Fighting Food Cravings and PMS

Do you have advice to manage PMS food cravings?

— Dee

[Have a question about women’s health? Ask Dr. Gunter yourself.]

Short Take

Food cravings can be experienced as part of PMS (premenstrual syndrome). There are no good studies specifically addressing food cravings, but aerobic exercise, cognitive behavioral therapy, calcium supplementation, oral contraceptives, spironolactone and some antidepressants are all potential therapies for PMS (and its symptoms).

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PMS consists of physical and/or emotional symptoms that occur each month in relation to the menstrual cycle. The symptoms occur only during the luteal phase, which begins after ovulation, most often in the week before the onset of bleeding. Symptoms should stop shortly after the period starts and not return until after the next ovulation.

PMS can be a confusing diagnosis to pinpoint because hormonal changes of the mensural cycle can worsen symptoms from other medical conditions and be mistaken for PMS, so a calendar documenting symptoms for two months is very helpful.

Symptoms of PMS include, but are not limited to:

Food cravings

Bloating

Breast tenderness

Joint pain

Fatigue

Mood swings

Irritability

Depression

Almost 85 percent of women have at least one of these symptoms, but most report no major impact on their daily life. When symptoms are moderate, as is the case for 12 to 20 percent of women, the diagnosis is PMS. In extreme cases, premenstrual mood dysphoria, or PMMD, is diagnosed when PMS symptoms cause significant distress or interfere with work, school, social activities or relationships. Approximately 3 to 5 percent of women have PMDD.

Understanding the Cause

The cause of PMS and PMDD is not known. While the cyclic nature of the condition and the disappearance with menopause indicates reproductive hormones are involved, levels of these hormones are the same among women with and without PMS. Some women may be more sensitive to the normal fluctuation of hormones throughout the menstrual cycle. Levels of certain neurotransmitters are altered in women with PMS, which may play a role in symptoms. Genetics may also be involved.

Food cravings caused by PMS are not well understood. Appetite and calorie intake is typically slightly higher for women during the luteal phase of the menstrual cycle. The hormone progesterone, which increases after ovulation, is believed to affect appetite. Food cravings — specifically for chocolate, sweet or salty food — are associated with the luteal phase. Whether PMS-related food cravings are caused by an increased awareness of typical hormonal fluctuations in appetite or a true increase in cravings above the baseline is not known.

Treating the Symptoms

Studies looking at treatment of PMS typically address multiple symptoms, so making specific recommendations for food cravings isn’t possible. Therapies can be tried to see how they improve food cravings, so maintaining a symptom log while you try various treatments may be helpful to gauge their effectiveness. I suggest you try each intervention for at least two months (if tolerated) before passing judgment on it.

Dietary Changes

Many treatment guidelines for PMS recommend a diet high in complex carbohydrates and fiber and low in sugar to treat symptoms, however, this recommendation is not based on robust data. A good quality study from 2018 suggests no link between carbohydrate consumption and PMS. Regardless, a diet high in complex carbohydrates and fiber and low in refined sugar is generally beneficial for non-PMS-related health reasons. Carbohydrates are a source of energy, and complex carbohydrates, such as whole grains, beans and vegetables, have more vitamins, minerals, fiber and phytonutrients than simple carbohydrates, such as white bread, soda and highly processed foods. A high fiber diet (containing about 25 grams of fiber a day) has been shown to have many health benefits, including lowering your risk of diabetes, heart disease and preventing constipation. (Being constipated is typically not a mood enhancer!)

Some studies have linked alcohol with PMS — whether alcohol is a cause of the condition or worsens symptoms is unknown. Alcohol can have an impact on estrogen levels and neurotransmitters. It can also negatively affect sleep, cause gastritis (a painful irritation of the stomach) and impact mood. These effects could worsen some symptoms of PMS. With this in mind, cutting back on alcohol or stopping altogether during the luteal phase is a reasonable strategy.

Many guidelines suggest eliminating caffeine to manage PMS symptoms, but this is based on conflicting and generally lower quality data. A good quality study suggests no link between caffeine or coffee and PMS. (I was very relieved to read this study, since telling people to give up coffee is hard!)

What to Try

For mild-to-moderate PMS the following therapies can be considered:

Regular aerobic exercise: 30 minutes a day on most days.

A calcium supplement: 500-1,200 mg a day. Of all the supplements studied for PMS, calcium has the most evidence to support its use.

Stopping smoking: You should anyway, right?

Improved sleep hygiene: Insufficient sleep may worsen fatigue and other symptoms of PMS.

Reducing or eliminating alcohol during the luteal phase

Cognitive behavioral therapy: A form of talk therapy that focuses on thoughts, feelings and behavior. This doesn’t mean your symptoms are in your head, rather, there is a very strong mind-body connection and that can be harnessed to reduce symptoms and suffering.

Chasteberry (Vitex agnus castus): This herbal supplement has been linked to improved PMS symptoms.

Vitamin B6: This supplement has also been linked to improved PMS symptoms.

Please consult with your doctor before starting any new vitamin or mineral supplement.

For moderate to severe PMS the following prescription medications can be considered:

Spironolactone: This is a diuretic (often called a water pill), which can help some PMS symptoms, such as irritability, feeling of swelling and food cravings.

Oral contraceptive pills: One option is to take the pill every single day and skip the placebo pills, hence skipping a period altogether.

Antidepressants: Drugs called selective serotonin reuptake inhibitors are typically the first choice for treating PMS. There is much evidence supporting taking fluoxetine (trade name Prozac), for PMS symptoms. It can be taken every day or just during the luteal phase (so approximately two weeks a month). Some women prefer this latter dosing option as they are taking the medication only when they need it, although it may be slightly less effective in treating PMS symptoms.

Dr. Jen Gunter, often called Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.

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