Cramps. Bloating. Moodiness. Water weight. Sleep disturbances. Constipation. Breast tenderness. Hot flashes.

Is it menopause, or is it PMS?

For this post, I’m talking about PMS…and if you know, you know.

Most of the time when we think of PMS—also known as premenstrual syndrome—we think of it as a bad thing, a disease, or something that should be cured. I won’t contest the fact that cramps and constipation are not fun, and that life would flow (flo?) a little smoother without these cyclic symptoms. I also want to make it clear that severe symptoms like debilitating cramps and aches, nausea or vomiting, or clinical depression are serious and significant, and should always be evaluated by a healthcare provider because they could signal a bigger problem like hormonal imbalances. Nobody should have to suffer like that! [Read more about what’s normal what’s not when it comes to periods here.] But when it comes to mild bloating, breast swelling, or abdominal discomfort, I want to challenge you to think differently about these annoyances.

One of the reasons I’m such a big fan of basal body temperature (BBT) charting and tracking cervical mucus is because it’s empowering. When we can follow our bodies own cues about our hormones and fertility, we not only are equipped with important information about when something is amiss, but we also are able to know when things are going right. When it comes to our menstrual cycles, the bleeding itself isn’t the main event—ovulation is—and knowing that we’ve ovulated and when gives us extremely powerful information about our health and well-being. Ovulation is the whole point of our periods, and its the unique superpower that our bodies have as women. Just like we want to make sure our thyroid is functioning as it should and that our blood sugar is well-controlled, sexual health (especially ovulation) is extremely important.

So, how does all that tie into PMS?

The normal symptoms of PMS (mild cramps, breast tenderness, fatigue, etc) are due to progesterone, the predominant hormone of the luteal phase of the cycle. I talk about these hormones and phases of the cycle more in this post, but here’s a refresher:

• You period starts on day 1 of your menstrual cycle. At this point, estrogen and progesterone levels are at an all time low.
• Throughout the first two weeks of the cycle (called the follicular phase), estrogen levels rise, stimulating the brain to release luteinizing hormone (LH). This hormone tells the ovaries to start ripening a “follicle” (premature egg). Estrogen also stimulates next layer of the uterine lining to form in case pregnancy takes place.
• On the day of ovulation, the mature follicle bursts open, releasing the egg. The egg travels down the fallopian tubes and, if it isn’t fertilized within 24-36 hours, dissolves and passes through the vagina.
• After ovulation, the remnants of the ovarian follicle (called the corpus luteum) begin to produce progesterone (and a small amount of estrogen) which thickens the uterine lining and makes it fluffy so that a fertilized egg can implant.
• After about a week, the corpus luteum “runs out of steam” so to speak, hormone levels start to fall back, and eventually drop back to their low point again. This hormonal ‘withdrawal’ allows the uterine lining to start to shed, and the next cycle begins.

Let’s circle back to progesterone. In addition to fluffing up the uterine lining, progesterone has a number of other normal, healthy, and good effects on our bodies. These physiologic functions include things like cancer prevention, maintaining our HDL cholesterol (the “good” cholesterol), and supports bone health, quality sleep, and more. But some of the other effects aren’t always as welcome, even though they are normal and natural effects of progesterone. These include slowing the digestive process so that more nutrients are absorbed, in case of pregnancy. This makes us feel bloated and constipated. Progesterone also stimulates the development of mammary (milk-producing) tissue in our breasts, again in case of pregnancy. As this new tissue starts to die off when it’s clear that a pregnancy hasn’t taken place, it can cause pain, swelling, and discomfort. Progesterone also slows down the metabolism, making us feel tired if we aren’t resting enough, sometimes leading to feelings of fatigue.

While bloating, constipation, breast tenderness and fatigue aren’t the most comfortable or enjoyable parts of being a woman, we experience them as a consequence of the normal, healthy functioning of our reproductive system. Without normal ovulation, our bodies don’t produce progesterone in the luteal phase. Sure, without progesterone, we wouldn’t experience PMS, but it would mean that we weren’t ovulating. Not ovulating is not healthy, period.

Personally, I’m pretty grateful for my period. After going nearly seven years without a healthy cycle, my sexual health and wellbeing is no longer something I take for granted. Sure, I have to deal with the occasional set of mild symptoms and use a hot pack every now and then, but knowing that my body is able to ovulate and maintain hormonal balance is worth the inconvenience. When my books are sore and I feel a little bloated as my period approaches, instead of being frustrated, I now find myself grateful for the knowledge that my body is functioning as it should. If I didn’t have those physical reminders on the outside, I might not know that everything is healthy and in order on the inside.

How do you approach PMS?