PMS & the Gut: How Are They Related?

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A woman’s menstrual experience can be as unique as each woman. Your period may come quietly without warning and pass with minimal discomfort or interruption to your daily life. Or it may descend upon you like the the Tasmanian devil cartoon character, with turmoil gradually approaching until it knocks you off your feet for a few hours or days.

If your experience resembles the latter, you’re not alone. PMS is common and effects up to 75% of women.

If you wish you had a way to turn this monthly intruder into a more welcomed guest, you’re in luck!  Did you know that the hormones that regulate your menstrual cycle are influenced by your gut? And you can actually improve PMS symptoms by improving your gut health!

Why Do We Experience PMS?

PMS includes a cluster of symptoms which may occur during the second half of a woman’s menstrual cycle, commonly 5–7 days before she starts to bleed.

The most common PMS symptoms include:

  • Fatigue
  • Bloating
  • Irritability
  • Depression
  • Anxiety
  • Cramps
  • Swelling or tenderness of the breasts

PMS symptoms occur in response to fluctuating estrogen and progesterone levels during menstruation. Changing hormone levels not only regulate fertility but  also can affect the neurotransmitter levels in the brain, which is why you may experience changes in your mood.

In my clinical practice, when I see a woman experiencing strong PMS symptoms, I often find it is related to estrogen dominance within her system—which is often directly tied to the health of her gut.

The Connection Between the Gut & PMS

Once estrogen does its job in the body, it is sent to the liver to be broken down into forms that can be eliminated in urine or stool. Your liver then passes these estrogen byproducts on to your gut for excretion. When your gut microbiome is healthy and balanced, this process functions smoothly and excess estrogen is flushed from the body.

This is due to the estrobolome, which is the collection of specific microbes in the gut that determine whether estrogen will pass out through stool as intended or whether it will recirculate through the body. When there is an imbalance in the estrobolome, estrogen may not be eliminated properly, and the higher amount of circulating estrogen intensifies PMS symptoms.

Unfortunately, while it’s easy to reach for products at the drugstore that are marketed for menstrual symptom relief, many of these medications can have a negative impact on the gut—which can further contribute to hormonal imbalances.    

PMS Solutions That May Harm Your Gut

Here are a few menstrual-symptom solutions you should avoid, because they can harm the gut:

  • Acetaminophen has a long list of potential side effects because it depletes antioxidants in the body. Antioxidants dispose of damaging free radicals and also support the liver in eliminating many toxins and potential carcinogens from the body--including pesticides, herbicides, mycotoxins, metals and harmful endogenous estrogen metabolites.
  • NSAIDs like naproxen and ibuprofen weaken your gut lining and its ability to resist stomach acid, which can lead to inflammation, bleeding, ulcers, or leaky gut.
  • Oral Contraceptive Pills (OCPs) contain synthetic hormones. Not only may OCPs aggravate PMS symptoms for some women, but research has found an increased incidence of inflammatory bowel disease (such as Crohn’s) in women who have taken OCPs.

Natural PMS Solutions That Won’t Harm Your Gut

Whenever possible, I recommend using natural alternatives that can alleviate PMS symptoms and support the health of your gut at the same timeMy top recommendations to encourage a healthy hormone balance include:

Modifying your diet.

  • Increase fiber through fruits, veggies, whole grains, and ground flax seeds.
  • Reduce refined carbohydrates, sugar and hydrogenated oils.
  • Increase cruciferous veggies (broccoli, cauliflower, brussels sprouts, kale, collard greens), onions and garlic.
  • Incorporate dark green leafy veggies.
  • Take prebiotic and probiotic supplements and eat fermented foods.

Making some healthy lifestyle changes. Engage in regular exercise to promote healthy blood flow and reduce cramping, and relaxation techniques to help reduce stress. Reduce exposure to xenoestrogens as well.

Trying natural supplements to support menstrual comfort:

  • Magnesium (200–400mg, 1–2 times per day) relaxes the muscles of the uterus to ease menstrual cramps and pain, helps to alleviate anxiety, and assists with bowel movements.
  • Botanical Medicine. There are several herbs that provide natural relief from PMS symptoms:
    • Cramp bark (300mg, 3–4 times per day) – reduces swelling and cramps
    • Jamaican dogwood (2–4mL, 3 times per day) – reduces migraines and cramps
    • Dong quai (1/2 tsp, 3 times per day) – reduces cramps and helps regulate cycle
    • Valerian (150–250mg, 3 times per day) – may reduce emotional symptoms of PMS
    • Wild yam (2–4 mL of tincture, 3 times per day) – reduces cramps and helps regulate mood
    • Ginger (150–500mg capsules, 3 times per day) – helps alleviate nausea and lessens menstrual cramps
    • Turmeric (500–2,000mg per day divided) - reduces inflammation, stimulates body’s natural pain killers and relieves menstrual cramps
  • Probiotics help promote a healthy gut, which aids in hormone balance.

Lifestyle and nutrition are key to the balance of your hormones. These lifestyle and dietary habits can help improve your gut health and keep your hormones balanced so you’ll experience less painful and disruptive menstrual cycles.



Dr. Briana Sinatra

Meet Dr. Briana Sinatra

Dr. Briana Sinatra is a board-certified naturopathic doctor with a vibrant practice in the Pacific Northwest. There she focuses on women’s and family health, taking a holistic approach to healthcare by empowering women with the knowledge and tools they need to live their best life now and protect their future wellness by looking at how all the systems in the body work together and how diet, lifestyle, and environment all influence health.

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