From acupuncture, CBD, and herbal elixirs to basic nutrition and exercise, these holistic PMS treatments will help you manage the source and symptoms of that monthly rollercoaster.

By Jillian Dara
August 11, 2020
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Cramps, bloating, mood swings… it's nearing that time of the month. We've nearly all been there: Premenstrual syndrome (PMS) reportedly affects 90 percent of women during the luteal phase of the menstrual cycle—typically a week prior to menses (the bleeding phase)—with symptoms running from a nuisance (bloating, fatigue) to debilitating (cramps, headaches, etc.), according to the U.S. Department of Health & Human Services.

"The menstrual cycle involves a delicate balance of hormones, particularly estrogen and progesterone," explains Angela Le, D.A.C.M., L.A.C., a doctor of Chinese medicine and founder of Fifth Avenue Fertility Wellness. "If these hormones are not regulated properly, some symptoms that can occur include fatigue, bloating, constipation, diarrhea, breast tenderness, loss or increased appetite, weight gain, insomnia, mood fluctuations, and emotional discomfort like anger, irritability, anxiety, and depression."

Of course, hormone fluctuations during your period are normal, explains Catherine Goodstein, M.D., ob-gyn at Carnegie Hill Ob/gyn in New York City. "Having progesterone be the dominant hormone in the luteal phase is completely normal, but it's that dominance which can make PMS worse for women."

But just because the symptoms of PMS are common doesn't mean you have to sit back and deal with them. "Women have been conditioned to accept PMS as our lot in life, but that's just not true," says Alisa Vitti, H.H.C., holistic health coach, functional nutritionist, and founder of FLO Living, a virtual online health center dedicated to hormonal issues.

"The biggest misconception is that pain with our periods is 'normal' and that we just have to 'suck it up,'" reiterates Lulu Ge, founder and CEO of Elix, an herbal supplement brand designed to treat PMS. "For far too long, society has made periods an embarrassing topic and keeping our pain in private has hindered us from finding more natural and side-effect-free solutions. I think it's wild that 58 percent of women are essentially prescribed hormonal birth control off-label for menstrual-related symptoms when it was created to be a contraceptive."

It's true: Hormonal birth control is often used as an effective PMS treatment for women with severe symptoms. This works because birth control pills block ovulation and the resulting surge in progesterone, says Dr. Goodstein. And, of course, you can "spot treat" symptoms by taking OTC medicine for cramps or digestive issues—but those don't tackle the root of the problem (hormones) or help with more complex symptoms like emotional discomfort or brain fog.

But if you don't want to go on birth control pills just to manage PMS, you're in luck. There are natural PMS treatments and remedies that you can tailor to your symptoms and which can help you make this time of the month a bit more bearable.

"No two women have the same menstrual experience," says Eve Persak, M.S. R.D.N. "Personalization helps—especially if PMS severely compromises your quality of life each month. When your approach is tailored to meet your unique needs, it's often easier and more effective at addressing your own set of symptoms."

Not sure where to begin? Experts weigh in on some of the best PMS treatments, including holistic options and natural remedies for PMS such as monitoring nutritional intake and moving more and trendy natural elixirs and balms.

Exercise

"PMS mood shifts are triggered by hormonal changes that can interfere with serotonin activity," says Lola Ross, co-founder and nutritionist at Moody Month, a female mood and hormone tracking app. "Exercise helps stimulate serotonin and dopamine, your happy neurotransmitters." (Thank you, runner's high!)

It's worth noting that, due to the changes in hormones, your body will perform differently throughout the different stages of your cycle. During the luteal phase of your cycle (when PMS symptoms occur), your body prepares to shed the uterine wall with a surge of the progesterone. "The sedating effects of progesterone can reduce energy and mental clarity which may not inspire an intense workout," says Ross. So while exercise will help you feel better mentally, you may not have the energy to go all-out at HIIT class. More gentle exercise, such as tai chi or a restorative yoga class, will help calm the adrenal stress (adrenal glands above your kidneys respond to stress by releasing cortisol and adrenaline hormones) and also support healthy circulation, says Ross. (Related: 6 Things to Know About Working Out on Your Period)

In addition to light exercise during the luteal phase, Ross encourages regular exercise to help build stress resilience and to support the nervous system. "High-intensity workouts are a good focus during the follicular phase [from the first day of your period through ovulation], when estrogen is higher, typically bringing with it increased mental clarity, determination and good blood sugar regulation, which helps to regulate energy levels," she says. "High circulating estrogen during the ovulation phase [the middle of your cycle] can mean that you may find energy is still pretty high and stamina is good...So the ovulation phase is potentially a great time for long trail runs or circuit-style cardio."

