Understanding PMS: What’s Normal, What’s Not, and How to Take Control

Sudden mood swings, feeling exhausted for days, or those relentless cravings for something salty or sweet— PMS hits everyone a little differently.

Some months may feel manageable, while other months can feel like your body is completely out of sync.

Do you often wonder what’s normal versus when something might need closer attention?

It turns out PMS is more than just hormones—it’s a reflection of how your entire body is functioning, including factors like inflammation, blood sugar imbalances, and nutritional deficiencies.

The ultimate goal is to give your body the care it needs so you can feel more balanced and aligned throughout your cycles.

Let’s break PMS down—what it is, why it happens, and how you can support yourself.

What is PMS?

Premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur in the luteal phase of your cycle—the time between ovulation and the start of your period.

Once hormone levels drop sharply (if no pregnancy occurs), your body might react with things like irritability, cravings, bloating, fatigue or breast tenderness as it prepares for menstruation.

How Common Is It?

PMS is incredibly common, with up to 75% of menstruating people, girls, and women experiencing symptoms during their cycles.

However, how it’s experienced varies widely:

• Mild to Moderate PMS: Around 20-32% report symptoms that can be annoying or uncomfortable but don’t typically interfere with daily life.
• Severe PMS or PMDD (Premenstrual Dysphoric Disorder): An estimated 3-8% experience life-disrupting PMS symptoms, including extreme emotional distress, severe pain, or depression.

Understanding where you fall on this spectrum is key—it helps you know what’s typical for your cycle and when it’s time to seek extra support.

What’s Happening in Your Body During PMS?

PMS is primarily driven by hormonal fluctuations, but it’s important to recognize how hormones interact with other factors—like neurotransmitters (brain chemicals), nutrient levels, and even lifestyle habits—to shape the intensity of your symptoms.

The Role of Hormones

During the luteal phase, after ovulation, progesterone and estrogen take center stage.

These hormones initially rise to maintain the uterine lining in case of pregnancy but plummet if fertilization doesn’t happen.

Here’s how their shifts affect you:

• Estrogen Drops: Low estrogen levels can result in mood swings, irritability, and increased water retention (aka bloating).
• Progesterone Drops: Known as the “calming hormone,” progesterone promotes relaxation. When it dips, you might feel more on edge or experience anxiety and fatigue.
• Serotonin is Impacted: Hormonal changes disrupt serotonin, the brain chemical that regulates mood, appetite, and sleep, making irritability, cravings, and low energy more likely.

It's a perfect storm—but the severity of PMS often depends on how sensitive your body is to these natural hormonal shifts.

Common PMS Symptoms and What They Mean

How PMS shows up can vary significantly from person to person—and even cycle to cycle.

Let’s look at the 3 main types of symptoms commonly associated with PMS:

1. Physical Symptoms

• Bloating: Caused by estrogen-driven fluid retention and inflammation.
• Breast Tenderness: A common result of fluctuating progesterone and estrogen levels.
• Fatigue: Body adjusting to hormonal changes, and blood sugar dips can make it worse.
• Cravings: Your body may crave quick energy (think sugary or salty snacks) due to imbalanced blood sugar.

What Can Help:

• Stay hydrated—drinking plenty of water helps reduce bloating.
• Choose whole foods with low glycemic indexes to balance blood sugar.
• Add anti-inflammatory foods like wild salmon or turmeric with black pepper, to help ease bloating and aches.

2. Emotional Symptoms

• Mood Swings: Rapid drops in estrogen affect serotonin, amplifying feelings of irritability or anxiety.
• Anxiety or Depression: A lack of magnesium absorption or vitamin B6 can worsen emotional symptoms by disrupting neurotransmitter function.
• Emotional Sensitivity: Hormonal fluctuations heighten emotional responses to stress.

What Can Help:

• Snack on magnesium-rich foods like almonds, bananas, or dark chocolate to relax your nervous system.
• Include vitamin B6 sources like poultry or eggs to ease mood swings.
• Practice mindfulness or breathing techniques when emotions feel heavy.

3. Behavioral Symptoms

• Sleep Problems: Difficulty falling or staying asleep is linked to hormonal shifts affecting melatonin.
• Brain Fog: Difficulty focusing can stem from serotonin imbalances and energy dips.
• Changes in Appetite: Eating less—or overeating—are common behavioral symptoms during PMS.

