Part 5 of PMS

Hormones, Weight Gain & Water Retention Explained

Discover > Natural Health > Part 5 of PMS: Hormones, Weight Gain & Water Retention Explained

Premenstrual syndrome (PMS) represents a range of physical and emotional symptoms that many women experience in the days leading up to menstruation. Among the myriad of symptoms associated with PMS, weight gain and water retention are two aspects that can greatly impact a woman's daily life. In this article, we'll delve into the fifth part of our PMS series, which focuses on the complex relationship between hormones, weight gain, and water retention during the menstrual cycle.

The key players in PMS symptoms are hormones, specifically estrogen and progesterone. These hormones are essential for regulating various processes within the body; however, their fluctuating levels throughout the menstrual cycle can have unintended consequences. As estrogen and progesterone levels fluctuate, they may cause the body to retain water, leading to feelings of bloating and weight gain. This can be particularly frustrating for women trying to maintain a healthy lifestyle, as they may see temporary increases in their weight despite careful diet and exercise management.

Understanding the connection between PMS, hormones, weight gain, and water retention is crucial for women looking to manage these symptoms effectively, especially when considering factors such as dysphoric disorder and other health conditions. Hormonal fluctuations can contribute to premenstrual symptoms, including mood symptoms and behavioral symptoms. For those with dysphoric disorder, the risk factors may exacerbate severe symptoms during this time.

Additionally, factors like salty foods (What wine goes well with salty foods?) and excess water weight can play a role in the overall experience. Medical history, including mood disorders, can further influence how individuals respond to these hormonal shifts. Exploring the impact of sodium levels on blood vessels is essential in comprehending the physiological aspects of these symptoms. In the following sections, we will delve into the science behind hormonal fluctuations, considering how these elements may contribute to the manifestation of symptoms, and provide practical tips on managing discomfort throughout the menstrual cycle.

Understanding PMS and Its Symptoms

Defining Premenstrual Syndrome

Premenstrual Syndrome (PMS) is a collection of physical and emotional symptoms that women experience in the days leading up to their menstrual period. It is caused by hormonal changes in the body and can affect women's daily life. The severity and duration of symptoms vary among individuals, with some women experiencing mild symptoms while others face more severe and disabling ones.

These symptoms, linked to hormonal fluctuations, vary widely among individuals. Common physical manifestations include breast swelling and breast pain, while affective symptoms may include mood swings and depressed mood. Keeping a daily symptom diary can be a helpful tool for tracking and understanding the patterns of these symptoms. For some, PMS can become a chronic condition, impacting overall well-being and daily life.

While lifestyle adjustments, such as managing body weight and incorporating evening primrose oil, may provide relief, severe cases may require medical attention. Healthcare providers can offer guidance on effective strategies and, if necessary, hormonal treatments to alleviate symptoms such as abdominal pain and other menstrual symptoms. It's essential for individuals experiencing significant disruptions to seek support and explore personalized approaches for managing the multifaceted aspects of premenstrual syndrome, including its potential links to mental disorders.

Typical Symptoms of PMS

There are numerous symptoms associated with PMS, and they can be different for each woman. Some of the most commonly observed symptoms include:

  • Bloating: A sensation of increased fullness and pressure in the abdomen, often due to water retention. Can lead to a temporary weight gain.

  • Cramps: Painful contractions of the uterus, which can range from mild to severe, occurring even before the onset of menstruation.

  • Irritability: A heightened tendency to become annoyed or upset quickly, which can trigger or worsen conflicts with others.

  • Mood swings: Emotional changes marked by periods of sadness, anger, or anxiety, making it difficult for a woman to maintain a stable mood.

  • Fatigue: A sense of tiredness and lack of energy that can interfere with daily activities.

In addition to these common symptoms, PMS can also encompass a variety of other physical and emotional manifestations. While not an exhaustive list, the table below summarizes some additional symptoms that women may experience during PMS:

  • Physical Symptoms:

    • Headaches

    • Breast tenderness

    • Food cravings

    • Acne

  • Emotional Symptoms:

    • Depression

    • Anxiety

    • Tearfulness

    • Difficulty concentrating

Women need to be aware of their symptoms and recognize the patterns. Identifying the presence of PMS can help women better manage their symptoms and seek necessary support from medical professionals.

