For many women, the pain body awakens particularly at the time preceding the menstrual flow. If you are able to watch and stay alert and present at that time and watch whatever you feel within, rather than be taken over by it, it affords an opportunity for the most powerful spiritual practice, and a rapid transformation of all past pain becomes possible.
What if premenstrual syndrome (PMS) was not a syndrome, a disorder, or an illness to be target treated? Not to diminish the symptoms that women experience during this phase of their cycle, rather to offer discerning insight that may in the future guide the treatment and management of these very real, and often life interrupting, experiences.
Such insight may even begin to offer a more diverse perspective in which the theoretical underpinnings of PMS begins to acknowledge causation, which in turn offers understanding of the links to marital dissatisfaction and relational breakdown. Indeed, what if a diverse perspective and discerning insight could offer an approach to PMS and its associated relationship stress with a more holistic and integrated intervention; one that takes evolutionary and genetic biopsychosocial dispositions into consideration before diagnosis and medical/surgical intervention? Thus, being able to offer lifestyle changes that work with the mind and body, rather than against it.
Such insight might just begin with defining what is meant by PMS or premenstrual syndrome.
The DSM defines PMDD (Premenstrual dysphoric disorder), which is the most severe and chronic form of PMS, under the following criteria:
Timing of symptoms
A) In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B) One or more of the following symptoms must be present: 1) Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection) 2) Marked irritability or anger or increased interpersonal conflicts 3) Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts 4) Marked anxiety, tension, and/or feelings of being keyed up or on edge
C) One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms from criterion B above
1) Decreased interest in usual activities
2) Subjective difficulty in concentration
3) Lethargy, easy fatigability, or marked lack of energy
4) Marked change in appetite; overeating or specific food cravings
5) Hypersomnia or insomnia
6) A sense of being overwhelmed or out of control
7) Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain
D) The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others.
E) Consider Other Psychiatric Disorders The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia) or a personality disorder (although it may co-occur with any of these disorders).
Confirmation of the disorder
F) Criterion A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles (although a provisional diagnosis may be made prior to this confirmation) Exclude other Medical Explanations
G) The symptoms are not attributable to the physiological effects of a substance (e.g., drug abuse, medication or other treatment) or another medical condition (e.g., hyperthyroidism).
And, while the prevalence of PMDD is only about 3-8% of women worldwide, the global prevalence of PMS is quite high, with around 50% of women of reproductive age experiencing some form of the aforementioned symptoms (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.
And the question that resonates from this information is why? Beyond 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 experience, and some women do not? And, 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 in Switzerland 10% of women report having PMS, in Iran around 98% experiencing symptoms. Albeit the report is highly subjective, the vast difference in reported experiences between Middle Eastern (higher) and European (lower) countries throughout various reports may highlight that there is something more to causation than a physiological sensitivity to hormonal flux. Yet, at the same time it cannot be negated that more recent studies have shown that the women most affected are those who “over express” 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). And, although the studies highlight the differential sensitivity as an “unrecognized 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 environment (read more here about epigenetics and the karmic fate of our genes).
By identifying that there is an association between gene expression and PMS, an association between culture and PMS, plus that there is a significant association between menstrual distress and relationship dissatisfaction (Coughlin, 1990 cited in Hofmeister, Do, & Bodden, 2016), perhaps, just as Hofmeister, Do, & Bodden have hypothesised, is not so far-fetched to allude that there is an evolutionary mechanism, or primal / inherent advantage to the symptoms of PMS. Which in turn will not only help to de-pathologize 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 advantageous lifestyle solutions rather than pharmacological or surgical intervention.
So, what if PMS and PMDD were an Evolutionary Advantage?
With the aforementioned knowledge that couples who have chosen to be together have lower rates of PMS, together with the aforementioned knowledge of the symptomatology of PMS (or PMDD), plus in taking into consideration the related phase of a woman’s cycle whereby mood changes occur as they relate to marital dissatisfaction, and place this information in correspondence to an understanding of an evolution paradigm – we can potentially hypothesize that there is a fundamental evolutionary advantage to PMS. That 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:
- As a species we have inherently evolved for genetic supremacy. Our closest living counterpart (evolutionarily speaking), the chimpanzee, chooses a mate to parent with whose genetic make-up 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).
- 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).
- 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 certain pheromones that are attractive to male counterparts are not present during the luteal phase of a woman’s cycle.
In spite of 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 an 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 the aforementioned knowing of epigenetics alongside the known impacts of inherited trauma and generational infertility as it relates 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 larger picture. And when we begin to see this larger picture, we might just be able to re-conceptualize the stigmas, and the treatment of ‘disorders’ such as PMS, PMDD, infertility and related reproductive ailments.
For what if rather that seeing PMS as a dis-order, we re-conceptualise it as a wellness insurer for the health of the mother? To treat pain and suffering with lifestyle medicine – 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.
