Many women think PMS is “normal” and something they have to just get over and deal with, but it’s not.

I work with several women every day at my health practice, and regardless of their original reason for signing up to work with us — fatigue, weight gain, digestive issues, autoimmune disease — we always do a comprehensive review called a “review of systems,” just to make sure we aren’t missing anything.

I am often shocked by what consistently comes up when we ask about PMS and hormone balance.

As many as 40 percent of the hundreds of women who come to our practice report experiencing some form of PMS, like heavy periods, bad cramps, breast tenderness, bloating, digestive changes, cravings, insomnia, headaches, and mood swings. They are popping ibuprofen all day, taking days off of work, and feeling awful and out of whack, just because of PMS.

The reality is these symptoms are not normal or necessary and can indicate deeper underlying issues, from inflammation to adrenal and thyroid imbalance to insulin resistance to high levels of anxiety and chronic stress.

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In functional medicine, the field of wellness medicine I practice, we educate our members about how to solve PMS from the root cause. As a result, we see women become totally free from PMS.

Here are my top five natural, nontoxic, and sustainable cures for PMS:

1. Eat an anti-inflammatory diet.

This means it's free of dairy, sugar, gluten, and processed foods. I refer to this as a “Core Eating Plan” because eating this way solves so many chronic symptoms. When it comes to PMS, inflammation increases the activity of aromatase, the enzyme that converts testosterone to estrogen, leading to higher levels of estrogen and estrogen metabolites, which cause the symptoms of PMS.

2. Balance estrogen with cruciferous vegetables.

Many PMS symptoms are caused by a state of hormonal imbalance called “estrogen dominance.” This can be due to having high levels of body fat as well as by slow estrogen metabolism.

A great way to increase the body’s rate of breaking down and disposing of estrogens is to eat cruciferous vegetables, which are high in a substance called indole-3 carbinol, which supports the phase-1 liver detoxification of estrogens. Indole-3 carbinol also lowers the 4-0H and 16-0H metabolites of estrogen, which are associated with higher breast cancer risk and PMS symptoms.

You can also supplement I3C (indole-3 carbinol) from trusted sources — I use Meta-I3C from Metagenics. But be careful about over-the-counter, store-bought supplements. The industry is self-regulated and you might not be getting what you think you are. Get supplements from a doctor who knows you personally and only works with professional-grade manufacturers.

3. Combat stress levels.

When you are chronically stressed, you are chronically producing cortisol, a hormone that is supposed to be released intermittently, in times of true stress, but not constantly.

The solution? Understand that chronic stress is a hormone disruptor and use yoga, meditation, breathing practices, and regular exercise to lower the hormonal effects of stress on the body. For a deep dive into stress and how to fix it, check out my video course!

4. Kill cramps with magnesium.

I tell all of my female patients with cramps to take two 200 mg tablets of magnesium glycinate daily at bedtime (at night because it helps with deeper sleep too!) and to increase that number to four tablets at bedtime for one week before their menstrual cycle begins. So many of my patients no longer need destructive painkillers as a result of taking regular magnesium glycinate.

5. Insulin is king.

Insulin is the hormone of the century. It’ powerful role in diabetes is only part of its widespread effects on the body and the hormone system. Higher levels of insulin trigger aromatase, which then increases estrogen levels. High levels of body fat increase insulin resistance, meaning your body has to make more insulin to control blood sugar, thereby further triggering aromatase.

Combat insulin by having protein, healthy fat, and fiber with every meal, eat lots of organic plant-based phytonutrients, and avoid all refined grains — even gluten-free ones! — and refined sugar.

There are also a number of other nutrients that balance estrogen and help immensely with PMS, including goji berries, grapeseed extract, curcumin, calcium d-glucarate, Vitex, EGCG from green tea, and certain soy extracts, which, contrary to popular belief, actually lower estrogen by down-regulating aromatase.

I recommend working with an experienced provider before self-medicating with herbs. They are powerful and need to be used correctly, in the setting of routine hormone testing to verify that what you suspect about your hormones is actually true.

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