Hormonal Changes and PMS

Estrogen and Progesterone Dynamics

During a woman's menstrual cycle, hormonal changes play a significant role in the development of Premenstrual Syndrome (PMS). The two key hormones involved are estrogen and progesterone. These hormones fluctuate throughout the menstrual cycle, causing various physical and emotional symptoms.

In the first half of the cycle, estrogen levels rise, reaching their peak just before ovulation. Then, during the second half of the cycle, estrogen levels decline while progesterone levels increase. It is believed that these hormonal fluctuations contribute to the development and intensity of PMS symptoms.

To illustrate the hormonal changes during the menstrual cycle, here is a simple table:

  • Menstruation

    • Estrogen: Low

    • Progesterone: Low

  • Pre-ovulation

    • Estrogen: Rising

    • Progesterone: Low

  • Ovulation

    • Estrogen: High

    • Progesterone: Low

  • Post-ovulation

    • Estrogen: Declining

    • Progesterone: Rising

How Hormones Affect Weight and Water Retention

Weight gain and water retention are common PMS symptoms, and they can be attributed to the hormonal changes mentioned earlier. These are a few ways in which estrogen and progesterone affect weight and water retention:

  • Estrogen: High levels of estrogen may lead to fluid retention. This is because estrogen affects the balance of electrolytes in the body, causing water to be retained.

  • Progesterone: Although progesterone has a diuretic effect, high levels can cause fluid retention due to its influence on the aldosterone system, a hormone that controls the balance of electrolytes.

Moreover, these hormonal changes can also cause fluctuations in blood sugar levels and affect appetite. In some cases, women may experience cravings for carbohydrate-rich or high-sugar foods during PMS. The consumption of these foods can lead to increased water retention and weight gain.

In summary, hormonal fluctuations driven by estrogen and progesterone during the menstrual cycle can influence PMS symptoms, including weight gain and water retention. The complex interplay between these hormones can trigger physical and emotional changes that women experience throughout their cycles.

Weight Gain Factors in PMS

Role of Diet and Salt Intake

During the premenstrual period, many women experience weight gain due in part to changes in their diet. It is not uncommon for cravings to increase, leading to the consumption of more high-calorie and high-sodium foods. This can cause the body to retain more fluids, leading to feelings of bloating and discomfort. It's important to note that this fluid retention can impact blood flow and overall well-being.

To alleviate these symptoms, individuals may consider incorporating dietary supplements or mineral supplements, ensuring they stay adequately hydrated by drinking plenty of water. In cases of severe premenstrual syndrome where symptoms extend beyond typical discomfort, seeking medical attention is crucial. Shortness of breath or any unusual symptoms should not be ignored, as they may be indicative of underlying issues that can affect the levels of hormones in the human body.

Additionally, individuals with anxiety disorders or depressive disorders may find that managing these conditions can positively impact the quality of life during the premenstrual period. Taking a holistic approach, addressing both dietary habits and mental health, can contribute to a more balanced and comfortable experience during this phase of the menstrual cycle.

It is recommended that women reduce their salt intake during this time. Aiming for a balanced diet with an emphasis on whole grains, fruits, vegetables, lean protein, and low-fat dairy can be beneficial. Additionally, it is essential to maintain regular hydration to assist in regulating fluid balance.

  • Reduce salt intake

  • Consume a balanced diet

  • Focus on whole grains, fruits, vegetables, lean protein, and low-fat dairy

  • Stay hydrated

Impact of Hormones on Metabolic Rate

The hormonal fluctuations experienced during PMS can also impact a woman's metabolic rate. Changes in the levels of estrogen and progesterone can cause the resting metabolic rate (RMR) to fluctuate, leading to a temporary increase in weight. Estrogen, when elevated, tends to increase RMR, while increased progesterone has a slowing effect.

  • Estrogen

    • Effect on RMR: Increases RMR

  • Progesterone

    • Effect on RMR: Slows RMR

It is important to be aware of these hormonal changes and how they might affect an individual's weight during the premenstrual period. Adjusting diet and exercise habits to accommodate fluctuations may help manage weight gain, but it is crucial to remember that these changes are temporary and typically resolve once menstruation begins.

Adapting exercise routines by incorporating more light to moderate cardiovascular exercise or engaging in stress-reducing activities like yoga can help offset the effects of hormonal fluctuations on weight gain. Providing your body with the nutrients it needs and engaging in regular physical activity can help in managing weight gain during PMS.

