When it comes to PMS, many people are all too familiar with the unpleasant physical and mental symptoms that interfere with their daily activities and relationships. 75% of women report experiencing PMS symptoms, but many aren’t aware of why.  What is happening in their bodies that creates these effects that are uncomfortable at best, debilitating at worst?
Connections Between Hormones and Neurotransmitters in PMS
Progesterone and GABA in the Luteal Phase
While the exact mechanisms behind PMS are not yet fully understood, research has shown that sensitivity to fluctuating hormone levels by neurotransmitters in PMS may be the culprit. PMS symptoms arise during the luteal phase of the cycle, just after ovulation. [1, 4, 6, 7, 8, 10] During this time, progesterone is produced by the corpus luteum in the ovary.
Progesterone metabolites travel through the blood and bind to GABA receptors in the brain. Over time, this can change the configuration of the receptor, causing receptor resistance and thus decreasing the inhibitory function of GABA. [1, 6, 7, 10] People taking hormonal birth control are in a similar situation, as the progestogens in some oral contraceptives can affect GABA receptors and functioning as well. [1, 7]
As serotonin and GABA work together to promote relaxation, good mood, and a sense of well-being, and have an inhibitory influence on pain perception, it is easy to see how decreased functioning of these neurotransmitters can add to the severity of PMS symptoms:
- mood swings
- decreased stamina
- tender breasts
It is important for the health care practitioner to first rule out dysmenorrhea and endometriosis, which are also associated with these symptoms and the reproductive cycle.
Serotonin Support for PMS Symptoms
Research has established that supporting serotonin function can help balance the system and alleviate PMS symptoms. [6, 7] Lifestyle interventions may also help fight PMS symptoms. 
A variety of studies support exercise as a means of reducing PMS symptoms, including aerobic exercise and yoga. [5, 9, 12, 13] Ensuring adequate micronutrients may also be beneficial, as some research shows lessened symptoms with supplementation of calcium, vitamin B6, and magnesium. [2, 3, 11]
Testing Neurotransmitter and Sex Hormone Levels
Before introducing therapies such as neurotransmitter support, it is essential to test sex hormones and neurotransmitters, particularly during the luteal phase. This can give both the client and the health care practitioner the information and guidance to individually tailor therapies in a safe and effective manner.
For many people, PMS symptoms are caused by sensitivities to changing hormone levels, which interact with neurotransmitters. Testing sex hormones and neurotransmitters can help reveal the picture of what might be causing symptoms. Neurotransmitter support can be beneficial, as well as lifestyle interventions such as physical activity and diet. A combination of these approaches can uncover the path to a PMS-free period!
- Bäckström, T., Andreen, L., Birzniece, V., Björn, I., Johansson, I. M., Nordenstam-Haghjo, M., … & Zhu, D. (2003). The role of hormones and hormonal treatments in premenstrual syndrome. CNS drugs,17(5), 325-342.
- Bendich, A. (2000). The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms .Journal of the American College of Nutrition,19(1), 3-12.
- Douglas, S. (2002). Premenstrual syndrome. Evidence-based treatment in family practice. Canadian family physician,48(11), 1789-1797.
- Elliott, H. (2002). Premenstrual Dysphoric Disorder. North Carolina medical journal,63(2), 72-75.
- El-Lithy, A., El-Mazny, A., Sabbour, A., & El-Deeb, A. (2015). Effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women .Journal of Obstetrics and Gynaecology,35(4), 389-392.
- Imai, A., Ichigo, S., Matsunami, K., & Takagi, H. (2014). Premenstrual syndrome: management and pathophysiology. Clinical and experimental obstetrics & gynecology,42(2), 123-128.
- Rapkin, A. J., & Akopians, A. L. (2012). Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder. Menopause international,18(2), 52-59.
- Ryu, A., & Kim, T. H. (2015). Premenstrual syndrome: A mini review. Maturitas,82(4), 436-440.
- Samadi, Z., Taghian, F., & Valiani, M. (2013). The effects of 8 weeks of regular aerobic exercise on the symptoms of premenstrual syndrome in non‑athlete girls. Iranian journal of nursing and midwifery research,18(1).
- Usman, S. A. B., Indusekhar, R., & O’Brien, S. (2008). Hormonal management of premenstrual syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology,22(2), 251-260.
- Whelan, A. M., Jurgens, T. M., & Naylor, H. (2009). Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol,16(3), e407-29.
- Wu, W. L., Lin, T. Y., Chu, I. H., & Liang, J. M. (2015). The Acute Effects of Yoga on Cognitive Measures for Women with Premenstrual Syndrome. The Journal of Alternative and Complementary Medicine,21(6), 364-369.
- Zhang, H., Zhu, M., Song, Y., & Kong, M. (2014). Baduanjin exercise improved premenstrual syndrome symptoms in Macau women. Journal of Traditional Chinese Medicine,34(4), 460-464.
Clinical Support Specialist at Sanesco International, Inc.
Emily Harrill is our newest Clinical Support Specialist, and a graduate of UNC Asheville with a Bachelor of Science in Health and Wellness Promotion. Improving quality of life for others is her ultimate goal. She enjoys being a part of the team at Sanesco, exploring wellness through the HPA-T Axis and encouraging others to use holistic, integrative means to achieve balanced health. She loves participating in challenging, empowering, and fun activities – especially Olympic weightlifting and belly dance.