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Premenstrual Syndrome (PMS), and Integrative Mental Health by Les Cole, MD & Delene Cole, LMFT

Do you have PMS?

Pre-Menstrual Syndrome (PMS) affects up to 75% of women. 20 – 40% of women have seen a medical doctor (often Ob-Gyn) for PMS symptoms. But if you have seen an alternative practitioner, these numbers are probably low.


The symptoms of PMS are many and varied, generally begin/occur between 1 week before your period to a few days after and include:


  • Abdominal bloating
  • Acne
  • Angry outbursts
  • Anxiety
  • Appetite changes
  • Asthma attacks
  • Avoidance of social activities
  • Backache
  • Bladder irritation
  • Bleeding gums
  • Breast swelling & tenderness
  • Bruising
  • Clumsiness
  • Confusion
  • Conjunctivitis
  • Constipation
  • Cramps
  • Cravings – salt/sweet
  • Crying spells
  • Decreased hearing
  • Decreased productivity
  • Decreased sex drive
  • Depression
  • Distractibility
  • Dizziness
  • Drowsiness
  • Eye pain
  • Facial swelling
  • Fatigue
  • Fear of going out alone
  • Fear of losing control
  • Finger swelling
  • Food sensitivity
  • Forgetfulness
  • Aches & pains
  • Headache
  • Herpetic outbreak
  • Hives or rash
  • Hot flashes
  • Alcohol sensitivity
  • Sensitivity to light & noise
  • Inefficiency
  • Indecision
  • Insomnia
  • Irritability
  • Joint pains
  • Leg cramps
  • Leg swelling
  • Mood swings
  • Nausea
  • Palpitations
  • Panic Attacks
  • Poor coordination
  • Poor judgment
  • Poor memory
  • Poor vision
  • Restlessness
  • Ringing in ears
  • Runny nose
  • Seizures
  • Sinusitis
  • Sore throat
  • Spots in vision
  • Suspiciousness
  • Tearfulness
  • Tension
  • Tingling in hands & feet
  • Tremors
  • Visual changes
  • Vomiting
  • Weight gain


If you have any of these symptoms during this time period, you likely have PMS. PMS may have primarily physical symptoms, psychological symptoms or both. When severe, PMS can be confused with PMDD. And some patients may actually have both. Click on PMDD to read more about that condition.


Many times the following PMS symptoms are diagnosed as Psychological or Psychiatric problems and are treated with Psychiatric medication like anti-depressants or anti-anxiety medications, and though these may work, they may give only partial relief.


  • Anxiety disorder
  • Depression
  • Seizure disorder
  • Panic attacks
  • Agoraphobia
  • Eating disorders
  • Various personality disorders


If you have PMS, the cause is an imbalance in your estrogen, your progesterone or both in your cycle. The use of birth control pills (BCPs) will often but not always help these symptoms which is why this is usually the first choice of Ob-Gyn doctors. Before starting a BCP read the risks, especially longer acting pills, injections or implants.


Here’s how it works.

Following menarche (when you start menstruating or having periods) you begin producing estrogen throughout your entire cycle. During the first half of your cycle your estrogen stimulates the growth of blood vessels in your uterine lining, the thickening of your uterine muscular wall and the growth of breast glands. This is in preparation for ovulation and the possibility of implantation of a fertilized egg. Once ovulation has occurred, the follicle where the egg developed in your ovary is called the corpus luteum and begins to secrete progesterone.


Progesterone has several functions during the 2nd half of your cycle. First, it, along with your estrogen maintains the uterine lining, uterine wall thickness and breast tissue development that occurred in the 1st half of your cycle (before ovulation). Secondly, your progesterone prevents estrogen from stimulating any further uterine lining growth, uterine wall thickening and breast tissue development. Thirdly, some of your progesterone is converted to allopregnanolone (a neurohormone) that crosses your blood brain barrier and stimulates your GABA receptors that help keep you calm, cool & collected.


What can go wrong?

If you don’t produce enough progesterone, estrogen can continue to stimulate the growth of your uterine lining & wall and breast tissue. This is called Estrogen Dominance and causes physical symptoms. As your breast tissue continues to grow, they often become tender near the end of your cycle, just before your period begins and then the tenderness decreases once your period has started. The thickened lining of your uterus causes heavy periods with excessive bleeding, which sometimes can lead to iron deficiency anemia. Finally, the thickened uterine wall can cause crampy, painful periods.


Also with low progesterone production, your levels of allopregnanolone are low, so your GABA receptors in your brain aren’t adequately stimulated to keep you calm, cool & collected. This gives rise to sadness, irritability, clouded thinking, anger, etc. – emotional dysregulation.


At St. Petersburg Health & Wellness we can easily measure your hormones with specialty salivary or urinary hormone tests. Balancing your hormones is then relatively simple to do. Once your hormones are balanced, your PMS symptoms will improve or disappear. Of equal importance, having balanced hormones helps prevent you from the increased future risks of endometriosis, fibroids, ovarian cysts, infertility, miscarriages and breast cancer, which are partially due to hormonal imbalances. At St. Petersburg Health & Wellness, we get to the underlying problems. Call 727-202-6807 to make an appointment and to get better answers.


Les Cole, MD practices Functional, Anti-Aging, Integrative & Preventive Medicine and is certified by the American Academy of Anti-Aging Medicine in Functional, Anti-aging and Regenerative Medicine and by the American Board of Integrative and Holistic Medicine. Delene Cole, LMFT is a Marriage and Family & Integrative Mental Health Therapist with additional certifications in Hypnosis, Internal Family systems Therapy and Soul Collage. To learn more about PMS & PMDD and other topics to improve your Health and Wellness, visit, Like us on Facebook, or call St. Petersburg Health & Wellness for an appointment 727-202-6807.