  • Be aware of hormonal changes

  • Adjust diet and exercise habits

  • Incorporate light to moderate cardio exercises or stress-reducing activities

Dealing with Water Retention

Identifying Causes of Fluid Retention

To deal with water retention effectively, it is important to identify the underlying cause. Common reasons for fluid retention include hormonal fluctuations, high sodium intake, and certain medical conditions. Making a few lifestyle changes can help alleviate symptoms:

  • Reduce salt intake: Consuming less sodium helps the body to retain less fluid.

  • Exercise regularly: Physical activity promotes circulation and reduces inflammation, which may contribute to bloating.

  • Stay hydrated: Drinking an adequate amount of water helps the body maintain proper fluid balance and reduces the chances of water retention.

Effective Diuretics and Supplements

Using diuretics and supplements can further help in reducing water retention. Here are some natural diuretics and supplements which may aid in alleviating the symptoms:

  1. Dandelion: A natural diuretic, dandelion helps the body eliminate excess fluid and reduce bloating.

  2. Green tea: Rich in antioxidants, green tea can also assist in the removal of excess water from the body.

  3. Magnesium: Magnesium supplements can alleviate fluid retention caused by hormonal imbalances, especially during PMS.

  4. Potassium: This essential mineral helps regulate fluid balance in the body and supports kidney function.

Dealing with water retention requires identifying the root cause and adjusting lifestyle habits accordingly. Including effective diuretics and supplements such as dandelion, green tea, magnesium, and potassium in your diet may also help alleviate symptoms.

The Influence of Diet and Nutrition

Understanding the impact of diet and nutrition on premenstrual syndrome (PMS) is crucial for women seeking holistic approaches to manage symptoms during their menstrual phase. From herbal remedies to addressing fluid buildup and abdominal pain, the relationship between dietary choices and menstrual symptoms is multifaceted. Water weight gain, often associated with PMS, can be influenced by lifestyle factors, and recognizing the connection between dietary habits and symptoms in women is essential.

Stress hormones play a role in exacerbating symptoms, and their interaction with psychiatric disorders, such as chronic fatigue syndrome, adds another layer to the complexity of managing PMS. Throughout this exploration, we'll delve into how herbal remedies, lifestyle adjustments, and insights from your health care provider can contribute to alleviating symptoms and enhancing well-being during the challenging days of treatment. Join us as we navigate the intricate interplay of nutrition, fluid dynamics, and holistic health in addressing the diverse facets of PMS.

Magnesium-rich foods and PMS

Magnesium plays a crucial role in our overall health, and its intake has been linked to a reduction in PMS symptoms. This vital mineral helps in the regulation of serotonin levels, which are associated with mood regulation. A magnesium deficiency can lead to irritability, mood swings, and even depression. Foods high in magnesium include:

  • Dark leafy greens (e.g., spinach, kale)

  • Nuts and seeds (e.g., almonds, pumpkin seeds)

  • Legumes (e.g., beans, lentils)

  • Whole grains (e.g., quinoa, brown rice)

  • Dark chocolate

Incorporating these magnesium-rich foods into your diet can help alleviate PMS symptoms and maintain a healthy hormone balance.

Managing Sugar and Carbohydrate Intake

During the luteal phase of the menstrual cycle, some women experience intense cravings for sugary and carbohydrate-rich foods. These cravings can lead to increased calorie consumption, weight gain, and water retention. To minimize these effects, focus on consuming complex carbohydrates and limiting the intake of simple sugars.

Complex carbohydrates are found in foods such as:

  • Whole grains (e.g., brown rice, whole wheat bread)

  • Fruits and vegetables (e.g., apples, peas)

  • Legumes (e.g., black beans, chickpeas)

These foods provide a steady source of energy and help regulate blood sugar levels, which can reduce cravings and mood swings associated with PMS.

In contrast, simple sugars —such as those found in candy, soda, and processed snacks— can cause rapid spikes and crashes in blood sugar levels, leading to increased cravings and mood instability. Limiting the intake of these types of foods can help improve PMS symptoms and contribute to a more balanced nutrition profile.

By paying attention to the type and quality of foods consumed, women can reduce the severity of PMS symptoms, manage weight gain, and maintain proper hormonal balance. Incorporating magnesium-rich foods and focusing on complex carbohydrates can significantly improve the overall experience during this sometimes challenging phase of the menstrual cycle.