Nutrition

More and more research is emerging around diet's role in your body's management of illness and inflammation as well as the way food affects your mood. As a result, it makes sense that nutrition may be able to play a role in reducing PMS symptoms; by adding (or eliminating) the right things in your diet on the days leading up to and during your cycle, you can help relieve symptoms.

Indeed, "nutrient deficiencies are the leading cause of hormonal imbalances," says Katie Fitzgerald, M.S., nutritionist and co-founder of HelloEden, a nutrional supplement designed to support a healthy hormone balance. You can adjust your nutrition as a form of PMS treatment by taking advantage of some of the pointers below.

Carbs

Persak recommends increasing whole-grain carbohydrates (such as quinoa, oats, teff, pumpkin, potato, corn) over processed carbs (such as white breads, pasta, and rice), because they can help regulate blood sugar to help keep moods more stable and provide a prolonged sense of satiety after eating.

Protein

Many cheeses, seeds, and meats contain specific amino acids (the building blocks of protein) that can help with PMS symptoms. More specifically, the amino acid tyrosine boosts the body's production of dopamine (the happiness hormone) and amino acid tryptophan boosts the body's production of serotonin (the brain chemical that creates a sense of calm), says Persak. She specifically recommends pumpkin seeds, parmesan cheese, soy, poultry, and whole-grain oats because they're packed with those aforementioned amino acids.

Fats

Cold-water fish, such as salmon, also contain omega-3 fatty acids, which regulate mood-based symptoms associated with PMS. "Omega-3 fatty acids may help lessen mood-based PMS symptoms (such as depressed and anxious feelings, poor concentration) as well as the bodily symptoms (bloating, headaches, and breast soreness)," she says. (Related: What Is Seed Cycling and Can It Help with Your Period?)

Micronutrients

Calcium, magnesium, potassium, and vitamin B6 are all micronutrients that Persak advises clients to increase their intake of via diet, or supplements if needed.

  • Calcium: "Calcium levels are shown to dip in the luteal phase of the menstrual cycle (just before a period)," says Persak, suggesting calcium-rich foods such as organic dairy products, broccoli, dark leafy greens, and tofu. "This drop is believed to contribute to moodiness and restlessness."
  • Magnesium: "Upping intakes of magnesium has been shown to improve fluid retention and breast tenderness, help the body settle into sleep and also serve as a relaxant," says Persak, pointing to magnesium-rich foods like avocado, dark leafy greens, and cacao. (See: The Benefits of Magnesium and How to Get More of It)
  • Potassium: "Potassium is the electrolyte of the body that balances sodium and helps to prevent fluids from collecting in the tissues," says Persak. "By increasing the food sources of this mineral (from banana, pumpkin, cucumber, watermelon, leafy greens, broccoli, and legumes) women can offset their intake of salty foods and release some of the water weight more readily."
  • Vitamin B6: Lastly, Persak emphasizes the importance of vitamin B6, believed to help relieve breast tenderness, fluid retention, depressed moods, and fatigue. She says the highest food sources of this vitamin include: salmon, chicken, tofu, pork, potatoes, bananas, avocados, and pistachios.

As for foods to avoid, well, Persak admits these are also the foods you might typically crave most as your period approaches as a result of increased progesterone (which increases your appetite): refined grains (bread, pasta, crackers, pastries), sweeteners (even honey and maple), large portions of fruits, salt and salted foods (canned foods, fast food, sauces), caffeine, and alcohol.

"Over-indulging on large simple carb portions that are low in fiber or fiber-free can cause more drastic shifts in blood sugar levels, which can exacerbate mood swings, promote cravings, compound headache pain, and contribute to overall inflammation," explains Persak.

Supplements

"Even with the most mindful diet, it can be difficult to get in everything you need," says Fitzgerald. That's where supplements can come into play. (Note: Supplements are not regulated by the Food and Drug Administration (FDA) and may interfere with prescription medicines. Consult your doctor and/or a dietitian before you begin taking any regular supplements to ensure safe use.)

"Zinc and estrogen are closely linked," says Fitzgerald. "Low levels of zinc are associated with irregular ovulation and PMS. You also want to incorporate a few things to help soothe inflammation, swelling, pain, and general malaise; ashwagandha and turmeric are amazing anti-inflammatory herbs. Bromelain, a chemical extracted from pineapples, helps to soothe inflammation in muscles. Probiotics are also great to tame the tummy and promote serotonin production for feelings of wellness." Though you can consume these nutrients by adjusting your diet—talking to a nutritionist or dietitian can confirm exactly what you need to consume more of—supplements can make it easier to ensure your nutrient intake is consistent, no matter the phase of your cycle.