What Can Help:

• Stick to a consistent sleep schedule, even on rough hormone days.
• Balance meals with protein and complex carbs to avoid energy crashes.
• Use tools like to-do lists or apps to stay organized when brain fog hits.

Root Causes and Contributing Factors

PMS symptoms might feel random, but they often stem from deeper imbalances.

Hormones, inflammation, and nutrient deficiencies all play a role in how your body reacts during the luteal phase.

Let’s break it down:

1. Hormonal Imbalance

Estrogen and progesterone are meant to work in harmony, but when the balance tips—like in estrogen dominance—symptoms intensify.

Too much estrogen can lead to bloating, mood swings, and tender breasts, while low progesterone might leave you feeling anxious, fatigued, or struggling to sleep.

What Can Help:

• Support liver health with cruciferous veggies like broccoli to help process excess estrogen.
• Manage stress with calming practices, as stress can lower progesterone.

2. Inflammation

Chronic inflammation worsens PMS symptoms like aches, fatigue, and bloating.

Triggers like sugary or processed foods, stress, and lack of movement can make your body’s internal alarm system overreact.

What Can Help:

• Add anti-inflammatory foods like wild berries, nuts, and seeds to your meals.
• Avoid inflammatory triggers like refined sugar and processed snacks.
• Stay active—gentle movement, like restorative yoga or walking, can work wonders.

3. Nutritional Deficiencies

Your body needs specific nutrients to manage PMS symptoms.

Key deficiencies—like magnesium, calcium, and vitamin B6—can worsen mood swings, bloating, cramps, and sleep issues.

What Can Help:

• Boost magnesium with nuts, spinach, or dark chocolate to ease tension and cramping.
• Add calcium-rich foods like 2 cups of kale or sardines to regulate mood and muscle function.
• Include vitamin B6 sources like bananas, fish, or chicken to support serotonin (your mood-balancing hormone).

What’s Normal (and What’s Not)?

It's important to know what falls into the “normal” range of PMS and when it might signal something deeper that needs attention.

Mild PMS Symptoms:

• Emotional Shifts: Mild irritability, anxiety, or brief mood swings that don’t interfere with daily life.
• Physical Discomforts: Bloating, mild fatigue, or breast tenderness, typically subsiding once your period begins.
• Cravings or Sleep Changes: Short-term changes in appetite or sleeping patterns are common.

When to Seek A Healthcare Provider:

• Severe Emotional Distress: Persistent or overwhelming depression, anxiety, or irritability that affect decision making, your relationships, or your ability to self-regulate could indicate PMDD (Premenstrual Dysphoric Disorder).
• Debilitating Physical Pain: Severe cramping or headaches that prevent you from working or completing basic tasks.
• Interference with Daily Life: If symptoms disrupt your job, schooling, or personal relationships regularly, it’s time to seek help.

PMS symptoms are predictable and cyclical, typically starting 5-7 days before your period and subsiding once it begins.

Tracking your symptoms for a few cycles can help provide clarity about whether your PMS symptoms fall within the normal range or need medical follow-up.

5 Ways to Take Control of PMS

Here's how you can proactively manage PMS while supporting your overall health:

1. Balance Your nutrition: Focus on whole foods—like leafy greens, fatty fish, grass-finished meats, and limit sugar and caffeine, to regulate blood sugar and reduce inflammation.
2. Improve Sleep Hygiene: Create a calm sleeping environment—think dark, cool, and quiet, reduce exposure from screens at least an hour before bed, and stick to a consistent sleep schedule—even on weekends.
3. Move Your Body: Going on walks, restorative yoga, or dancing in your kitchen boosts endorphins and reduces stress.
4. Stress Management: Writing out your thoughts or frustrations can help you feel more in control of what’s on your mind, deep breathing exercises, and prioritizing gratitude throughout the day.
5. Track Your Symptoms: On a paper chart or through Read Your Body can help you identify consistent patterns to address with self-care or professional support.

To Wrap Things Up

Understanding PMS is about more than just managing symptoms—it’s about listening to your body and recognizing what it needs.

While some physical and emotional changes before your period are normal, severe symptoms don’t have to be your reality.

Start small: notice your symptoms, make targeted adjustments, and seek out a healthcare provider if things feel unmanageable.

With knowledge and the right support, you can reclaim control and feel more connected to your body, every step of the way.