PMS: Why Your Symptoms Aren’t “Normal” and What They’re Telling You
A functional medicine approach to PMS, PMDD, and cycle-related hormone imbalance
Many women are told—directly or indirectly—that PMS is just part of being female. That feeling bloated, irritable, anxious, exhausted, or emotionally raw every month is something to tolerate, manage, or medicate around.
But PMS is not a character flaw, and it is not random.
While hormonal fluctuations are a normal part of the menstrual cycle, significant or disruptive PMS is a signal—one that reflects underlying imbalance rather than something your body is doing “wrong.” When symptoms worsen month after month, interfere with daily life, or escalate into severe mood changes, the cycle is offering information that deserves to be understood.
In functional medicine, PMS is viewed as feedback from the body. It reflects how well ovulation is occurring, how hormones are being regulated and cleared, how the nervous system is responding to stress, and how resilient the body is overall. When those systems are supported, PMS often improves—sometimes dramatically.
This article explores what PMS actually represents, why common approaches often fall short, and how a root-cause approach can help restore more predictable, stable cycles. We’ll also address more severe presentations, including PMDD, and why suppressing symptoms isn’t the same as resolving the underlying issue.
PMS Is a Signal, Not a Flaw
PMS is often framed as something to endure or manage around. But from a physiological standpoint, it is better understood as feedback.
The menstrual cycle is a coordinated conversation between the brain, ovaries, adrenal glands, thyroid, liver, gut, and nervous system. When that communication is smooth, hormonal shifts tend to feel subtle and predictable. When something is off, symptoms appear — often cyclically, often with increasing intensity.
PMS is one of the clearest ways the body communicates that something in that system needs attention.
This does not mean the body is malfunctioning. It means it is responding — to stress, to metabolic strain, to disrupted ovulation, to impaired hormone clearance, or to a nervous system that has been operating in survival mode for too long.
Many women notice that PMS follows recognizable patterns:
symptoms that reliably worsen in the days before menstruation
mood changes that feel out of proportion to circumstances
physical discomfort that resolves quickly once bleeding begins
cycles that become harder to tolerate over time rather than easier
These patterns are not random. They are timing clues.
When symptoms are cyclical, they are almost always hormonally mediated. When they intensify with age, stress, illness, or lifestyle changes, they point toward systems that are becoming less resilient under load.
Seeing PMS as a signal — rather than a nuisance — shifts the question from “How do I stop this from happening?” to “What is my cycle trying to tell me?” That shift is where meaningful change begins.
What PMS Actually Is (And Why It Happens)
Premenstrual syndrome (PMS) describes a cluster of physical, emotional, and cognitive symptoms that occur during the luteal phase of the menstrual cycle — the window between ovulation and the start of menstruation (1).
This timing matters.
After ovulation, progesterone should rise and work in coordination with estrogen to stabilize mood, support sleep, regulate inflammation, and prepare the uterine lining. When that balance is disrupted — whether through low progesterone, exaggerated estrogen effects, or impaired hormone regulation — symptoms emerge (2).
Importantly, PMS is not caused by hormones simply fluctuating. Hormones fluctuate in every menstrual cycle. PMS develops when the body’s response to those fluctuations becomes dysregulated (3).
Research has consistently shown that many women with PMS do not have abnormally high estrogen levels when measured in isolation. Instead, symptoms often reflect:
altered estrogen–progesterone balance
impaired luteal phase support
heightened sensitivity of the nervous system to hormonal shifts
interaction between hormones and stress, inflammation, or metabolic strain (2,4)
This helps explain why PMS can worsen during periods of chronic stress, sleep disruption, illness, blood sugar instability, or major life transitions. These factors do not change hormones directly — they change how the body processes and responds to them (5).
PMS is also cyclical for a reason. Symptoms tend to resolve rapidly once menstruation begins because estrogen and progesterone drop together, temporarily removing the imbalance that drove the symptoms in the first place (1). That relief is another clue that PMS is hormonally mediated rather than random or psychological.
From a functional perspective, PMS reflects how resilient the hormonal system is under load. When ovulation is consistent, progesterone is adequate, stress physiology is regulated, and hormone clearance is efficient, PMS symptoms are typically mild or absent. When those systems are strained, PMS becomes louder.