Role of Exercise in Alleviating PMS

Regular exercise can play a significant role in alleviating symptoms of Premenstrual Syndrome (PMS) like weight gain and water retention during the menstrual phase. Incorporating different physical activities into everyday routines can help reduce the severity of symptoms and improve overall mood throughout the challenging days of treatment.

This section will delve into the benefits of aerobic exercise as well as yoga and meditation, exploring how these activities serve not only as effective tools for managing physical symptoms but also as stress relievers during the entire menstrual phase. Whether it's engaging in cardiovascular exercises or embracing the calming practices of yoga and meditation, incorporating these activities into your routine can contribute to a more balanced and comfortable experience throughout the days of treatment for PMS.

Aerobic Exercise Benefits

Aerobic exercise is a type of physical activity that increases heart rate and improves the body's oxygen consumption. Some examples of aerobic exercises include:

  • Brisk walking: A 30-minute walk at a moderate pace can help elevate mood and alleviate stress.

  • Cycling: Low-impact cycling can help reduce water retention and shed excess weight caused by PMS.

  • Swimming: An excellent form of low-impact aerobic exercise, swimming assists in weight loss and muscle tone improvement.

Regular aerobic exercise has been shown to enhance mood and reduce irritability and anxiety in individuals experiencing PMS. Additionally, aerobic exercises aid in lowering stress levels and improving sleep quality. By incorporating aerobic activities into a daily routine, one can alleviate PMS symptoms more effectively.

Yoga and Meditation as Stress Relievers

Yoga and meditation are two powerful tools for managing stress during PMS. Their practice involves gentle stretches, deep breathing exercises, and mental focus. A few popular Yoga poses that can assist in PMS relief are:

  1. Child's Pose (Balasana): Helps relieve tension in the lower back, hips, and thighs.

  2. Cat-Cow Stretch (Marjaryasana-Bitilasana): Increases spinal flexibility and relieves back tension.

  3. Bridge Pose (Setu Bandha Sarvangasana): Stretches the chest, neck, and spine while reducing anxiety and fatigue.

Meditation is a practice that allows the mind to focus on a single thought, such as the breath or a mantra. Practicing meditation regularly can help manage PMS by reducing anxiety, lowering stress levels, and improving sleep quality. A few effective meditation techniques for stress relief include:

  • Mindfulness Meditation: Focusing on the present moment while acknowledging thoughts and emotions without judgment.

  • Progressive Muscle Relaxation: Gradually tensing and relaxing different muscle groups to release physical tension.

  • Breathing Exercises: Deep, controlled breaths to promote relaxation of the body and mind.

The combination of yoga and meditation can be advantageous in managing PMS symptoms by fostering a calm and balanced mind-body connection. Incorporating these practices into daily life can assist in alleviating the emotional and physical upheaval that often accompanies PMS.

The Connection Between Age and PMS

PMS Through Different Life Stages

Premenstrual syndrome (PMS) affects women differently at various stages of life. In general, younger women may experience more intense symptoms, while older women may have more moderate symptoms. However, the severity of PMS can vary greatly among individuals.

  • Adolescence: During puberty, hormonal changes are significant, and PMS may be more severe for some girls. It may take a few years for the body to find a hormonal balance, and PMS symptoms may improve over time.

  • Young adulthood: In their 20s and early 30s, women may begin to notice patterns in their PMS symptoms. They may also find strategies to manage them, such as lifestyle changes or medications.

  • Late adulthood: As women enter their 40s, they may experience more intense PMS symptoms due to fluctuating hormone levels and the approach of menopause.

Pre-menopause and Menopause Considerations

Age plays a crucial role in the experiences of premenopausal and menopausal women. The hormonal changes that occur during these life stages can lead to a variety of symptoms.

  1. Pre-menopause: This stage occurs in the years leading up to menopause, and is characterized by fluctuations in hormone levels. Some women experience perimenopause, a transitional phase marked by irregular periods, hot flashes, and mood changes, as well as PMS symptoms.

  2. Menopause: Menopause is the time when a woman permanently stops menstruating, usually around the age of 45-55. During this stage, estrogen and progesterone levels decrease, which can trigger symptoms similar to PMS, such as mood swings, irritability, and fatigue. However, these symptoms typically subside as the body adjusts to the new hormone levels.

