What Causes PMS? Understanding the Root Causes of Painful PMS Inflammation

What causes PMS symptoms? If you dread your period because of painful cramps, headaches, or hormonal migraines, you’re not alone. 

While these symptoms are incredibly common, they’re often a sign of underlying inflammation, and aren’t something women simply need to tolerate. This inflammation is driven largely by prostaglandins, hormone-like compounds involved in immune, inflammation, and tissue signaling. Let’s explore how prostaglandins influence PMS symptoms and what you can do to reduce inflammation and support a more manageable menstrual cycle.

 

Why PMS Symptoms Happen: The Role of Prostaglandins and Inflammation

Elevated prostaglandin activity contributes to many of the symptoms women experience around their menstrual cycle. Prostaglandins are immune signaling molecules that are derived from arachidonic acid, an omega-6 fatty acid, and are involved in inflammation, blood flow regulation, and uterine contractions. One of the most abundant prostaglandins, prostaglandin E2 (PGE2), plays a complex role by both initiating inflammation and helping resolve via anti-inflammatory activity.

The primary trigger for increased prostaglandin production is progesterone withdrawal in the late luteal phase. During most of the luteal phase, progesterone suppresses inflammatory pathways and helps keep prostaglandin levels in check. As progesterone levels fall shortly before the menstrual cycle begins, inflammatory signaling increases, enzymes involved in prostaglandin production become more active, and prostaglandin breakdown slows. Together, these changes produce a surge in prostaglandins around the start of the menstrual cycle that initiates the breakdown and shedding of the uterine lining.

While prostaglandins peak around menstruation and can contribute to severe menstrual cramping and hormonal migraines around menstruation, many PMS symptoms occur during the luteal phase beforehand. Ultimately, the degree of inflammation, as well as stress, nutrient deficiencies, and individual sensitivity to hormonal fluctuations all influence the severity of PMS symptoms.

 

Factors that Can Amplify PMS Symptoms 

#1. Elevated Baseline Inflammation

Although a rise in prostaglandins before and during menstruation is normal, underlying chronic inflammation can amplify this inflammatory cascade around menstruation and contribute to more severe PMS and menstrual symptoms. Several factors can increase baseline inflammatory activity and set the stage for an exaggerated prostaglandin surge.

Factors that can increase baseline prostaglandin levels include:

• The 4 main energy leaks:
  • • • Nutrient depletion (vitamin and mineral insufficiencies, low energy availability, blood sugar dysregulation)
      • Immune activation (high viral load, mold mycotoxin exposure)
      • Exercise stress (overtraining, under-recovery, cortisol and adrenal dysregulation)
      • Toxic burden (gut dysbiosis, environmental toxin exposure)
• Poor sleep
• Excess body fat and estrogen imbalance (adipose tissue promotes estrogen production and can amplify PMS-related inflammation)
• Sedentary lifestyle

 

#2. Chronic Stress and HPA Axis Dysregulation

Women with more severe PMS symptoms consistently report higher levels of stress. Chronic stress may not directly increase prostaglandins, but altered cortisol patterns and HPA axis dysfunction can promote systemic inflammation and increase sensitivity to hormonal changes, amplifying symptoms throughout the luteal phase and during menstruation. 

For example, chronic stress can impact progesterone production, which we know helps blunt inflammatory processes in the luteal phase. Without adequate progesterone post-ovulation, we miss out on these anti-inflammatory benefits leading up to menstruation and may be more susceptible to prostaglandin-driven inflammation during menstruation.

 

How to Lower Your Inflammatory Load and Improve PMS Symptoms

To effectively lower inflammation and improve PMS symptoms long term, we first need to address the underlying energy leaks driving chronic inflammation and elevated baseline prostaglandin levels. Take our free 2-minute quiz to identify your number one energy leak and uncover the next steps to begin resolving it. While addressing these deeper root causes, targeted nutrition strategies can also help calm the acute inflammation that naturally rises around menstruation and support more comfortable menstrual cycles.

