The Hormone Cafe

In this episode of The Hormone Café, Dr. Sarah Pederson, holistic OB-GYN at Vera Health and Fertility, dives deep into PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder). She explains why PMS is not normal, explores the root causes behind luteal-phase mood and physical symptoms, and outlines a comprehensive, holistic framework for treatment — from nutrition and lifestyle to supplements, hormone testing, and medical therapies.

In This Episode, You’ll Learn:

💡 What PMS and PMDD Actually Are

• PMS occurs during the luteal phase (after ovulation, before your period)
• Common symptoms: irritability, rage, mood swings, headaches, cramps, breast tenderness
• PMDD is a more severe form with debilitating mood symptoms that impair daily functioning
• PMS should not be normalized — symptoms almost always indicate an underlying imbalance

🩺 Root Causes of PMS & PMDD

• Blood sugar instability (increased insulin resistance during the luteal phase)
• Inflammation
• Hormonal imbalances (estrogen, progesterone, LH, FSH)
• Poor-quality or absent ovulation
• Gut and detox pathway dysfunction
• Chronic stress and elevated cortisol

🍽️ How to Eat During the Luteal Phase

• Your body needs more calories, rest, and nutrients after ovulation
• Aim for a 1:1 ratio of protein to carbohydrates
• Increase carbohydrates, but choose high-quality sources:
  • Seed breads
  • Protein pastas
  • Brown rice and wild rice
• Always pair carbohydrates with protein
• Avoid large amounts of sugar, which fuel inflammation and worsen mood symptoms

🥑 Anti-Inflammatory Foods That Reduce PMS Symptoms

• Omega-3–rich foods:
  • Fish (2–3x/week)
  • Chia seeds
  • Flax seeds
• Leafy greens for antioxidants:
  • Kale
  • Arugula
  • Spinach
• Turmeric for inflammation reduction (cook with it or add to drinks)

🧠 Why Blood Sugar Matters for Mood

• Blood sugar spikes increase inflammation
• Inflammation disrupts neurotransmitters in the brain
• This directly worsens irritability, rage, anxiety, and depression in the luteal phase
• Continuous glucose monitoring can be helpful during this phase

🧪 Hormone Testing for PMS & PMDD

• Test hormones during the luteal phase (typically ~7 days after ovulation)
• Check:
  • Estrogen
  • Progesterone
  • LH and FSH
• Consider testing on your worst symptom day if symptoms spike just before your period
• Mapping hormone patterns helps identify crashes, imbalances, and estrogen dominance

⚖️ Common Hormone Imbalances Linked to PMS

• Low progesterone
• High estrogen (estrogen dominance)
• Rapid estrogen drops before menstruation
• Anovulation (periods without ovulation)

🌿 Supplements Used for PMS & PMDD (Based on Labs)

• Vitex (chasteberry) to support hormone production
• Omega-3s (~1,000 mg daily if not eating enough fish)
• Magnesium for mood and muscle relaxation
• L-theanine and GABA for mood and anxiety support (taken at night)
• Adaptogens for stress-related PMS:
  • Ashwagandha
  • Rhodiola
• DIM or calcium d-glucarate for estrogen metabolism (only if estrogen is high)

⚠️ Important Note on Supplements
 Supplements should always be chosen based on your specific hormone profile.
Do not take estrogen-lowering supplements if estrogen is already low.

💊 Medical Treatment Options (When Needed)

• Bioidentical progesterone during the luteal phase for low progesterone
• Bioidentical estradiol for estrogen crashes or severe luteal symptoms
• “Bridge dosing” to prevent sudden hormone drops before your period
• SSRIs/SNRIs (e.g., sertraline/Zoloft):
  • Can be used as needed or only during the luteal phase
  • Do not require daily, long-term use in many cases

🏃 Lifestyle Factors That Matter in the Luteal Phase

• Adequate calories and protein to support hormone production
• Exercise to help metabolize hormones (can tolerate higher intensity if well-fueled)
• Daily bowel movements to support estrogen detoxification
• Stress reduction to lower cortisol and improve mood regulation

🧬 Real Patient Case Highlight
 A patient with severe rage and PMS symptoms was found to be:

• Not ovulating
• Estrogen dominant
• Insulin resistant
• After blood sugar regulation, cyclic progesterone, and nutrition changes, she resumed ovulation, normalized her luteal phase, and felt like herself again.

Key Takeaways:
PMS and PMDD are not normal and should not be dismissed.

Luteal-phase symptoms are signals of deeper hormonal, metabolic, or inflammatory issues.

Targeted nutrition, hormone testing, supplements, and — when needed — medical therapy can dramatically improve symptoms.

Feeling amazing every day is possible with the right support.