What is PMS – Premenstrual Syndrome
Premenstrual syndrome (PMS) refers to a group, or a combination, of physical, emotional, and psychological symptoms that many women suffer from, starting around a week or two before menstruation.
PMS is thought to be due to the rapid drop in the levels of the two female hormones, estrogen and progesterone in the absence of a pregnancy, with a reduction of symptomology within a few days after the start of menstruation as hormone levels begin rising again.
Symptoms tend to recur in a predictable pattern and can vary from just slightly noticeable to intense and severe. However, this pattern tends to change with ages, and PMS symptoms may get worse during the late 30s and 40s as menopause is approaching. This is especially true for women whose moods are sensitive to changes in hormone levels during the menstrual cycle as hormone levels fluctuate unpredictably as the body transitions into menopause.
For some women, PMS symptoms may become so acute that it can become so debilitating that it may be a sign of Premenstrual dysphoric disorder (PMDD), a health condition similar to PMS, but more serious. PMDD causes severe irritability, depression, or anxiety in the week or two before the start of menstruation and may require medications or other types of treatment interventions to help with your symptoms.
Symptoms of Premenstrual Syndrome
Most women have at least one sign of PMS each month and can be physical, emotional, behavioral, and/or psychological. A diagnosis typically involves one or more of the symptoms of PMS starting five days before the onset of menstruation and lasting for three months in a row or longer. Symptoms of PMS typically include:
- Bloating or a gassy feeling
- Tender breasts
- Excessive hunger and food cravings
- Backache especially in the lower back
- Muscle aches
- Joint pain
- Lower tolerance for noise and/or light
- Swollen hands and feet
- Acne and pimples
- Weight gain
- Constipation or diarrhea
- Tense and/or anxious
- Crying for seemingly no reason
- Mood swings
- Difficulties with sleep and/or insomnia
- Don’t want to be with people
- Feel overwhelmed or out of control
- Angry outbursts
- Forget things
- Loss of mental focus
Premenstrual Syndrome Medications & Treatments
Women deal with PMS in various ways with treatments and interventions focusing on the management of symptoms and their severity. Usually, treatments and lifestyle changes can help manage and reduce most symptoms.
Several over-the-counter (OTC) medicines can help treat some PMS symptoms and include pain relievers that can help reduce physical symptoms such as cramps, headaches, backaches, and breast tenderness. These include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen as well as other types of anti-inflammatories and analgesics like aspirin and paracetamol. Some women also find that taking an OTC pain reliever right before menstruation starts, may lessen the amount of pain and bleeding they have during their period.
If OTC medications are ineffective, a treating physician may recommend prescription medicines. Hormonal birth control may help with the physical symptoms of PMS, while diuretics which are designed to increase the amount of water and salt expelled from the body as urine may reduce symptoms of bloating and breast tenderness.
Antidepressants may help relieve the emotional symptoms of PMS for some women, with selective serotonin reuptake inhibitors (SSRIs) being the most common type prescribed for the treatment of PMS symptoms. Similarly, anti-anxiety medications may help reduce feelings of anxiousness.
However, all of these medications come with unwanted side effects, often causing other symptoms to worsen. Many of these medications also carry additional risks, making them unsuitable for use in many women.
Often simple lifestyle and/or dietary changes are enough to help relieve many of the symptoms of PMS, including:
- Tracking moods and symptoms in a journal to find patterns.
- Regular aerobic physical activity of about 30 minutes a day throughout the month. Exercise is thought to help with symptoms such as depression, difficulty concentrating, and fatigue.
- Eating healthy foods and taking supplements. Focus on foods rich in calcium like dairy, green leafy vegetables, and canned salmon while supplementing with vitamins and minerals like folic acid, magnesium, vitamin B-6, vitamin E, and calcium with vitamin D are also thought to help.
- Avoiding foods and drinks with caffeine, salt, and sugar in the two weeks before the onset of menstruation.
- Getting enough sleep, aiming for about eight hours of sleep each night. Lack of sleep is linked to depression and anxiety which can make PMS symptoms such as moodiness worse.
- Reducing stress by practicing breathing exercises, meditation, yoga, and other types of mindfulness activities.
- Quitting smoking. In one large study, women who smoked reported more PMS symptoms with a higher level of severity than the women who did not smoke.
- Herbal remedies like ginkgo Biloba, ginger, chaste berry (Vitex Agnus), evening primrose oil (EPO), and St. John’s Wort have been reported to provide relief from many PMS symptoms.