 

Tip 1: Increase Anti-inflammatory Nutrients

Supporting your body’s natural anti-inflammatory pathways can help reduce excessive prostaglandin activity and improve PMS symptoms. Focus on foods and nutrients rich in antioxidants and bioactive compounds that promote a healthy inflammatory response and support the production of anti-inflammatory prostaglandins.

Some of our favorite anti-inflammatory nutrients include:

• Polyphenol-rich berries, colorful produce, herbs, and spices:
  • • These antioxidant-rich plant compounds help combat oxidative stress, a major trigger for inflammatory signaling and prostaglandin production, and decrease the inflammatory burden that contributes to PMS symptoms.
• Ginger:
  • • Ginger contains bioactive compounds that have been shown to inhibit enzymes involved in prostaglandin production. Research shows ginger can be particularly helpful for reducing menstrual cramps by dampening inflammatory signaling pathways.
• Turmeric (curcumin):
  • • Curcumin, the active compound in turmeric, also has potent anti-inflammatory effects and suppresses inflammatory pathways that stimulate prostaglandin production. It also acts as an antioxidant, helping to reduce oxidative stress.
• Magnesium:
  • • Magnesium supports muscle relaxation, nervous system function, and the enzymes involved in producing anti-inflammatory prostaglandins. Supplementation has been shown to improve PMS-related cramps, headaches, back pain, and mood disturbances, likely through its ability to modulate prostaglandin activity and reduce smooth muscle contractions.
• Zinc:
  • • Zinc is a well-known immune-supportive mineral that also helps promote enzyme activity to more efficiently produce anti-inflammatory prostaglandins. Zinc supplementation before and during the menstrual cycle has been shown to help alleviate pain and cramping. 
• Vitamin E (especially annatto-derived tocotrienols):
  • • Vitamin E is a fat-soluble vitamin essential for cellular health, reproduction, and protection against oxidative stress. Tocotrienols, a highly bioactive form of vitamin E, have been shown to directly influence inflammatory pathways and suppress prostaglandin production, reducing period pain and inflammation.

 

Tip 2: Support Healthy Fatty Acid Balance

Because prostaglandins are made from fatty acids, supporting healthy fatty acid balance is an important part of promoting a healthy inflammatory response and more comfortable menstrual cycles. Omega-3 fatty acids are especially important because they help regulate inflammatory pathways and have been shown to reduce PMS symptom severity and even decrease reliance on pain medications for menstrual cramps.

Some of our favorite omega-3-rich foods include:

• SMASH fish (salmon, mackerel, anchovies, sardines, and herring)
• Pasture-raised eggs
• Grass-fed beef (grass-fed beef has been shown to have a significantly lower omega-6 to omega-3 ratio compared to grain-fed beef)
• Chia seeds and flax seeds

In clinical practice, we frequently find low omega-3 levels and suboptimal omega-6:omega-3 ratios in blood test results. For many individuals, supplementing with at least 2 grams of combined EPA and DHA daily can help replenish omega-3 stores and support healthy inflammatory respone.

Interestingly, some women with PMS may have difficulty converting dietary fats into compounds that produce anti-inflammatory prostaglandins. In other words, the issue may be less about avoiding omega-6 fats altogether (learn more about the nuances in our latest podcast) and more about helping the body properly utilize them.

Several nutrients play important roles in these conversion pathways, including magnesium, vitamin B6, zinc, vitamin C, and niacin (vitamin B3). Supporting these nutrients through diet and supplementation may help promote the production of anti-inflammatory prostaglandins that help counterbalance the inflammatory effects of menstruation.

 

Next Steps to Calm Inflammation to Improve PMS

PMS symptoms are often a reflection of increased inflammatory activity rather than an inevitable part of having a menstrual cycle. While prostaglandins naturally rise before and during menstruation, elevated baseline inflammation, poor fatty acid balance, and blood sugar dysregulation can amplify this response and make symptoms significantly worse.

By supporting inflammation at its roots through nutrition, targeted supplementation, and blood sugar balance, many women can experience less painful periods, improved energy, and a more resilient menstrual cycle. These are all areas we support in our 1:1 coaching program, where we use advanced functional testing and a personalized root-cause approach to help resolve chronic inflammation to restore balance, energy, and resilience within the body.