Premenstrual Syndrome (PMS) and the Impact of Insight

Furthermore, while the prevalence of PMDD is only about 3-8% of women worldwide, the global prevalence of PMS is relatively high, with around 50% of women of reproductive age experiencing some form of the symptoms mentioned above (Direkvand-Moghdam, Sayemiri, Delpisheh, & Kaikhavandi, 2014, p. 108); in some reports, there is up to 80% prevalence of PMS symptomatology. Meaning, nearly every second or third woman experiences some form of “psychological and physical symptoms that cause significant impairment during the luteal phase of the menstrual cycle” (Hofmeister, Do, & Bodden, 2016); in many circumstances, these symptoms require intervention, which, by and large in western culture, is treated with pharmacological or surgical intervention rather than lifestyle changes.

Moreover, the question that resonates from this information is why? Beyond the recognition of varied PMS symptoms and beyond the physiology of proximate causation (i.e. women’s moods change due to the fluctuation of oestrogen and progesterone), is there an underlying cause or even a biopsychosocial purpose of these symptoms? Why is it that some women experience such severe life-altering experiences, and some women do not? Furthermore, why is it that the average prevalence of PMS varies significantly between cultures?

Cultural / Genetic Variance of PMS

Direkband-Moghadam, Sayehmiri, Delpisheh, & Kaikhavandi (2014) stated that while 10% of women in Switzerland report having PMS, around 98% experience PMS in Iran symptoms of PMS. Although the report is highly subjective, the vast difference in reported experiences between Middle Eastern (higher) and European (lower) countries throughout various reports may highlight something more to causation than a physiological sensitivity to hormonal flux. Nevertheless, at the same time, it cannot be negated that more recent studies have shown that the women most affected are those who “overexpress” the large complex of genes called the Extra Sex Combs/Enhancer of Zeste, or ESC/E(Z) differently to those who are not affected by PMS or PMDD (Henriques, 2017). Furthermore, although the studies highlight the differential sensitivity as an “unrecognised aspect of hormonal signalling or a difference in cellular response” (Hoffman et al., 2017), epigenetic studies have shown that gene transcription and expression is malleable – changeable through the environment (read more here about epigenetics and the karmic fate of our genes).

The association between gene expression and PMS, culture and PMS, and a further significant association between menstrual distress and relationship dissatisfaction (Coughlin, 1990 cited in Hofmeister, Do, & Bodden, 2016) assists us in understanding the hypothesis. Perhaps there is an evolutionary mechanism or primal/inherent advantage to the symptoms of PMS. This, in turn, will not only help to de-pathologise PMS (much like the perspective of morning sickness as a form of evolutionary wellness insurance for a foetus), it might just allow us to offer more practical lifestyle solutions rather than pharmacological or surgical intervention.

So, what if  PMS and PMDD were an Evolutionary Advantage?

We can potentially hypothesise that there is a fundamental evolutionary advantage to PMS. We understand that couples who have chosen to be together, have lower rates of PMS. With the listed symptomatology of PMS (or PMDD) and considering the related phase of a woman’s cycle whereby mood changes related to marital dissatisfaction, we can place this information into an evolutionary paradigm, whereby there is a fundamental evolutionary process advantage to PMS. The underlying mechanisms of marked affective lability; marked irritability, anger, or increased interpersonal conflicts; markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts; as well as marked anxiety and tension, are inherently aimed for mate reselection due to genetic incompatibility. Albeit subjectively, this may be quite an offensive hypothesis, objectively when we look at our evolutionary ancestors (bonobos and chimpanzees), or even our more recent ancestors (genetic monogamy over pair-bonding monogamy), and objectively look at what the word “dissatisfaction” denotes (expressing or showing lack of satisfaction: not pleased or content with experience). We can perhaps surmise that the fundamental evolutionary advantage of PMS is to dissolve a pair-bond and to initiate a move to a genetically compatible bond for the next fertile window (two weeks to find a compatible mate).

