Over 90% of women get some premenstrual symptoms leading up to their monthly period. Women in their 30s are most likely to have PMS, and some may experience symptoms so severe they interfere with the ability to perform daily activities and responsibilities. Conventional premenstrual syndrome (PMS) therapies include over-the-counter pain relievers, prescription hormonal birth control, and antidepressants. While these may be effective at masking symptoms, they are ineffective at correcting the root cause of PMS. This article will discuss what PMS is and the top functional medicine labs to regularly order for patients who suffer from it to help them achieve symptom-free menstrual cycles. (6) 

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What is Premenstrual Syndrome (PMS)?

Premenstrual syndrome (PMS) is a common condition that affects many women in their reproductive years. It refers to a combination of physical, emotional, and behavioral symptoms that occur in the days or weeks leading up to menstruation and typically resolve within a few days after the period starts.

PMS can be diagnosed in patients when symptoms present five days before their period for at least three consecutive menstrual cycles, resolve within four days after their period starts, and interfere with normal activities (6).

Physical Symptoms

• Breast tenderness or swelling
• Bloating and weight gain
• Headaches or migraines
• Fatigue and lethargy
• Muscle and joint pain
• Food cravings, often for sweet or salty foods
• Acne
• Constipation or diarrhea (7) 

Emotional and Behavioral Symptoms

• Mood swings
• Irritability, anger, and increased sensitivity to rejection or criticism
• Anxiety
• Depression or feelings of sadness
• Difficulty concentrating
• Insomnia (7) 

The severity and specific symptoms can vary between women. Some may experience mild symptoms that do not significantly impact their daily life, while others may have more severe symptoms that interfere with their work, relationships, and overall well-being. If the symptoms significantly disrupt daily activities or cause distress, it may be referred to as premenstrual dysphoric disorder (PMDD), a more severe form of PMS. (3) 

What Causes Premenstrual Syndrome (PMS)?

Although the exact cause of PMS is not fully understood, functional medicine offers insights into potential factors contributing to PMS symptoms.

Key causes of PMS from a functional medicine perspective include hormonal imbalances, such as changes in estrogen and progesterone levels during the menstrual cycle. Some research suggests that high estrogen is correlated with PMS severity, while other studies point to low progesterone as the culprit. (1, 7) 

Many factors play into healthy hormonal cycling. Impaired liver function, genetic variations, stress, nutritional deficiencies, intestinal dysbiosis, and exposure to endocrine-disrupting chemicals all impact hormone synthesis, metabolism, and detoxification - leading to hormonal imbalances. (1, 7) 

An imbalance in gut microbiota, called dysbiosis, and intestinal health can also influence neurotransmitter function and inflammation, contributing to mood swings and other PMS symptoms. Neurotransmitters are chemical messengers in the brain that are responsible for regulating mood, emotions, and other physiological functions. Fluctuations in hormones during the menstrual cycle can influence neurotransmitter levels and function, contributing to the emotional and psychological symptoms experienced during PMS. Neurotransmitter imbalances thought to be involved in PMS include low serotonin, gamma-aminobutyric acid (GABA), dopamine, and endorphins. (5) 

Why is it Important to Run Functional Medicine Labs Bi-Annually on Your PMS Patients?

The combination of lab testing, clinical evaluation, and patient-reported symptoms helps healthcare providers develop a comprehensive approach to managing PMS effectively. While it is important to realize that no lab tests can definitively diagnose PMS, regular lab testing can help confirm a clinical diagnosis by ruling out other conditions that may have similar symptoms, such as thyroid disorders. This ensures that patients receive the appropriate treatment for their specific condition.

Routine lab testing also helps to identify underlying factors contributing to PMS, monitor cyclical hormonal patterns, and track the effectiveness of treatment strategies over time. Lab results provide data points that offer a detailed view of each patient's health status, allowing healthcare providers to create and modify tailored treatment plans for an individual's needs.

Top Functional Medicine Labs to Run Bi-Annually on Your PMS Patients

Functional medicine tests provide an in-depth snapshot of the body's physiological and biochemical mechanisms contributing to PMS symptoms. Often providing a more detailed evaluation of hormone, neurotransmitter, and nutritional status than standard labs, ordering the following labs on a bi-annual basis can be helpful in the management of PMS.

Comprehensive Hormone Panel

A comprehensive female hormone panel measures the primary female sex hormones in serum to help detect and treat hormonal imbalances. However, because a single blood draw can easily miss hormonal fluctuations causing symptoms, a DUTCH Cycle Mapping test is a functional medicine alternative that utilizes daily urine samples throughout an entire menstrual cycle to more accurately detect estrogen-dominant and progesterone-deficient hormonal patterns.

Liver Panel

Healthy liver function is mandatory for healthy hormonal balance. Adrenal, sex, and thyroid hormones and environmental toxins that can contribute to hormonal imbalances are detoxified by the liver before being eliminated from the body.

Micronutrient Panel

Nutritional deficiencies can also play a role in PMS. Insufficient intake of essential vitamins and minerals like B vitamins, magnesium, calcium, vitamin D, and omega-3 fatty acids can affect hormone production and metabolism and the severity of PMS symptoms (1, 7). A micronutrient panel measures these nutrients and others to comprehensively screen for nutritional imbalances.

Neurotransmitter Panel

A neurotransmitter test measures neurotransmitters, their precursors, and their derivates to determine imbalances in neurotransmitter levels and help pinpoint where the imbalance stems from. 

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Summary

PMS is a common female health concern characterized by physical, emotional, and behavioral symptoms that occur in the days to weeks before starting a menstrual period. Regular lab testing can uncover underlying factors contributing to these unwelcome symptoms, helping to create tailored treatment plans that effectively restore healthy hormonal balance and symptom-free periods.