Is It PMS Or Is It My Blood Sugar?

As women, we know the hardships of having varying hormonal symptoms during our cycles. Many experience a variety of symptoms each month that are attributed to premenstrual syndrome (PMS). For some, PMS is negligible, but for many it can be debilitating. Some women even experience symptoms of hormone imbalances during all stages of their cycle. The most common complaints include

• Mood imbalances 
• Depression and Anxiety
• Irritability
• Cramping
• Heavy periods
• Irregular Cycles
• Acne
• Abnormal Hair Growth

What you eat can play a huge role in these symptoms, which is why we just released our new Hormone Guide to share the science behind why these imbalances occur, plus tips to get started in balancing your hormones through nutrition and lifestyle!

Blood Sugar Imbalance is a Root Cause of Hormonal Imbalance

When you eat carbohydrates, your body breaks down those carbohydrates into simple sugar, which causes blood sugar to rise. As blood sugar rises, the pancreas releases a hormone called insulin, which helps move glucose out of the blood and into your cells. Heavy carbohydrate diets, such as the standard American diet, can contribute to PMS symptoms because they alter hormone balance, including how your cells respond to insulin. 

Consistently consuming carbohydrate-rich foods - particularly without the balance of protein and fiber - can cause cells to become insulin resistant, meaning that the cells stop responding to insulin. This leads to a greater concentration of glucose in the bloodstream. The pancreas tries to compensate by releasing even more insulin, but over time, this leads to high fasting insulin levels, an example of hormone imbalance. Although it's well understood that chronic insulin resistance (aka elevated fasting insulin levels) can lead to the development of diabetes, it’s lesser known that this can also impact other hormones and increase PMS symptoms.

Insulin and Testosterone

Androgens are a group of sex hormones that includes testosterone. Hyperinsulinemia increases androgen production. Additionally, hyperglycemia decreases the production of sex hormone-binding globulin in the liver, which contributes to the quantity of free, unbound androgens. 

When testosterone is in the unbound state, it is considered free testosterone. Although testosterone is necessary for energy, muscle building, body composition, and fertility, elevated free testosterone levels are associated with acne and hirsutism (abnormal hair growth). Elevated testosterone levels are a common symptom amongst women who experience polycystic ovarian syndrome (PCOS). In women with PCOS, at least 60% present with hirsutism, and 35% present with acne.

Insulin and Progesterone

In cycling females, progesterone is an important hormone for balancing moods, ensuring a restful sleep, and supporting cognitive function. High insulin has been shown to increase the levels of progesterone during the luteal phase.  Although the luteal phase is when progesterone peaks during a woman’s cycle, excessively elevated levels can contribute to fatigue, increased hunger, irritability, bloating, and breast tenderness (1). 

People who experience more PMS have also been found to intake higher calories during their luteal phase, possibly an association with leptin resistance, a hunger-regulating hormone, which is commonly found alongside insulin resistance. Over time, excess caloric intake can lead to obesity where individuals are noted to have higher insulin levels and decreased insulin sensitivity.

Insulin and Estrogen

Similarly to progesterone, estrogen supports sleep, focus, and mood.  It is also needed for neurotransmitter balance and insulin sensitivity. If estrogen levels are too high, an imbalance between estrogen and progesterone can develop. This imbalance is called estrogen dominance, which is a term coined to explain symptoms related to an imbalance of these hormones. Estrogen dominance can lead to mood imbalances, poor energy, heavy periods, acne, cramping, anxiety, irritability, and even weight gain (1). The imbalance between progesterone and estrogen can also further decrease insulin sensitivity, thus exacerbating PMS symptoms. Elevations are associated with insulin resistance and elevated androgens (1). 

How To Improve Your PMS By Controlling Blood Sugar

One study tracked cycling females over 15 years and found that better-controlled blood glucose was associated with lower PMS symptoms overall. In this study, specifically those with type two diabetes -- compared to the control group -- were found to have more irregular menstrual cycles, increased anxiety, irritability, depression, and irritable bowel disease.

Abnormal blood sugar levels are present in at least 50% of US adults and can be a major contributor to hormone imbalance. If you are struggling with hormone imbalances, start controlling your blood sugar in the following ways:

1. Consider Wearing a CGM: You can track your blood sugar using a continuous glucose monitor (CGM) which is a device that can be worn on your arm. Wearing a CGM can help you tweak your diet, and lifestyle, to improve glycemic control. It can also help to track patterns in daily activities or food choices that may be driving symptoms. Although there are numerous factors that impact blood sugar, food and lifestyle are larger drivers that give you control over your health. For more information on how to use a CGM, download our free CGM guide.
2. Choose Optimal Carbs: Replace ultra processed carbohydrates (eg white bread, white rice, crackers & chips) with whole food options, such as sweet potatoes, brown rice, beans and legumes. Whole food carbohydrates contain more fiber, which will decrease how quickly sugar enters the bloodstream and lowers the postprandial (or post-meal) spikes. 
3. Avoid Eating Carbs Alone: Eat your carbohydrates with healthy fats, fiber, and protein. Balancing your macronutrients at each meal will support optimal glucose and insulin levels. For more information on how to balance your macronutrients see our Optimal plate guide. 
4. Work With a Functional Dietitian! Work with one of our Functional Medicine Dietitians to help you identify if imbalanced blood sugar is at the root of your hormone imbalances. Functional dietitians can run additional labs on hormones that may be impacting your symptoms and help you improve your quality of life.

Let us help you use food as medicine consistently every day with blood sugar balancing meal plans! Our team of functional meidince dietitians would love to support you in The Being Collective, our meal planning and coaching program that includes hundreds of blood sugar balancing recipes, a weekly plan that you create for you and/or your family that generates an automated grocery list and a meal prep plan for the week. This is the best way to improve your efficiency in the kitchen, get DELICIOUS blood sugar balancing meals on your plate, and help you make progress with your health goals.

Additional References

1. Precision Analytical Inc. Dutch Interpretive Guide. First Edition. Published May 2023.