Debunking PMS - Understanding our menstrual cycle

Do you know that up to 85% of menstruating women have at least 1 or more premenstrual symptoms? (1,2)

There are more than 200 symptoms associated with PMS and the most common and consistently described by women are irritability, dysphoria and tension.(2) The other more common symptoms women experienced are (3):




So, what really is Premenstrual Symptoms (PMS) ?

PMS is characterised as the physical and emotional symptoms that consistently occur during the luteal phase of the menstrual cycle. There are two main phases in a regular menstrual cycle : Follicular phase and Luteal phase. PMS happens during the later part of the cycle, which is at the luteal phase.



Studies has shown that the effect of menstrual cycle is the result of hormonal fluctuations on physical changes. (4-8). It is due to the fluctuating levels of estrogen - progesterone throughout the menstrual cycle that attributes to the symptoms, especially during the luteal phase.

Women are exposed to a variety of concentrations in female sex steroid hormones that are essential in regulating the patterns of the ovulatory cycle. These female sex hormones are:

  • Estrogen

  • Progesterone

  • Follicle stimulating hormone

  • Luteinising hormone



Explanation of the Menstrual Cycle

#1 Follicular Phase

The follicular phase is divided into two sub-phases:

  1. Early follicular phase (EFP) - low concentration of estrogen and progesterone

  2. Late follicular phase (LFP) - maximal estrogen concentration and low progesterone levels

It is during the LFP where it ends with an upsurge of luteinising hormone that precedes ovulation.

The follicular phase is where it is recommended for women to focus more on their strength training as this is the period where there is an increase in estrogen and nor-adrenaline levels which are both associated with performance improvement. (9) If you'll like to know more, check out our article about exercise and pms here.


#2 Luteal Phase

Once the luteinising hormone has dropped to basal levels, luteal phase begins. Luteal phase is when the body begins to prepare for an implantation of a fertilised egg. Progesterone, which the dominant hormone during luteal phase, starts to increase and estrogen starts to decrease, but gradually rises over time along with progesterone. (10)


If conception does not happen, estrogen and progesterone starts to fall during 22-24 days of the cycle.

Therefore, this falling of hormones can trigger the start of PMS.


Mild symptoms of PMS can be managed through lifestyle changes, including a healthy diet, caffeine and sodium reduction, exercise or through stress reduction. However, if symptoms persists and bothers you, it is recommended to consult with a health care specialist.

Read on the next post on how exercise can manage PMS!



With love,

Ashley





References:

1. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 15, April 2000. Premenstrual syndrome. Obstet Gynecol. 2000;95:1–9.


2. Steiner M, Born L. Diagnosis and treatment of premenstrual dysphoric disorder: an update. Int Clin Psychopharmacol. 2000;15(suppl 3):S5–17.


3. Wyatt K, Dimmock PW, O'Brien PM. Premenstrual syndrome. In: Barton S, ed. Clinical evidence. 4th issue. London: BMJ Publishing Group, 2000:1121–33.


4. Janse de Jonge X. Effects of the menstrual cycle on exercise performance. Sports Medicine. 2003;33(11):833–51.


5. Elliott KJ, Cable NT, Reilly T, Diver MJ. Effect of menstrual cycle phase on the concentration of bioavailable 17-β oestradiol and testosterone and muscle strength. Clinical Science. 2003;105(6):663–69.


6. Constantini NW, Dubnov G, Lebrun CM. The menstrual cycle and sport performance. Clinics in Sports Medicine. 2005;24(2):e51–e82.


7. Redman LM, Weatherby RP. Measuring performance during the menstrual cycle: a model using oral contraceptives. Medicine & Science in Sports & Exercise. 2004;36(1):130–36.


8. Rechichi C, Dawson B, Goodman C. Athletic performance and the oral contraceptive. International Journal of Sports Physiology and Performance. 2009;4(2):151–62


9. Giacomoni M, Bernard T, Gavarry O, Altare S, Falgairette G. Influence of the menstrual cycle phase and menstrual symptoms on maximal anaerobic performance. Medicine & Science in Sports & Exercise. 2000;32(2):486


10. Romero-Moraleda B, Coso JD, Gutiérrez-Hellín J, Ruiz-Moreno C, Grgic J, Lara B. The Influence of the Menstrual Cycle on Muscle Strength and Power Performance. J Hum Kinet. 2019;68:123-133. Published 2019 Aug 21. doi:10.2478/hukin-2019-0061