Understanding that we are each unique – different forms of premenstrual syndrome
Traditional Ayurvedic wisdom acknowledges our biopsychosocial dispositions by way of constitutional make up – our unique dosha and individual imbalances within the doshic system. As Mel Robin (2009) states, and as we shall begin to highlight below:
The complexities of the menstrual cycle and the delicate balance involved between powerful hormonal forces imply a multitude of ways that the cycle can go wrong. In addition to the specific problems of lack of ovulation, too little or too much bleeding, endometriosis, fibroids, and ovarian cysts, there is a less specific broad class of menstrual-related symptoms collectively called premenstrual syndrome (PMS). It is said that there are at least 150 different symptoms associated with PMS, relating primarily to an imbalance of the estrogen and progesterone levels or to a sluggish liver that is unable to handle the efficient removal of toxins generated by the menstrual process. It is most recently accepted that PMS relates to estrogen imbalance… [Rychner] assigned such  symptoms to one of four categories: type A (anxiety, irritability, and mood swings), type C (craving, fatigue, and headache), type D (depression, confusion, and memory loss), and type H (water retention, bloating, weight gain, and breast tenderness). Mixed type symptoms are seen, and the pattern is not necessarily constant from one month to the next…
By using this wisdom to mindfully accept our femininity, and to move into the pain-body rather than to avoid it or to fix it, while at the same time committing to lifestyle changes that work within our constitutional makeup (biopsychosocial disposition), we can begin to re-balance our minds and bodies, reduce symptomatology, and maximise – through potent yoga programs – our fertility.
Fertility is an inherent right for women, and while our current culture wants to move toward the quick fix and the ARC fix, ancient wisdom alongside evolutionary premise highlights that by reconnecting to the feminine energy – the intuit wisdom within our bodies as they sync with the earth’s rotational and magnetic fields, we can begin to “watch over what we feel within, rather than being taken over by it” (Tolle, 2010) and re-generate for longevity.
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 here, to introduce you to some of the wisdom that encapsulates what it means to re-balance mind and body, we share two excepts. The first, Mel Robin looks toward PMS types with reference to the nervous system, and the second, David Fawley looks toward PMS and menses types with reference to 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 also important as 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 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 required and need 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 body. Inversions promote urination.
- 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 in the outdoors 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 body – pearl or moonstone. Warm sesame oil applied to head and abdomen.
As reproductive disorders and infertility prevalence heightens and as pharmacological and surgical intervention become the favoured course of action, there is a need for diverse perspectives and discerning insight so as to offer an approach to PMS, PMDD, infertility, and their associated relationship stress with a more holistic and integrated intervention; one that takes evolutionary and genetic biopsychosocial dispositions into consideration before diagnosis and medical/surgical intervention. There is indeed a need (a billion-dollar need) to offer lifestyle changes that work with the mind and body, rather than against it.
References and Additional Resources
“The results indicated that low serum levels of vitamin D and calcium during the luteal phase of the menstrual cycle could contribute to the incidence and exacerbation of PMS symptoms. Moreover, the mean severity and number of PMS symptoms decreased after calcium and vitamin D supplementation.”
“The review of the selected studies indicates that vitamin D and calcium supplementation, or the use of a diet rich in these two micronutrients, could improve serum levels during the luteal phase, and thus eliminate or improve PMS symptoms.”
“Under the hypothesis we have proposed, PMS and PMDD are not diseases or ‘syndromes’, but arise as a normal consequence of adaptive strategies developed during our evolutionary history, similar to morning sickness (Flaxman and Sherman 2000) and other apparently maladaptive states (Baptista et al. 2008; Kinney and Tanaka 2009).”
“There is a significant relationship between menstrual distress and marital dissatisfaction (Coughlin 1990). Marital relationships of PMS sufferers deteriorate during the luteal phase, whereas relationship satisfaction is similar between PMS and nonPMS sufferers during the follicular phase (Ryser and Feinauer 1992). Of course, male behaviours are also part of this equation, and it is known that male partners often respond to premenstrual symptoms by avoidance and withdrawal (Cortese and Brown 1989), increasing the likelihood of estrangement. Comparisons between the quality of life in the follicular versus luteal phases of PMS sufferers show the greatest relative decline in attitudes towards immediate family and marital status (Halbreich et al. 2003). The monthly conflict associated with PMS has been linked to deterioration of relationships and to divorce (Graze et al. 1990), although the wide variety of outside factors to be considered make demonstration of causality difficult. The preferential direction of PMS towards partners is suggested by the fact that conjoint monitoring of PMS symptoms within a relationship improves marital satisfaction (Frank et al. 1993). Consequently, it does appear that PMS symptoms are more extreme in the home, that animosity is directed at partners, and that marital dissatisfaction peaks during the luteal phase for PMS sufferers. Together, these phenomena might increase the likelihood of partnerships dissolving.”
“PMS has high heritability; gene variants associated with PMS can be identified; animosity exhibited during PMS is preferentially directed at current partners; and behaviours exhibited during PMS may increase the chance of finding a new partner. Under this view, the prevalence of PMS might result from genes and behaviours that are adaptive in some societies, but are potentially less appropriate in modern cultures. Understanding this evolutionary mismatch might help de-pathologize PMS, and suggests solutions, including the choice to use cycle‐stopping contraception.”
“This study evaluated the prevalence of PMS in different areas in world wide. Based on our results, the pooled prevalence of PMS was 47.8% (95% CI: 32.6-62.9). The lowest and highest prevalence were reported in France 12% (95% CI: 11-13) and Iran 98% (95% CI: 97-100) respectively.”
“One study found that many women who participated in a 12-week yoga program had less menstrual pain, cramps, and bloating. They also had more energy and a better mood. Another study showed that certain yoga poses – “cobra,” “cat,” and “fish” — helped ease painful cramping (dysmenorrhea).”
“We present a theoretical argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this area.”