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The vast majority of women already know: PMS sucks. During the luteal phase of the menstrual cycle (that's the second half, between ovulation and your period), 75 percent of women experience physical issues—cramping, bloating, backaches, headaches, weight gain, breast tenderness, sleeping issues, digestive issues—as well as emotional problems, like anxiety, sadness, irritability, mood swings, low self-esteem, and general exhaustion. (And that's just your run-of-the-mill PMS. Some women experience an extreme version, otherwise known as PMDD.)
But it turns out you may be unintentionally making yourself feel even shittier. There are a handful of circumstances and choices that, when they coincide with that post-ovulation period, can make the monthly pains way, way worse. Luckily, they're all somewhat controllable. Here are nine ways you may be making your PMS worse than it needs to be—and what you can do to find relief.
An Undiagnosed STI
A recent study in Evolution, Medicine, and Public Health found that before women were diagnosed with a sexually transmitted infection (STI) like chlamydia, herpes, or HPV, they were twice as likely to report headaches, cramps, and emotional sensitivity in the two weeks leading up to their period. Sounds crazy, but it's actually thanks to your body's natural immune response and the inflammatory cascade from the infection that increases pain and heightens your emotions, ob-gyn Natasha Chinn, M.D., recently told us. (Read more on all that here: Apparently, an Undiagnosed STI Could Be to Blame for Your Terrible PMS)
Skimping On Sleep
Not getting enough shuteye—or enough quality sleep, thanks to things like stress and anxiety—can worsen PMS, says Atlanta-based ob-gyn Tami Prince, M.D. "If we don't sleep, we can't produce certain hormones responsible for stabilizing our health and well-being," she explains. On top of this, you also score the baseline traits of a bad night's sleep—irritability, fatigue, brain fog—which just pile on the premenstrual symptoms we all know and loathe. And unfortunately, worse symptoms from a few sleepless nights become a catch-22: Women with worse PMS symptoms or menstrual cramps score poorer quality sleep, reports a new study published in Sleep Medicine Clinics. (Related: Why Sleep Is the No. 1 Most Important Thing for a Better Body)
Rosé All Day
"Excessive alcohol use can increase levels of estrogen-disrupting hormones, which lead to dehydration, bloating, and water retention, making PMS symptoms intolerable," explains Sherry Ross, M.D., an ob-gyn and women's health expert at Providence Saint John's Health Center in Santa Monica, CA. And while you probably have a different opinion of "excessive alcohol," she says pretty much anything beyond the healthy one drink per day for women will hurt—but only when repeated multiple nights in a row. (And by the way, a new study claims even moderate amounts of alcohol are bad for your health.)
Being Stressed AF
A 2018 study in Saudi Medical Journal found female college students who were super stressed were nearly three times as likely to experience worse PMS symptoms in the luteal phase, and twice as likely to have painful cramps during their period. "Stress exacerbates depression, anxiety, weight loss or weight gain, and foggy brain. PMS, along with common stress symptoms, can make the one to two weeks prior to your period debilitating," says Dr. Ross. What's more, people tend to perceive pain differently when they're under stress, Dr. Prince points out, which means both physical and emotional aches might bother you more. Go-to stress relievers like exercise and meditation can help relieve PMS, she says. (Related: How I Regained Control Over My Body After Years of Debilitating PMS)
Low Vitamin D Levels
Some studies, including a large one recently published in the Journal of the Academy of Nutrition and Dietetics, have found women with low vitamin D levels were more likely to experience certain exacerbated symptoms—namely cramps, fatigue, anxiety, and confusion, tied to their cycle. While there are also studies finding no link between the vitamin and symptoms, some research has shown supplementing vitamin D can help alleviate PMS-related pains, emotionality, and painful cramps, and it's a relatively harmless fix to try. "Vitamin D is needed so that calcium can be absorbed, which in turn allows for our muscles, including the heart, to contract properly," explains Dr. Prince. Without proper contraction, your organs and tissue have limited blood flow, which increases fatigue, muscle fatigue, and cramping, she says.
Eating All the Food
"In the week or two before your period, hormonal changes cause bloating, diarrhea, and constipation," explains Dr. Ross. Eating foods that are already tied to bloating on a good day will just exacerbate the problem. Plus, for many women, water retention, weight gain, and bloating are all tied to mood, potentially exacerbating the emotional parts of PMS, she adds. (Related: Exactly What to Do When You Overeat, According to Nutritionists)
One study found that among high school students, PMS symptoms were worse when they ate fried foods, sugary drinks, and fast food—but, surprisingly, also fruit. In the two weeks before your period, Dr. Ross recommends steering clear of dairy, high-sodium foods (read: takeout), and red meat, but also cruciferous vegetables, beans, even apples, peaches, and pears, all of which will make bloating, constipation, and diarrhea worse.
If you have a history of depression or anxiety, your imbalanced hormones can make your PMS routinely worse—the extreme of which is known as PMDD. But even without chronic concerns, if the stars align against you and throw an anxiety-inducing situation in your lap right before your period, you're more likely to feel depression, anxiety, and general, uncontrollably emotional feelings that are already wrapped up in PMS—but worse, says Dr. Ross. "If you feel more emotionally fragile, you may not handle the one to two weeks leading up to your period as well as you would during less stressful times." (Related: Try This Guided Meditation the Next Time You Feel Overwhelmed with Anxiety)
Too Much Caffeine
"Caffeine is considered a vasoconstrictor which decreases blood flow to organs," explains Dr. Prince. Two main ways this manifests: constricted blood vessels in the GI tract make you bloated and not enough blood to the heart will skyrocket your heart rate and induce anxiety. Stick to your usual shot count to avoid unpleasant side effects.
Sneaking In a Cigarette
Cigarettes affect your hormone levels, which can exacerbate PMS symptoms, says Dr. Prince. And you don't have to be a chain-smoker to feel the effects; even just one or two slip-up smokes to relieve stress or when you're out drinking count, too.