Understanding PMS this way creates space for meaningful intervention — not by suppressing the cycle, but by supporting the systems that regulate it.
Common Hormonal Patterns Behind PMS
While PMS symptoms can look different from person to person, they tend to arise from a small number of recurring hormonal patterns rather than random imbalance. Identifying these patterns helps explain why symptoms are predictable, cyclical, and often worsen under stress or with age.
Estrogen–Progesterone Imbalance
In clinical practice, PMS is very often a progesterone problem rather than an estrogen overproduction problem.
Progesterone is produced only after ovulation. When ovulation is delayed, inconsistent, or suppressed, progesterone output falls. Estrogen levels may remain within laboratory “normal” ranges, but without progesterone’s stabilizing influence, estrogen’s effects become exaggerated (6).
This imbalance can contribute to:
heavy or painful periods
breast tenderness and bloating
anxiety or emotional reactivity
sleep disruption
migraines that cluster before menstruation
This pattern is commonly referred to as estrogen dominance, though in many cases estrogen itself is not excessive — it is simply unopposed.
For a deeper explanation of how this imbalance develops and why clearance matters, see
→ Estrogen Dominance: Symptoms, Causes, and Natural Treatments
Impaired Ovulation and Luteal Phase Support
Because progesterone is produced only after ovulation, PMS is frequently linked to suboptimal ovulatory function.
Chronic stress, under-eating, excessive exercise, inflammation, blood sugar instability, and hypothalamic–pituitary–adrenal (HPA) axis dysregulation can all suppress or weaken ovulation (7). When this happens, progesterone output declines even if estrogen production remains unchanged.
This explains why many women are told their hormones are “normal” while continuing to experience severe PMS. Standard labs may capture estrogen values, but they often fail to reflect whether ovulation is occurring consistently or whether progesterone is sufficient across the luteal phase (8).
Nervous System Sensitivity to Hormonal Shifts
PMS is not only a reproductive hormone issue — it is also a neurohormonal one.
Estrogen and progesterone interact directly with neurotransmitters such as serotonin, GABA, and dopamine. When hormonal signaling becomes unstable, the nervous system can become more reactive to normal cyclical changes (9).
This is why symptoms such as anxiety, irritability, low mood, or emotional overwhelm often intensify in the days before menstruation, even in women without a prior mental health diagnosis. The issue is not psychological weakness; it is heightened neuroendocrine sensitivity.
This sensitivity is particularly relevant in more severe presentations, including PMDD.
Stress, Blood Sugar, and Metabolic Load
Hormonal balance does not operate in isolation. Cortisol, insulin, and inflammatory signaling all influence how estrogen and progesterone are produced, metabolized, and perceived by the body (10).
Chronic stress and blood sugar instability can:
suppress ovulation
reduce progesterone availability
impair estrogen clearance
amplify inflammatory signaling
Over time, this creates a hormonal environment where PMS becomes more intense and less predictable, even without dramatic changes in reproductive hormone levels.
Why These Patterns Matter
These patterns explain why PMS is rarely resolved by suppressing symptoms alone. They also explain why two women with similar lab values can experience dramatically different symptoms.
PMS reflects how multiple systems are interacting, not just how much estrogen is present. Addressing those interactions — rather than overriding them — is what allows cycles to become more stable and more tolerable over time.
When PMS Is More Severe: Understanding PMDD
For some women, PMS is not just uncomfortable — it is debilitating.
Premenstrual dysphoric disorder (PMDD) represents the severe end of the PMS spectrum, marked by intense mood symptoms that reliably emerge during the luteal phase and resolve shortly after menstruation begins (11). These symptoms can include severe anxiety, irritability, rage, depression, hopelessness, emotional withdrawal, or feeling fundamentally unlike oneself for a predictable window each month.
What distinguishes PMDD is not the presence of different hormones, but a heightened sensitivity to normal hormonal shifts (12).
Research shows that many women with PMDD have hormone levels that fall within conventional reference ranges. The issue lies instead in how the brain and nervous system respond to changes in estrogen and progesterone — particularly their downstream effects on serotonin, GABA, and stress signaling pathways (13).
