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PMS
PMS is more than just “a bad week” before your period. It refers to the physical and emotional changes that can show up after ovulation and improve once your period begins. Things like mood changes, cravings, bloating, fatigue, breast tenderness, and sleep changes are common, but that doesn’t mean you have to simply push through them every month.
PMS symptoms: does your cycle take over every month?
Your hormones naturally shift throughout your cycle, and some bodies are more sensitive to those changes than others. Even when hormone levels look “normal,” the way your body responds to those shifts can still create noticeable symptoms. Understanding your unique cycle pattern can help uncover what’s contributing and guide a more personalized approach.
The timing of your symptoms tells us a lot. When symptoms consistently appear in the one to two weeks before your period and improve once bleeding begins, there may be a hormonal pattern worth exploring.
PMS exists on a spectrum. Some people experience mild changes, while others experience premenstrual symptoms severe enough to affect mood, relationships, work, or daily life. More severe symptoms, such as those seen with premenstrual dysphoric disorder (PMDD), deserve to be recognized and supported, not dismissed as something you just have to live with.
You may benefit from an assessment if you experience:
- Irritability, anxiety, or low mood before your period
- Mood changes that impact relationships, work, or daily life
- Breast tenderness, bloating, or headaches before your period
- Intense cravings or changes in appetite
- Fatigue or sleep changes during the second half of your cycle
- Symptoms that improve once your period starts
- Feeling like you “lose yourself” for part of every month
- PMS symptoms that have changed or worsened over time, especially in your late 30s or 40s
What causes PMS?
Hormone Sensitivity
Research suggests severe PMS often involves heightened brain sensitivity to normal progesterone and estrogen fluctuations rather than abnormal levels. This is why symptoms can be severe while blood tests look fine, and why treatment focuses on modifying the response.
Serotonin Shifts
Estrogen supports serotonin signalling, and its luteal decline can lower mood, patience and impulse control in sensitive women. The serotonin connection explains why mood symptoms dominate some patterns.
Nutrient Status
Calcium, magnesium and vitamin B6 each have randomized trial evidence in PMS. Depletion doesn't cause PMS by itself, but correcting it may reduce symptoms for many women.
Blood Sugar and Stress Load
The second half of your cycle (the luteal phase) can be a time when your body feels a little more sensitive to changes in blood sugar, stress, and energy levels. Many people notice PMS symptoms feel more intense during months when they’re running on less sleep, feeling more stressed, or not fueling their body consistently. Supporting steady blood sugar, recovery, and stress levels can be an important piece of helping you feel better throughout your cycle.
Perimenopausal Transition
PMS commonly intensifies in the years before menopause as hormone swings widen. Worsening PMS after 35 often marks the start of that transition.
Up to 90%
3 to 8%
How is PMS tested?
The foundation is your cycle pattern, ideally tracked across two cycles: which symptoms, which days, how severe. This distinguishes PMS from conditions that merely worsen premenstrually, like anxiety, thyroid dysfunction or iron deficiency, which need their own treatment.
Bloodwork commonly includes a thyroid panel, ferritin and vitamin D. Where mood symptoms are severe, we screen properly for PMDD and involve medical and mental health care as needed.
How is PMS treated?
Treatment focuses on supporting the factors that may be contributing to PMS symptoms. This can include nutrition strategies to support steady blood sugar and hormone balance, and where indicated, supplements and lifestyle strategies that support sleep, stress regulation, and overall hormone health.
We track your symptoms over time to better understand your unique cycle pattern and adjust your care plan based on how your body responds.
How Somewhere Health helps
Care starts with the bigger picture rather than a single test. If you've already been diagnosed, we build on what you know. If you suspect something deeper but have never had a full workup, we can order the testing that gets you clear answers.
Your first visit is 75 minutes with a licensed naturopathic doctor who has reviewed your full intake. Together you'll create a plan that may include nutrition and lifestyle changes, targeted supplementation, and functional testing where appropriate. Bloodwork happens at any LifeLabs or Dynacare, and specialty panels like the DUTCH test ship to your door.
Appointments are completely virtual, so you can access care from anywhere in Ontario, and visits are covered by most extended health benefits plans.
Our Approach
- Nutrition and dietary guidance
- Lifestyle recommendations
- Stress and sleep support
- Targeted supplementation
- Functional or laboratory testing when appropriate
- Ongoing monitoring and treatment adjustments
- Collaborative care with your broader healthcare team when needed
How it Works
Dr. Courtney Ranieri is a licensed naturopathic doctor with Therapeutic Prescribing authorization, in practice since 2018. She holds a Doctor of Naturopathic Medicine from the Canadian College of Naturopathic Medicine and an Honours BSc from Western University, and her clinical focus is women's health: hormones, fertility, digestion, pelvic floor and metabolic care. She sees patients across Ontario virtually.