The age of a woman can significantly influence her experience of PMS symptoms. Awareness of these changes and consulting with a medical professional can help manage and cope with the symptoms.

Emotional and Psychological Aspects of PMS

Coping with Mood Swings and Irritability

Mood swings and irritability are common symptoms of PMS, affecting many women in the days leading up to their menstrual cycle. It is crucial to develop coping strategies to manage these emotional shifts. Some effective methods include:

  • Regular exercise: Physical activity has been shown to release endorphins, which can help alleviate mood swings and irritability.

  • Mindfulness techniques: Practices like deep breathing, meditation, and progressive muscle relaxation can help focus the mind and regulate emotions.

  • Maintaining a healthy diet: Consuming a balanced diet with plenty of fruits, vegetables, and lean protein can provide the body with essential nutrients to support emotional well-being.

  • Getting sufficient sleep: Prioritizing sleep can help the body regulate hormones, reducing the likelihood of severe mood swings.

Addressing Anxiety and Depression

Anxiety and depression are also common psychological manifestations of PMS. It's essential to acknowledge these emotions and seek appropriate support. Some approaches to managing anxiety and depression during PMS include:

  • Cognitive-behavioral therapy (CBT): CBT is an evidence-based therapy that helps identify and address negative thought patterns that contribute to anxiety and depression.

  • Support groups: Connecting with others who experience similar emotional challenges during PMS can provide a sense of understanding and support.

  • Medication: In some cases, healthcare providers may recommend medications like antidepressants or anxiolytics to help manage symptoms of anxiety and depression during PMS.

To effectively manage the physical and emotional symptoms of PMS, a variety of strategies can be employed, each with its own methods and benefits:

  • Method: Regular exercise

    • Description: Physical activity 3-5 times a week for 30-60 minutes

    • Benefits: Releases endorphins, promotes mood balance

  • Method: Mindfulness techniques

    • Description: Deep breathing, meditation, progressive muscle relaxation

    • Benefits: Focuses the mind, regulates emotions

  • Method: Healthy diet

    • Description: Balanced consumption of fruits, vegetables, lean protein

    • Benefits: Provides essential nutrients

  • Method: Sufficient sleep

    • Description: Prioritize 7-9 hours of sleep per night

    • Benefits: Regulates hormones, reduces mood swings

  • Method: CBT (Cognitive Behavioral Therapy)

    • Description: Evidence-based therapy with a trained therapist

    • Benefits: Addresses negative thought patterns

  • Method: Support groups

    • Description: Connect with peers who face similar PMS-related emotional challenges

    • Benefits: Provides understanding, emotional support

  • Method: Medication

    • Description: Consultation with a healthcare provider for appropriate prescriptions

    • Benefits: Helps manage severe anxiety, depression

Incorporating these strategies and seeking support where needed can help women navigate the emotional and psychological aspects of PMS while fostering a sense of resilience and well-being.

Medical Treatments and Hormone Therapies

When it comes to addressing hormonal imbalances related to PMS, weight gain, and water retention, medical treatments, and hormone therapies are available options. This section will explore two primary therapies: the usage of birth control pills and the pros and cons of hormone replacement therapy.

Usage of Birth Control Pills

Birth control pills, also called oral contraceptives, can effectively treat hormonal imbalances. They contain synthetic hormones, such as progestin and estrogen, which regulate menstrual cycles and alleviate various PMS symptoms.

Benefits of using birth control pills include:

  • Reduced symptoms: Lighter periods, decreased period pain, and diminished mood swings.

  • Regulation of menstrual cycle: Predictable cycles with consistent timing.

  • Improved skin: Some pills may help reduce acne.

However, there are potential side effects as well:

  • Increased risk of blood clots, heart attack, and stroke for certain individuals.

  • Nausea, headaches, and breast tenderness.

  • Potential weight gain due to water retention.

Consulting with medical professionals is crucial before starting any birth control pills to ensure the right prescription and minimize side effects.

Hormone Replacement Therapy Pros and Cons

Hormone replacement therapy (HRT) is another treatment option for addressing hormonal imbalances, primarily related to menopause. However, its application for PMS symptoms, weight gain, and water retention is a less common, yet viable option.