This is an important distinction.
PMDD is often framed as a primary psychiatric disorder, yet its defining feature is precise cyclical timing. Symptoms intensify after ovulation, peak in the days before menstruation, and lift rapidly once bleeding begins. That pattern strongly implicates hormonal and neuroendocrine regulation rather than a fixed mood disorder (11,14).
From a functional perspective, PMDD reflects:
exaggerated neurohormonal sensitivity
impaired progesterone signaling or ovulatory disruption
stress-system dysregulation
inflammatory or metabolic strain interacting with hormonal shifts
These factors can amplify emotional symptoms without changing a woman’s baseline mental health outside the luteal phase.
Recognizing PMDD as part of the PMS continuum matters because it changes the therapeutic focus. Rather than suppressing symptoms in isolation, care can be directed toward improving hormonal stability, supporting ovulation and progesterone adequacy, regulating stress physiology, and stabilizing the nervous system’s response to cyclical change.
For many women, this reframing alone is profoundly validating. Severe premenstrual symptoms are not a personal failing — they are a sign that the system regulating hormones and stress is under strain.
Why Hormonal Birth Control Often Masks PMS Instead of Fixing It
Hormonal birth control is one of the most common interventions offered to women with PMS. For some, symptoms improve temporarily. For others, they change in character. And for many, symptoms return — sometimes more intensely — after discontinuation.
This response is not accidental.
Combined oral contraceptives and other hormonal birth control methods work by suppressing ovulation and overriding the body’s natural hormonal rhythm (15). While this can blunt cyclical symptoms in the short term, it does not address the regulatory systems that drive PMS in the first place.
Without ovulation, progesterone is not produced endogenously. The cyclical rise and fall of estrogen and progesterone is replaced by a steady intake of synthetic hormones, and the monthly bleed that occurs during placebo weeks is not a true menstrual cycle, but withdrawal bleeding (16).
Because PMS is tightly linked to ovulation, luteal phase signaling, stress physiology, and hormone clearance, suppressing the cycle can mask symptoms without resolving the underlying imbalance (17). This helps explain why many women feel “better” initially on birth control, yet experience a return — or escalation — of symptoms once they stop.
In clinical practice, it is common to see women who were placed on hormonal birth control for PMS, acne, irregular cycles, or mood symptoms, only to discover years later that ovulatory dysfunction, progesterone insufficiency, metabolic stress, or impaired estrogen clearance were never addressed.
This does not mean hormonal birth control is always inappropriate. It does mean it is often presented as a solution for PMS when it is more accurately a symptom management tool, not a corrective one.
For a deeper discussion of how hormonal birth control affects ovulation, hormone signaling, nutrient status, and post-pill recovery, see
→ Hormonal Birth Control: What It Really Does to Your Hormones
How PMS Is Properly Evaluated
PMS cannot be accurately understood by looking at a single hormone value in isolation. It is a pattern, not a number.
In conventional care, hormone evaluation is often limited to basic blood testing performed at a single point in time. While this approach can identify overt abnormalities, it frequently misses the regulatory dynamics that drive cyclical symptoms such as PMS (18).
From a functional medicine perspective, proper evaluation focuses on why symptoms are occurring, not simply whether a hormone falls within a reference range.
Key elements of an effective PMS evaluation include:
Ovulatory function and luteal phase adequacy
Progesterone is produced only after ovulation. If ovulation is inconsistent or suppressed, progesterone may be insufficient even when estrogen appears normal (6,19).Estrogen–progesterone balance and clearance
PMS is often driven by exaggerated estrogenic signaling rather than absolute estrogen excess. Impaired metabolism or clearance can amplify symptoms without altering serum levels (20).Stress physiology and cortisol rhythm
Chronic stress can suppress ovulation, alter progesterone availability, and increase nervous system sensitivity to hormonal shifts (21).Blood sugar regulation and metabolic load
Insulin resistance and glucose instability can worsen PMS by increasing inflammatory signaling and disrupting hormone balance (10,22).Gut health and estrogen recirculation
The gut plays a direct role in estrogen metabolism and elimination. Disruption in this system can lead to estrogen recirculation and persistent symptoms (23).Nutrient status and genetic influences
Deficiencies and genetic variations affecting methylation and detoxification pathways can impair hormone regulation over time (24).