In addition to nutritional supplements, some women may increase their intake of supplements not necessarily designed for PMS, but to soothe key symptoms, like Love Wellness Mood Pills (mood-boosting supplements containing vitamin B6, the neurotransmitter GABA, organic St. John's Wort, and organic chasteberry which may ease anxiety or depression caused by PMS) or Well Told Health's sleep supplement (containing organic lemon balm and organic goji berries which may aid with insomnia during PMS). Other companies offer elixirs or tinctures designed specifically to treat PMS, like Moon Bitters by Roots and Crown, PMS Berry Elixir by The Wholesome Co., and Marea, a powder packet you mix with water—all using various herbs or other natural ingredients that are said to help with hormonal balance.

For a more personalized approach, a new company called Elix offers an all-natural herbal tincture designed to target the root cause of symptoms on an individual basis. You complete a health assessment quiz and Elix's medical board then formulates a blend to consume as a tincture leading up to your cycle. (Related: Are Personalized Vitamins Worth It?)

Herbs like angelica sinensis, white peony, licorice, cyperus, and corydalis are all used in Chinese herbal medicine for their natural healing powers—and might be used in your custom tincture. "Angelica sinensis is known as the 'female ginseng' and the hormonal health herb in Chinese herbal medicine," says Li Shunmin, D.C.M., a member of Elix's medical advisory board and a professor at Guangzhou University of Traditional Chinese Medicine. "It's included in nearly every formula to address women's health issues. It regulates menstruation by generating new blood cells and invigorating blood flow...It also addresses constipation by assisting the intestines with increased fluid." White peony root is said to stimulate the immune system and is anti-inflammatory, while licorice root soothes spastic pains, particularly uterine cramps during menses, says Shunmin. And as for cyperus, "it's a traditional herb for any gynecological symptom that might be due to stress; irregular cycles, mood swings, breast tenderness and a host of other hormonal symptoms." Lastly, Shunmin explains corydalis is a potent pain reliever and known to help with mood swings as it acts as an antidepressant.

CBD Products

With CBD all the rage right now, it's no wonder it's finding its way into PMS treatments as well. (ICYMI, here's what we know about the benefits of CBD so far.)

"In general, CBD helps with mood imbalances, improves resilience, and can relax the smooth muscle to minimize uterine cramps [when ingested or applied topically]," says Le, who has experience treating symptoms with CBD products and often recommends Radical Roots to her patients. That's why topical CBD products, ingestibles, and even suppositories have grown in popularity among brands like Charlotte's Web, Maxine Morgan, and Vena CBD.

For example, CBD brand Mello recently released Mello Bottom, a suppository with 75mg of CBD from full-spectrum hemp extract designed to alleviate symptoms of PMS based on studies that conclude CBD is an effective analgesic/pain reliever (uterine cramps), helps treat mood disorders (anxiety, mood swings, and irritability), and is an anti-inflammatory (including IBS and muscle inflammation). Foria Wellness, a company that makes hemp and cannabis wellness products, including CBD and THC arousal oils and CBD suppositories designed to help with pelvic pain, whether it's from PMS, sex, or other issues.

Though some practitioners swear by CBD when it comes to PMS, it's worth noting that CBD products—as well as other holistic alternatives such as supplements and tinctures—are not regulated by the FDA, says Dr. Goodstein. (Related: How to Buy Safe and Effective CBD Products) Because it's such a new field, "there's little evidence supporting their safety and efficacy," she says. "For that reason, if I have a patient who is suffering with PMS symptoms and they are not on board with the treatments I have at my disposal, I will often refer them to an acupuncturist."

Acupuncture

"For thousands of years, Chinese medicine has successfully treated PMS by regulating hormonal imbalances, reducing inflammation, and increasing relaxation and endorphin production [using acupuncture]," says Le. "In a study demonstrating the efficacy of pharmaceutical treatment compared to acupuncture, women who were treated with acupuncture were more likely to have PMS symptoms alleviated compared to those on hormones." (See: Everything You Need to Know About the Benefits of Acupuncture)

Le explains that acupuncture points stimulate the nervous system and by doing so release chemicals that regulate blood flow and pressure to increase endorphins, reduce inflammation, and lower stress. "Essentially, these biochemical changes enhance the body's natural healing capacity and promote physical and emotional wellbeing," says Le. For these reasons, acupuncture might be able to benefit your sex life as a whole, in addition to being a PMS treatment.

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