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

What causes PMS symptoms? If you dread the days leading up to your period because of painful cramps, bloating, 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 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 levels trigger inflammation that contributes to many PMS symptoms. Prostaglandins act as immune signaling molecules involved in inflammation. Interestingly, they are derived from arachidonic acid, an omega-6 fatty acid.

Prostaglandins help regulate uterine contractions, blood flow, immune activity, and inflammatory responses throughout the body. One of the most abundant prostaglandins, prostaglandin E2 (PGE2), plays a complex role by both initiating inflammation and also helping resolve it by promoting anti-inflammatory activity.

In the days leading up to menstruation, declining progesterone levels trigger a natural rise in inflammatory signaling and prostaglandin production to help break down and shed the uterine lining. This increase is a normal and necessary part of the menstrual cycle. However, when prostaglandin levels are already elevated before the late luteal phase, the surge around menstruation is amplified, leading to a more pronounced inflammatory response.

Ultimately, the degree of inflammation in the body helps determine the severity of PMS symptoms. Excess prostaglandin activity can contribute to more severe cramping, bloating, breast tenderness, digestive upset, mood changes, and even hormonal migraines in susceptible individuals.

2 Main Factors That Raise Inflammatory Load:

1. Elevated Baseline Inflammation

Although a rise in prostaglandins before and during menstruation is normal, underlying chronic inflammation can amplify this response and contribute to more severe PMS 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, including:
  • • • Nutrient depletion (vitamin and mineral insufficiencies, low energy availability, blood sugar dysregulation)
      • Immune activation (high viral load, mold mycotoxin exposure)
      • Exercise stress (overtraining, underrecovery, 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. Omega-6 Dominance

Prostaglandins are created from omega-6 fatty acids. You may know of omega-3s, which are anti-inflammatory essential fatty acids that we must get through food or supplementation. Omega-6 fats are their counterpart and are also essential, meaning our bodies cannot produce them on their own.

Inherently, omega-6 fats are not bad, however, when consumed in excess of omega-3 fats, they can shift the body toward producing more pro-inflammatory prostaglandins, deplete omega-3 levels, and promote an overall inflammatory environment. 

When consuming a diet centered around whole foods, excess omega-6 intake is typically less of a concern. 

However, chronic consumption of processed seed oils and ultra-processed foods can make it easy to consume omega-6 fats in excess. Over time, this has a significant impact on overall inflammation balance within the body, and may amplify PMS symptoms and menstrual pain.

Examples of omega-6-rich ingredients and foods:

• Safflower oil
• Sunflower oil
• Corn oil
• Soybean oil
• Canola oil
• Walnuts
• Meat, poultry, and dairy (However, a recent study conducted among North American beef samples found that grass-fed beef had a significantly lower omega-6 to omega-3 ratio compared to grain-fed beef.)

How to Lower Your Inflammation 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 reduce PMS symptoms. Focus on foods and nutrients that are rich in antioxidants and bioactive compounds that combat oxidative stress and promote a healthy inflammatory response. Over time, these nutrients can help lessen the intensity of PMS symptoms month after month.

Some of our favorite anti-inflammatory nutrients include:

• Polyphenol-rich berries, colorful produce, herbs, and spices:
  • • Polyphenols are powerful antioxidants that help neutralize oxidative stress, a major trigger for inflammatory signaling and prostaglandin production. By reducing free radical damage and supporting healthy immune function, these plant compounds help 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, particularly magnesium glycinate, plays an important role in regulating inflammation, supporting muscle relaxation, and maintaining healthy nervous system function. Magnesium 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.
• 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: Balance Your Omega-6 to Omega-3 Ratio

Because prostaglandins are made from fatty acids, maintaining a healthy balance between omega-6 and omega-3 fats is an important part of supporting a balanced inflammatory response. Modern diets often contain an excess of concentrated omega-6 fats from processed vegetable and seed oils, ultra-processed foods, and conventionally raised meat and dairy products. Over time, this imbalance can favor the production of more inflammatory prostaglandins and contribute to more severe PMS symptoms.

To support a balanced inflammatory response, we typically aim for an omega-6 to omega-3 ratio between 1:1 and 4:1. Restoring a healthier omega-6 to omega-3 ratio involves both reducing concentrated sources of omega-6 fats (see the list above) and increasing omega-3-rich foods such as:

• SMASH fish (salmon, mackerel, anchovies, sardines, and herring)
• Pasture-raised eggs
• Grass-fed beef
• Chia seeds and flax seeds

Research has shown that consistent omega-3 intake can reduce PMS symptom severity and may even decrease reliance on pain medications for menstrual cramps. In clinical practice, we frequently find low omega-3 levels and suboptimal omega-6:omega-3 ratios. For many individuals, supplementing with at least 2 grams of combined EPA and DHA daily can be a helpful strategy to replenish omega-3 stores and support healthier fatty acid balance.

The goal isn’t to fear whole-food sources of omega-6 fats, but rather to reduce concentrated omega-6 sources while increasing anti-inflammatory omega-3s to support a healthier inflammatory response.

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.