This systems-based approach explains why many women are told their labs are “normal” while continuing to experience significant PMS. Without assessing ovulation, timing, clearance pathways, and stress physiology, key drivers remain invisible.
A thorough evaluation allows care to be targeted and proportional, rather than reactive or suppressive. It also creates a framework for tracking progress over time as systems are supported and symptoms improve.
How PMS Improves When the Root Cause Is Addressed
Because PMS reflects how multiple systems are interacting, improvement rarely comes from a single intervention. Instead, symptoms tend to ease when the body regains regulatory capacity — when ovulation becomes more consistent, progesterone signaling stabilizes, stress physiology quiets, and hormone clearance improves.
Rather than forcing the cycle into submission, functional care focuses on supporting the systems that regulate it.
Restoring Hormonal Stability and Ovulatory Support
When ovulation is consistent and progesterone production is adequate, many of the hallmark symptoms of PMS begin to soften. Progesterone plays a stabilizing role in the nervous system, supports sleep, modulates inflammation, and buffers estrogen’s effects during the luteal phase (6,19).
This is why PMS often improves as:
stress load decreases
energy availability improves
under-fueling or over-training is corrected
inflammatory and metabolic strain is reduced
These changes support ovulation indirectly, without needing to override the cycle.
Regulating the Nervous System Response
PMS is as much a nervous system issue as it is a reproductive hormone issue.
Chronic stress, poor sleep, trauma exposure, and prolonged sympathetic activation can heighten sensitivity to normal hormonal shifts (21). When the nervous system is operating in a constant state of vigilance, even small luteal-phase changes can feel overwhelming.
Supporting parasympathetic tone — the body’s “rest and regulate” state — often reduces:
premenstrual anxiety
emotional reactivity
irritability
sleep disruption
This is especially relevant for women with PMDD-like symptoms, where neurohormonal sensitivity plays a central role (12,13).
Improving Metabolic and Blood Sugar Resilience
Blood sugar instability and insulin resistance can worsen PMS by increasing inflammatory signaling and disrupting hormone production and clearance (10,22).
When glucose regulation improves, many women notice:
fewer cravings before menstruation
more stable mood
less fatigue
reduced bloating and headaches
This connection is often overlooked, yet it is one of the most powerful levers for improving cycle-related symptoms.
Supporting Gut and Detoxification Pathways
Estrogen metabolism does not end with production. It depends on effective processing and elimination through the liver and gut.
When gut motility is impaired, inflammation is present, or estrogen is recirculated rather than cleared, PMS symptoms can persist even when hormone levels appear normal (20,23). Supporting digestion, bowel regularity, and detoxification capacity often plays a quiet but meaningful role in symptom resolution.
Acupuncture and Whole-System Regulation
Acupuncture supports PMS by working upstream — regulating the nervous system, influencing the neuroendocrine-immune network, and improving communication between the brain and hormonal organs (25).
Research shows acupuncture can:
modulate stress physiology
influence ovarian and hypothalamic signaling
improve cycle regularity
reduce pain and mood symptoms associated with PMS
In clinical practice, acupuncture is often most effective when integrated with lifestyle and metabolic support, rather than used in isolation.
When these systems are supported together, PMS often becomes less intense, less disruptive, and more predictable. For many women, symptoms that once felt inevitable begin to feel manageable — or disappear entirely.
Care is individualized, paced, and responsive to how the body adapts over time. This approach avoids suppression and instead works with the cycle’s underlying biology.
For women seeking a comprehensive, root-cause approach to PMS and cycle-related symptoms, care is supported through
→ Women’s Health & Fertility Support
You Don’t Have to Suffer Every Month
Many women have spent years planning their lives around their cycle — bracing for a predictable window of discomfort, emotional strain, or exhaustion. Over time, that pattern can begin to feel inevitable.
But PMS is not something the body does without reason.
When symptoms show up month after month, they are reflecting how the hormonal system is responding to stress, metabolism, nervous system regulation, ovulation, and hormone clearance. Those systems are adaptable. When they are supported, PMS often changes — sometimes gradually, sometimes dramatically.
