Have you ever wondered how stress, anxiety and other emotional states of distress contribute to how our bodies feel physically?We read about it all the time—stress creates an environment ideal for illness(es) and imbalances—but many of us do not entirely understand why or how this happens. We may give lip service to the mind/body connection and its importance but not truly grasp how complex this interplay really is.
This is certainly the case when it comes to discussing the relationship between chronic stress and PMS.When we sit and really think about how delicate, complex, and individualized the cascade of hormones is in a women’s body it is pretty amazing. It’s no wonder that there is an epidemic of hormonal imbalances in our society, endorsed through the prevalence of PMS. If my private practice is a sample of the general well being of women between the ages of 22-65, it suggests that the vast majority of women feel tired, stressed, unbalanced and generally not so great physically or emotionally.
As I unravel their narratives, I am struck by how often their histories include both high levels of stress, acute anxiety, historical traumas and a chronic pattern of PMS.Let’s define PMS so that we know we are talking about the same thing. The term PMS was coined in 1931 to describe a constellation of symptoms occurring in the luteal phase of a women’s cycle. The luteal phase happens from mid-cycle (ovulation) through to the onset of bleeding (menses). According to the ARHP, between 43-55 million women experience uncomfortable symptoms during this phase of their cycle. Twelve to twenty-five million complain that the symptoms are severe enough to interfere with the quality of their life. The lifetime prevalence is estimated between 13-18%, most often occurring in the decades between 20-40. Average age of onset is 26. There is heavy overlay between women endorsing symptoms of PMS and the presence of PTSD, anxiety, and depression.
The causes of PMS are multi-determined, unique to each woman, and highly complex. A short list of possible causes include:
– Cyclic changes in hormones
– Chemical changes in the brain
– Chronic stress
– Adrenal burnout
– Nutritional deficiencies
Those statistics are pretty staggering, both as a clinician and a woman. As a licensed psychologist, the area I spend most of my time exploring with the women I see in my practice is where stress, anxiety, trauma, grief, and depression interplay with our hormones and can wreak havoc on the precarious sense of balance.
Let’s explore how stress directly impacts our ability to produce, modulate and balance our hormones. The term Adrenal Fatigue, or Adrenal Burnout, is a hot topic of discussion right now. There is growing curiosity about the important role the adrenals plays in everything from hormonal production and distribution to how we respond and experience stress in our life. Our adrenal glands are located on top of each kidney and have a rather complex structure given their tiny size.
It’s beyond the scope of this essay to discuss the adrenal functioning in depth, but suffice it to say, they play a major role in hormone balance and are the hormonal epicenter of our fight-or-flight instinct.
One of the main roles of the adrenal gland is to release a stress hormone, cortisol, when danger is perceived. This hormone then sends messages throughout the body that indicate stress is on the horizon. From a Darwinian standpoint, this is a valuable and life saving response that has contributed to our ability to quickly regulate our response to our immediate and ever changing environment.
On the flip side, the adrenals can rather easily be tipped towards chronic or over production of this stress hormone, even in the absence of a true threat. When this occurs for an extended period of time, you can experience adrenal burnout, which then impairs your body’s ability to produce, regulate, modulate and balance other hormones important to our emotional and physical equilibrium, including DHEA, estrogen, progesterone, and testosterone.
We know from research examining the underlying physiological aspects of PTSD that chronic adrenaline and cortisol production creates a detrimental and unregulated pattern of fight-or-flight response, resulting in adrenal fatigue, emotional distress, and severe anxiety. When this occurs the result is often experienced as hormonal fluctuations that create unwanted and unsavory patterns of emotional distress throughout a woman’s monthly cycle.
The role of stress in our hormonal balance is a complex and nuanced dance between our brain, endocrine system, adrenals, liver, and our mind. It is no wonder so many things can go wrong when you think about how many systems need to be communicating with each other in an optimal way in order to achieve a sense of equilibrium. My experience has been that underneath the endorsement of PMS is a long history of emotional stress, trauma, anxiety, loss and often grief. The key is to help my patient’s create a relationship where they can better metabolize these experiences and collaborate on life style choices that will promote hormonal balance.
Here are steps we can take to better understand what our bodies is communicating through the language of PMS. These changes should be implemented for a minimum of 90 days in order to assess their efficacy.
Many of the suggestions are actually quite intuitive, but it does require from us a substantial degree of participation in a process of healing where responsibility falls squarely on our own shoulders.
Attempt to engage this 90-day process with a sense of wonder and curiosity.
1. Limit or avoid caffeine.
2. Avoid alcohol.
If you find that hard to do, be curious about the nature of that “partnership.”
3. Limit salt and avoid trans fats (fried food etc).
The latter is associated with hormonal disruption that over time will wreak havoc on your system.