To enumerate and succinctly postulate:

1. As a species, we have inherently evolved for genetic supremacy. Our closest living counterpart (evolutionarily speaking), the chimpanzee, chooses a parent mate whose genetic makeup most differs from their own. While the details of this inherent ability are unknown, this choice ensures genetic supremacy, longevity, and the familiar male dominance within groups (Smith, 2017).
2.  PMS occurs in the luteal phase of a woman’s cycle. It is during the luteal phase that “the remnants of the follicle that released the egg (now called the corpus luteum) release large amounts of the hormone progesterone as well as oestrogen… If fertilisation does not occur, the corpus luteum breaks down, and progesterone levels decline, leading to the disintegration of the uterus lining. During the luteal phase, women may experience physical and emotional changes including tender or lumpy breasts, fluid retention, bloating, mood swings, tiredness or anxiety” (Women’s Health Queensland Wide, 2015).
3.  Heightened Marital Dissatisfaction occurs during the phase of a woman’s cycle that indicates failed fertilisation and/or implantation. On a surface level, we may see male partners responding to premenstrual symptoms due to the enculturated need to avoid emotion and menstruation in general; yet below the surface, we may see this enculturation as a progression of evolutionary history – men avoid women in the luteal phase because it was not conducive to finding a superior mate. This is also supported by the notion that specific pheromones that are attractive to male counterparts are not present during the luteal phase of a woman’s cycle.

Despite our cultural conditioning to shun or to ‘fix’ mental and physical suffering related to PMS and indeed infertility, when we look at these three notions, we might speculate that these disorders are not disorders; rather, they are mechanisms by which we have evolved to ensure the inheritance of genetic supremacy. Marital discontent may be a behavioural reaction to an inherent and intuitive knowing that this choice of ‘mate’ is not suitable for genetic compatibility; the more a couple cannot reproduce, the likelier a marital breakdown occurs (three times more likely according to this source).

De-Pathologize, Re-Conceptualise, Re-Balance, and Re-Generate for Longevity

De-Pathologize and Re-Conceptualise

When we reiterate epigenetics alongside the known impacts of inherited trauma and generational infertility related to the increase of modern reproductive technology and the physical, psychological, sociological (inclusive of financial) implications this has on individuals and cultures, we can begin to see a MUCH more comprehensive picture. Moreover, when we begin to see this larger picture, we might be able to re-conceptualise the stigmas and treat ‘disorders’ such as PMS, PMDD, infertility, and related reproductive ailments. For what if, rather than seeing PMS as a disorder, we re-conceptualise it as a wellness insurer for the health of the mother? To treat pain and suffering from a lifestyle medicine perspective – to change the way we approach male and female well-being holistically – and to maximise reproductive ‘fitness’ and gene pool longevity naturally, rather than by forced pharmacological intervention?

Re-Balance and Re-Generate for Longevity

One way of achieving this reproductive ‘fitness’ is to utilise traditional wisdom – wisdom sourced from the epochs before the advent of assisted reproductive technology (ARC) and the billion-dollar industry of infertility (an estimated 25 billion USD, with growth to 41 billion USD in 2026). Such wisdom encompasses seeing woman in a manner that respects femininity, and rather than being under subordination of our bodies or identifying with a physical or mental ‘pain-body’ (Tolle, 2010), we empower ourselves, look holistically within – into the core of who we are without denigrations or self-judgment and to truly honour who we are in the presence of our cycle.

Yoga, CBT based Mindfulness, and Acceptance and Commitment Therapy for PMS and Fertility

When looking to watch over what we feel within, rather than being taken over by it, we begin with knowledge, for knowledge is empowerment, and with empowerment, the autonomy to see that we are not trapped in a cycle – we are the cycle. Thus, we share two exceptions to introduce you to some of the wisdom that encapsulates what it means to re-balance mind and body. Mel Robin looks toward PMS types regarding the nervous system, and David Frawley looks toward PMS and menses types regarding diet and ayurvedic healing.

