Women's Health

Explaining Changing Hormones During Periods: The Science of PMS

Doctors can help their patients understand the hormone changes during periods by explaining what kinds of symptoms are normal.

You likely have a revolving door of patients asking how to handle their periods or premenstrual syndrome (PMS) symptoms. Changes in hormones during periods can be annoying or even disruptive for women. These issues can be compounded by puberty for young adolescents who have just started their periods, and their parents will likely want advice on how to help.

Researchers are still trying to understand how changes in hormones during periods affect women, and by what mechanisms. Estrogen and progesterone spike at different phases in the menstrual cycle, and a growing body of literature is connecting these shifts to changes in the brain. Your patients may not be too concerned with the exact science, but it is important to help them understand what's normal and what's a sign of something that requires a closer look.

Understanding Brain Changes During PMS

One study published in PLOS ONE found that women with PMS experienced adverse effects on concentration, memory and stress at different stages of their menstrual cycle. Women with PMS also had higher scores on a depression index during the luteal phase than those without PMS.

Medical Daily reports that the hormone spikes of a menstrual cycle affect mood. Estrogen increases during the start of a period can suppress adrenaline and cortisol, leading to happier feelings and more energy. Women may also be less impulsive at the start of their periods and more so when estrogen levels decrease.

According to Medical Daily, about 3 in 4 women experience some level of period pain, and research suggests that hurtful cramps can cloud the mind, causing cognitive difficulty when it comes to focusing on complex tasks. Many of these studies are still in the early stages, however, and are conducted in small sample sizes, often less than 100 women.

Help Your Patients Know What's Normal

Although we may not have a full understanding of period hormone changes and why, you can still help explain to your patients what's normal. For a young person experiencing her first period, the cramps or heavy bleeding may be a little scary. For her parents, period mood swings, combined with those tied to puberty, may be concerning. More than 90 percent of women say they have some form of premenstrual symptoms, and about 5 percent have the more severe premenstrual dysphoric disorder (PMDD). And that's what your patients should be cautioned to watch for.

What PMS symptoms are normal? Cramps, bloating, diarrhea, constipation, sore breasts and headaches before the period begins are all common PMS symptoms due to hormone changes, as is feeling irritable, tired, anxious and crying for seemingly no reason. A sign that this is ordinary is if her symptoms start to resolve around four days after starting her period.

What's not normal? Severe pain, deep depression or other symptoms that strongly interfere with her ability to go to work or school or perform daily activities. These can be signs of PMDD, and patients should be encouraged to make an appointment if this continues for multiple cycles.

PMS can also worsen existing conditions like irritable bowel syndrome, depression and chronic fatigue syndrome. Counsel your patients on lifestyle adjustments they can make during their period to try to minimize the impact. These recommendations might include:

  • Exercise regularly.
  • Eat healthy foods. Limit salt, sugar and caffeine in the weeks leading up to the start of her period.
  • Get at least seven hours of sleep every night.
  • Try meditation or other strategies to cope with stress.
  • Don't smoke. Teens especially should be counseled not to start smoking.

You can also talk to your patients about ways to manage discomfort with over-the-counter pain killers, vitamins or supplements and birth control. Period symptoms vary from person to person, as do the effects on their personal or social life. Help your patients understand their hormones during periods, what's normal, what needs further evaluation and how they can address the worst symptoms each month.