4. Eat foods high in calcium and magnesium.
Try making a bone broth recipe and incorporating 1-cup daily to your regiment. My favorite recipe is on Kale and Kombucha. If you don’t like the idea of bone broth, consider taking supplements.
Please discuss with your physician about reputable brands.
5. Increase omega-3 oil consumption.
Omegas are found in wild caught salmon, flax, walnuts, sardines, etc.
6. Eliminate all processed foods.
All of them. Including and most importantly sugar…sorry, no way around it. The good news is that once you eliminate all processed junk, you are left with tons of real food you can eat. Vegetables, fruits, proteins, nuts and seeds, etc are all available for you to enjoy in bountiful amounts.
7. Get at least eight hours of sleep.
And let’s bring back nap time too if possible. Even 20 minutes once a day will help immensely.
8. Incorporate a daily mindfulness practice.
Preferably 10-15 minutes in the AM and PM. Create this space as a time to breath, observe your mind and body, and calm the central nervous system. Explore the various models of mindfulness that focus on calming and re-calibrating the vagus nerve.
9. Exercise more days than not.
At least 30 minutes. Enough to sweat.
10. Work with a licensed psychologist.
To metabolize stress and trauma, process grief, create and tweak coping skills, and observe your interior world.
We have long known that inflammation is often a first indicator that the delicate balance inside our body has begun to falter. Many of the early signs of imbalances are expressed through the language of inflammation. We can trace inflammation back to the vast majority of our physical symptoms. As it turns out, certain psychiatric symptoms, such as depression, are also an indicator of systemic and neurologic inflammation.
The statistics on depression are staggering and inching north each passing year. According to the NIMH 16 million people in United States suffer from at least one episode of depression in 2012. That is nearly 7% of the population. According to the WHO, 350 million people suffer from depression worldwide. It is the leading cause of workplace disability (http://www.healthline.com/health/depression/facts-statistics-infographic#2). These statistics highlight the epidemic of suffering that people experience and reminds us that there are psychiatric illnesses and circumstances where medication is indicated. The onset of anti-depressants as a mainstream mechanism to treat Major Depression (MD) has had an enormous impact on the fields of psychiatry and psychology. The ability to help the most severe cases of depression has been a major step forward for our field as a science. However, there are a large number of cases that we see within a clinical setting that could be better addressed by encouraging our patient’s to view their body and mind as a fully integrated and whole system. Instead we artificially compartmentalize the various systems of the body, including the brain, and thus further dis-integrate the emotional healing process. As patients, we began to believe that the remedy was external. Our commitment to participate in our own process of becoming well and the aspect of our health that is, at its core, a collaborative endeavor between patient and doctor atrophied over time under this paradigm.
Scientific literature is pretty clear on the presence of inflammation in people who endorse symptoms of depression. There is a myriad of scientific literature that examines this complicated and multi-determined relationship. We know from the presence of elevated cytokines in the blood work of patients experiencing major depressive episode that inflammation is occurring at a systematic level (Biol Psychiatry. 2010 Mar 1;67(5):446-57. doi: 10.1016/j.biopsych.2009.09.033. Epub 2009 Dec 16. AND J Affect Disord. 2012 Aug;139(3):230-9. doi: 10.1016/j.jad.2011.08.003. Epub 2011 Aug 26.) Additionally, there is now compelling scientific evidence that suggests the presence of neuroinflammation in patients who endorse depressive symptoms (JAMA Psychiatry. 2015;72(3):268-275. doi:10.1001/jamapsychiatry.2014.2427.) Research exploring the relationship between inflammation and depression is key to better understanding how best to use medication(s) to treat the most acute, refractory and often life threatening expression of this debilitating mental illness. This field of research is promising, but it is still very much in the early phases of providing patients with concrete medication and treatment options.
However, for many of the people struggling with mild to moderate depression, if we provide them with the data and knowledge to treat and calm systemic inflammation using dietary and lifestyle choices, they will experience significant relief and feel more personally empowered. Environmental toxins, allergies, standard American diet (SAD), excessive stress, certain medications, trauma, and a myriad of other influences all converge to leave us vulnerable to inflammatory responses that further exacerbate our physical and emotional dis-ease. It is vital that we turn our focus away from the symptoms and begin to address the core issue of inflammation in an effort to promote wellness.
There are a lot of ways you can start to address inflammation right in the comfort of your own home. Most of these interventions are quite intuitive. Please strive to adhere to these goals for a minimum of 90 days. Take time each day to reflect on the changes are you experiencing, both physically and emotionally, as you create wellness based habits in your life.
2-inches Ginger root
2-inches Turmeric Root
2 Sticks Cinnamon
1-2 Tbsp. coconut cream
Boil 4 cups of water. Cut up ginger and turmeric and 1 stick of cinnamon. Boil for 20 minutes or longer. Place 1 tbsp. coconut cream in a teacup. Pour in the tea.