This does not require suppressing the cycle or overriding hormonal signaling. It requires listening to what the cycle is communicating and responding at the systems level.
For women with mild PMS, this may mean subtle adjustments that improve resilience. For those with severe or PMDD-level symptoms, it often means a deeper evaluation and more structured support. In both cases, the goal is the same: a cycle that feels predictable, tolerable, and supportive rather than disruptive.
PMS is not a personal failing, and it is not something to simply “push through.” It is information — and when that information is acted on thoughtfully, meaningful change is possible.
If you’re experiencing persistent or worsening PMS and want a root-cause, individualized approach to care, support is available.
If you suspect a hormonal imbalance may be contributing to your symptoms and would like guidance from a trusted provider, you may
Request a complimentary 15-minute consultation with Dr. Martina Sturm at Denver Sports and Holistic Medicine.
This call is an opportunity to discuss your concerns, ask questions, and determine appropriate next steps based on your individual history.
Frequently Asked Questions About PMS
What is PMS
PMS, or premenstrual syndrome, is a group of physical and emotional symptoms that occur after ovulation and before menstruation. Symptoms vary but commonly include bloating, breast tenderness, irritability, mood changes, fatigue, cravings, and sleep disruption.
What causes PMS
PMS is most often linked to hormonal imbalance and nervous system sensitivity during the luteal phase. Common contributors include low progesterone due to impaired ovulation, exaggerated estrogen effects, stress physiology disruption, blood sugar instability, inflammation, and impaired hormone clearance.
Is PMS normal
Mild cyclical changes can be common, but significant PMS that interferes with daily life is not something you should have to tolerate. Persistent symptoms are a signal that the cycle is under strain and deserve evaluation.
What is the difference between PMS and PMDD
PMDD is a more severe presentation of premenstrual symptoms, primarily involving intense mood symptoms that reliably occur in the luteal phase and improve shortly after menstruation begins. PMDD is often driven by heightened sensitivity to hormonal shifts rather than abnormal hormone levels on standard labs.
Can hormonal birth control fix PMS
Hormonal birth control may reduce PMS symptoms for some women by suppressing ovulation and flattening hormonal fluctuations. However, it typically does not address the underlying drivers of PMS such as ovulatory dysfunction, stress physiology, metabolic instability, or impaired hormone clearance.
Why does PMS get worse with age or stress
PMS often worsens when stress load increases, sleep quality declines, metabolic health shifts, or inflammation rises. These factors can suppress ovulation, reduce progesterone support, and increase nervous system reactivity to hormonal changes.
How long does it take to improve PMS naturally
Many women notice improvement within one to three cycles once key drivers are addressed, while longer-standing patterns may require several months of consistent support. Timelines depend on ovulation, stress physiology, metabolic resilience, gut health, and hormone clearance.
When should I seek help for PMS
Consider getting support if PMS symptoms are worsening, affecting work or relationships, disrupting sleep, causing severe mood symptoms, or making you feel unlike yourself for a predictable window each month.
Resources
Office on Women’s Health – Premenstrual Syndrome (PMS)
National Library of Medicine – Premenstrual syndrome and premenstrual dysphoric disorder
National Library of Medicine – Neuroendocrine mechanisms of premenstrual symptoms
Cleveland Clinic – Premenstrual Syndrome (PMS): Symptoms, Causes, and Treatment
National Library of Medicine – Progesterone and neurosteroid regulation of mood
National Library of Medicine – Estrogen, serotonin, and mood regulation across the menstrual cycle
BioMed Central – Premenstrual dysphoric disorder: evidence for neurobiological mechanisms
National Library of Medicine – Stress, cortisol, and ovulatory function
National Library of Medicine – Insulin resistance and reproductive hormone disruption
National Library of Medicine – Gut microbiota and estrogen metabolism
National Library of Medicine – Estrogen metabolism and clearance pathways
National Library of Medicine – Neuroendocrine-immune network and acupuncture mechanisms
Live Science – What is PMDD and how is it different from PMS
National Breast Cancer Foundation – Estrogen metabolism and hormone balance