Pros of hormone replacement therapy include:

  1. Alleviation of symptoms: Relief from hot flashes, night sweats, and vaginal dryness.

  2. Protection against bone loss: Helps reduce the risk of osteoporosis.

  3. Reduced risk of colon cancer: HRT is associated with a lower risk of developing this type of cancer.

On the other hand, there are cons to consider:

  1. Increased risk of breast cancer: Especially when using a combination of estrogen and progestin.

  2. Potential blood clots and stroke risks: Particularly when using oral estrogen.

  3. Potential heart disease risk: For women who start HRT more than 10 years after menopause.

It's essential to seek professional medical advice before committing to hormone replacement therapy to weigh the benefits and risks for your specific situation and determine the most appropriate course of action.

Prevention and Management Strategies

Lifestyle Modifications

Implementing specific lifestyle changes can help prevent and manage weight gain and water retention caused by hormonal fluctuations during PMS.

  1. Maintain a balanced diet: Opt for whole, unprocessed foods, such as fruits, vegetables, whole grains, and lean proteins. Limit salt intake to reduce water retention.

  2. Stay hydrated: Drink sufficient amounts of water throughout the day.

  3. Exercise regularly: Engage in moderate-intensity physical activities, such as walking, swimming, or yoga, to help manage weight and mood.

  4. Get enough sleep: Aim for 7-9 hours of quality sleep per night to support overall health.

  5. Manage stress: Utilize relaxation techniques, such as deep breathing, meditation, or mindfulness practices, to reduce stress-related hormonal imbalances.

Symptom Tracking and Physician Consultation

Symptom tracking can help individuals be more aware of their PMS-related symptoms while facilitating clearer communication with healthcare professionals. Maintaining a symptom diary that records the following aspects can be useful:

  • The severity and duration of symptoms (e.g., weight gain, bloating, mood changes)

  • Dietary habits (e.g., salt intake, unprocessed food consumption)

  • Exercise frequencies and types

  • Stress levels and coping mechanisms

  • Sleep patterns and quality

Regular physician consultations can help ensure appropriate management of PMS symptoms. Be prepared to discuss your symptom diary findings with your healthcare provider, who may recommend additional lifestyle modifications, treatments, or therapies, depending on the severity of the symptoms and individual needs. In some cases, they may prescribe medication or supplements to help manage hormonal imbalances related to PMS. Remember, timely consultation and open communication with your healthcare provider are essential in achieving optimal symptom management.

Advancements in PMS Research and Perspectives

Recent Scientific Findings

Over the past few years, research in the field of premenstrual syndrome (PMS) has expanded. This includes advances in understanding the connection between hormones, weight gain, and water retention. For instance, a study conducted by the Mayo Clinic highlighted the importance of hormonal fluctuations in PMS symptoms, such as bloating and weight gain.

In addition to hormonal changes, recent discoveries have unveiled the role of genetics in PMS susceptibility. Some genes have been linked to an increased risk of experiencing more severe PMS symptoms. These findings have contributed to a better understanding of PMS and its effect on weight gain and water retention.

Expert Opinions and Guidelines

Experts in the field have provided valuable insights and developed guidelines to help manage PMS symptoms. The American College of Obstetricians and Gynecologists (ACOG) offers several recommendations:

  1. Monitoring the menstrual cycle to identify and predict PMS symptoms

  2. Engaging in regular exercise to alleviate bloating and weight gain

  3. Consuming a balanced diet, including foods rich in complex carbohydrates and limiting salt intake

  4. Implementing stress reduction techniques, such as deep breathing exercises or meditation

A table summarizing some of these guidelines can be seen below:

  • Menstrual cycle monitoring

    • Recommendation: Track symptoms to identify patterns and triggers

  • Exercise

    • Recommendation: Engage in regular physical activity

  • Diet

    • Recommendation: Consume a balanced diet and limit salt intake

  • Stress reduction techniques

    • Recommendation: Practice deep breathing, meditation, or yoga

Researchers and experts continuously strive to find innovative approaches to understanding and managing PMS. With ongoing advancements in research, individuals experiencing PMS can find support and resources to help them cope with symptoms like weight gain and water retention.

Footnotes

  1. Mayo Clinic. (2019). Premenstrual syndrome (PMS). Retrieved from https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780 ↩

  2. American College of Obstetricians and Gynecologists. (2021). Premenstrual Syndrome (PMS). Retrieved from https://www.acog.org/womens-health/faqs/premenstrual-syndrome ↩

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