CBD for PMS (Premenstrual Syndrome)
Research & Scientific Evidence
To date, there are no studies investigating the efficacy of cannabidiol (CBD) in the treatment of PMS symptoms directly. However, from studies investigating other conditions (e.g., anxiety, depression, irritable bowel syndrome, and pain), we can deduce how CBD may help reduce the symptoms of PMS in women, especially as they relate to pain, gastrointestinal discomfort, and mood.
One such research study is from 2007, published in the European Journal of Pharmacology. The study investigated the therapeutic potential of CBD on neuropathic pain and inflammatory pain.
Rats with induced neuropathic and inflammatory pain received oral preparations of CBD. Neuropathic rats received four different cannabidiol doses of 2.5 mg/kg, 5 mg/kg, 10 mg/kg, and 20 mg/kg respectively while inflamed rats were given only the dose relieving the neuropathic pain (20 mg/kg). Treatment was administered once a day for a week. CBD’s efficacy was evaluated using various measures including behavioral tests as well as the testing of specific cannabinoids and TRPV1 receptor antagonists.
Based on the results of these measures, the researchers concluded that repeated oral treatments of CBD reduce pain through two mechanisms: Firstly by inhibiting the uptake of anandamide which is involved in pain control through activation of cannabinoid CB1 and CB2 receptors; and secondly by acting as an agonist and desensitization of the vanilloid TRPV1 receptors implicated in pain processing.
In a 2018 review study published in the journal Biochemical Pharmacology, researchers reviewed the current literature investigating the role of cannabinoids receptors and cannabinoids such as CBD in normal gastrointestinal function as well as in disorders including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).
From the literature, they concluded that cannabinoids such as CBD affect gut motility mainly by activating CB1 and CB2 receptors present on enteric neurons. CBD also targets GPR55 and AM841 receptors, both of which are useful in the treatment of GI motility disorders. This means that CBD is able to regulate GI motility in both physiological and pathological situations, including constipation, diarrhea, IBS, and gastroesophageal reflux. Similarly, CBD can also help reduce visceral sensitivity in the gastrointestinal tract as well as reduce inflammation and abdominal pain, again via activation of the CB1 and CB2 receptors.
In a 2017 review study published in the British Journal of Pharmacology, researchers reviewed the literature related both to showing the anxiolytic effects of cannabidiol as well as studies investigating its effects on various fear and drug memory processes.
The literature showed that there are various lines of evidence showing that CBD presents with powerful anxiolytic effects via at least two mechanisms. The first is that CBD mediates the action of endocannabinoids on cannabinoid receptors in neural circuit mechanisms involved with both anxiety and fear memory. The second mechanism is that CBD interacts with the same serotonin subtype 5-HT1A receptors targeted by anxiolytic, antidepressant, and antipsychotic medications. They concluded that CBD can regulate emotion and emotional memory processing as well as interact with the brain in such as way that it may be useful as a treatment for anxiety-related complaints.
Anecdotal Evidence for using CBD for PMS
Anecdotal evidence seems to be a mixture of women swearing by using CBD to help reduce symptoms of PMS, while others are frustrated and underwhelmed. It would seem that the differences between these two groups of women are rooted in two main differences. Firstly, the quality and quantity of the CBD products used; and secondly, the type and severity of symptoms it is used for. Many women also report that using CBD in conjunction with tetrahydrocannabinol (THC) is more effective in reducing severe PMS symptoms, especially when caused by concomitant issues such as endometriosis.
CBD as a Complementary Treatment
CBD interacts with the ECS and regulates endocannabinoid levels, which in turn increase anandamide levels, reducing stress responses and returning hormones and the nervous system to a state of homeostasis. In addition, CBD is thought to decrease anxiety and have a calming effect. This is especially helpful in women suffering from sleep difficulties during PMS as CBD has the ability to promote REM-sleep, the sleep-stage which is thought to especially benefit emotional health. CBD can also help reduce gastrointestinal irritation and bowel inflammation from NSAID use.
CBD acts as an analgesic, anti-inflammatory, and anxiolytic agent. In addition, because of the way CBD interacts with the endocannabinoid system (ECS), it has the ability to regulate reactivity in the body, maintain metabolism, and help enhance resilience that can help with mood swings, all of which makes it a powerful ally in reducing many of the most common symptoms of PMS. However, CBD has not been researched in the context of PMS, and as such, it is important to speak to your primary treating physician first. He or she can help put together a plan that includes CBD along with other treatment options to help you deal with PMS symptoms safely and effectively.