly affect daily life.
PMS looks different for everyone, and symptoms can change over time depending on stress levels, lifestyle, nutrition, and overall health.
Premenstrual syndrome - what is it?
PMS symptoms can vary widely and may include a combination of physical, emotional, and cognitive changes such as:
Not everyone experiences all of these symptoms, and the intensity can differ from cycle to cycle.
In a natural menstrual cycle, meaning without hormonal birth control or hormonal IUDs, hormone levels shift throughout the month and influence how we feel physically and emotionally.
During the follicular phase, which begins on the first day of menstruation and continues until ovulation, estrogen levels gradually rise. Many people notice increased energy, improved mood, and a greater desire for social connection during this phase. Testosterone also increases before ovulation and can influence libido.
Estrogen supports the growth of the uterine lining, which will later shed during menstruation if pregnancy does not occur. It also affects cervical mucus, which changes throughout the cycle. Tracking signs such as cervical mucus, cervical position, and basal body temperature can help identify ovulation and cycle patterns.
After ovulation, progesterone becomes the dominant hormone for the remaining twelve to fourteen days leading up to menstruation. Progesterone is often described as calming or sedating and is associated with a desire to slow down, rest more, and sleep longer. It can also slow digestion and influence fluid retention.
If pregnancy does not occur, progesterone levels naturally decline, leading to menstruation.
From a holistic and educational perspective, some practitioners describe PMS symptoms as being influenced by patterns such as relative estrogen excess or lower progesterone production. Progesterone is only produced after ovulation, so irregular or absent ovulation may affect this balance.
Lifestyle factors such as chronic stress, diet, alcohol intake, digestion, liver function, and exposure to environmental estrogens can also influence how hormones are processed in the body.
For individuals transitioning off hormonal birth control or hormonal IUDs, it can take time for natural menstrual rhythms to re establish. During this period, nutritional and lifestyle support is often emphasized to help replenish nutrients that may become depleted over time.
While PMS is common, some symptoms can overlap with other menstrual or hormonal conditions that require individualized assessment and care. Experiences such as severe or persistent pain, very heavy bleeding, significant mood changes, or ongoing cycle irregularity may be associated with conditions such as dysmenorrhea, endometriosis, fibroids, or polycystic ovarian syndrome (PCOS).
These conditions are distinct from PMS and vary widely in how they present and how they are supported. Because of this complexity, working with a qualified healthcare practitioner such as a medical doctor, naturopath, or trained herbalist can help determine whether further evaluation or testing is appropriate.
From a holistic perspective, supporting PMS often begins with addressing foundational lifestyle factors. The following approaches are commonly discussed in nutritional and herbal practice as supportive strategies.
Eating regular meals that include protein, healthy fats, and complex carbohydrates can help stabilize blood sugar throughout the day. Highly processed foods, refined sugars, excessive caffeine, and alcohol may contribute to energy fluctuations and increased stress responses.
Balanced blood sugar supports overall hormone regulation and energy levels.
A diverse and healthy gut microbiome plays an important role in digestion, regular elimination, and hormone processing. Traditional guidance often includes:
Individual sensitivities to foods such as gluten or dairy can vary, and paying attention to personal responses is encouraged.
Adequate hydration supports digestion and regular bowel movements, both of which are important for overall hormonal balance. Many people aim for approximately two to three liters of water daily, adjusting for activity level and climate.
The liver plays a central role in processing hormones. Traditional nutritional guidance often emphasizes:
Reducing alcohol intake and minimizing exposure to environmental chemicals through household and personal care products is also commonly recommended.
Moderate, enjoyable movement is often associated with improved physical and emotional wellbeing during the menstrual cycle. Activities such as walking, yoga, or gentle strength training can be supportive. Over exercising may place additional stress on the body, so rest and recovery are equally important.
Consistent sleep routines and stress management practices play a significant role in hormonal health. Practices such as spending time in nature, connecting with others, creative expression, and relaxation techniques can help the body move out of a stress response.
Herbal medicine has a long history of use in supporting menstrual comfort and hormonal balance. Herbs commonly discussed in traditional practice include:
Cramp Bark: Traditionally used in Western herbalism, cramp bark is valued for its calming relationship with muscle tension and menstrual discomfort. The bark has a long history of use in women’s herbal traditions and is commonly included in supportive menstrual formulas.
Corydalis: Corydalis is a spring flowering plant traditionally used in herbal systems to support comfort during times of physical tension. The root contains naturally occurring plant compounds historically associated with relaxation and ease and has often been included in formulas supporting menstrual and abdominal comfort.
Ginger: Ginger is a warming and aromatic root with a long history of use in both culinary and herbal traditions. Traditionally valued for its relationship with digestion and circulation, it is often included in menstrual and digestive formulas to support comfort and balance.
White Peony: White peony is a flowering perennial native to East Asia with a long history of use in traditional herbal systems, particularly within Chinese and regional folk practices. The root is commonly combined with other herbs in balanced formulas and has traditionally been associated with harmony, nourishment, and support during cyclical changes.
Black Cohosh: Black cohosh is a woodland plant native to eastern North America with a long history of traditional use among Indigenous communities and early herbal practitioners. The root has been valued for its strong affinity with women’s cyclical experiences and is typically used in carefully balanced formulas guided by experienced herbalists.
Dong Quai: Dong quai is an aromatic root with a long history of use in East Asian herbal traditions, particularly within Traditional Chinese Medicine. Often regarded as a classic women’s herb, it has traditionally been included in formulas intended to nourish and support cyclical balance and is most often used in combination with other botanicals.
Schisandra: Schisandra is a berry bearing vine traditionally used in East Asian herbal systems and valued for its relationship with resilience and balance. Known for its distinctive combination of flavors, the fruit has often been included in formulas designed to support the body during times of physical or emotional demand.
Milk Thistle: Milk thistle is a flowering plant with a long history of traditional use across Europe, North Africa, and Asia. In herbal practice, it has been valued for its close relationship with the liver and internal balance and is commonly included in wellness focused formulas alongside other supportive herbs.
Rosemary: Rosemary is an aromatic evergreen herb native to the Mediterranean region with a long history of use in both culinary and herbal traditions. Traditionally valued for its stimulating and bitter qualities, it has been included in herbal practices to support digestion, circulation, and mental clarity.
These herbs are traditionally used within the context of individualized care and are often combined based on personal patterns and needs. The first three herbs are included in Apotheka’s Cramp Relief Tincture as an example of traditional formulation.
Certain nutrients are frequently explored in holistic nutrition as supportive tools for menstrual health, including:
Supplement needs vary from person to person, and guidance from a qualified practitioner is recommended when considering supplementation.
PMS is highly individual, and there is no one size fits all approach. Working with a medical herbalist or holistic nutritionist can help identify underlying contributors and create a plan that reflects your unique body, lifestyle, and goals.
If you are seeking personalized guidance, booking a consultation can provide tailored support.
Written by:
Michelle Reichert
Medical Herbalist and Holistic Nutritionist
Founder of Apotheka Herbal
Focus: Women’s Health, Digestion, Hormonal Balance
This article is intended for educational purposes and reflects holistic and traditional perspectives.
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