Mel Robin: Gynaecology, Pregnancy, and Sexual Function

Type A PMS

• Vata-Pitta (anxiety irritability, mood swings)
  • Predominant excitation of SNS, so PNS relaxation postures are important.
  • Regular exercise is also essential as a universal antidote to mood swings.
  • Yoga postures are Savasana, downward-facing Savasana, child’s pose.
  • Place savasana throughout the practice time 3-4 times per hour.

Type C PMS

• Vata (craving, fatigue, headache)
  • Craving for sugar and chocolate due to hyperactivity of the body’s insulin at this time and its need for glucose as a substrate.
  • Cravings for sweets is often said to be related to a deficiency of serotonin in the brain (we recommend natural sunlight and other natural remedies where possible).
  • The cravings are eased by promoting blood flow to the abdomen and pelvis so choose Dhanurasana and setu bandhasana.

Type D PMS

• Vata-kapha (depression, confusion, memory loss)
  • Sympathetic energy is required and needed for more excitation and warmth.
  • Yoga Postures are primarily backbends such as urdhva mukha svanasana, dhanurasana, setu bandhasana.

Type H PMS

• Kapha (water retention, bloating, weight gain, breast tenderness)
  • Reduce water retention in the body. Inversions promote urination.
  • Yoga postures that are mild inversions should be practiced against wall such as upavistha konasana, padasana, ardha halasana (although some schools of thought may disagree with this inverted posture during menses for energetic reasons related to apanic flow, although there is no scientific evidence to support negative effects).

David Fawley: Ayurveda and the Menses

Pitta Type PMS and Menses

• Period is heavy, abundant, and excessive and may contain clots.
• Period may come early and there may be spotting between periods. Symptoms are worse at noon and midnight. The pitta times of day are 10am/pm-2am/pm.
• PMS comes with anger, irritability, prone to arguments, temperamental and prone to violent outbursts. There may be diarrhoea, thirst, sweating, fever, or feeling of overheating in the upper half of the body.

Treatment: Anti pitta diet with herbs such as coriander, fennel, saffron, aloe vera, red raspberry and shatavari. Rose water internally and rose, jasmine, sandalwood oil used externally. Place flowers in the home. Dandelion tea as blood cleanser – dandelions greens taken internally. Gemstones are pearl, moonstone and red coral.

Kapha type PMS and Menses

• Period is often late and flow is pale or even whitish, thick mixed with clots or mucus.
• PMS is indicated by tiredness, heavy feeling, sentimentality, weeping, needing to be loved. Breast tenderness and swelling may occur. Lack of appetite and some nausea. Colds, flus and mucus discharges may increase. Symptoms may be worse in the early morning or evening at Kapha times of day 6am/pm-10am/pm.

Treatment: Anti Kapha diet and herbs such as turmeric, black pepper, cinnamon, ginger, cloves, rosemary, aloe vera. Swollen breasts use turmeric, saffron, dandelion. Light meals, fasting ok, no heavy foods or oily foods. Activity outdoors is recommended.

Vata type PMS and Menses

• Periods are delayed or irregular – flow scanty, brown or black and lasts only a few days. Pain is worst at sunrise or sunset – vata times of day 2am/pm – 6am/pm.
• PMS Characterised by anxiety, depression, insomnia, headache and severe cramping pain.
• Shifting moods and feelings of abandonment, suicidal thoughts, feeling of dying. Feeling the cold, thirst, dry skin.

Treatment: Anti vata diet with Herbs such as turmeric ginger and nutmeg, aloe vera and liquorice, rosemary and cinnamon. Garlic, cooked onions to tone internally. Ayurvedic herbs such as Shatavari and Ashwagandha. No stimulants such as tea coffee, chocolate or alcohol, tobacco. Red gemstones to build the blood – garnet, red coral, ruby. White stones to increase fluid of the body – pearl or moonstone. Warm sesame oil is applied to the head and abdomen.