PMS in Practice: Understanding Symptoms, Stress and Nutritional Support

PMS is one of the most common concerns affecting women of reproductive age, yet many women continue to feel dismissed, unsupported or unsure where to turn for help. While hormonal fluctuations are central to PMS, factors such as stress, blood sugar regulation, nutrient status and lifestyle can all play a role in shaping symptom severity.

To explore these connections, we spoke with nutritionist Bella Dorey from Bella’s Nutrition about her experience supporting women with hormone-related symptoms. Bella shares her perspective on the hormonal changes that occur before menstruation, the impact of stress on PMS, and the nutritional and lifestyle approaches she considers most valuable in practice.

The following responses reflect Bella's professional opinions, experience and approach to supporting women with PMS.

What role do hormonal fluctuations play in the development of PMS symptoms?

PMS refers to a collection of symptoms that typically occur during the luteal phase and resolve with the onset of menstruation. It is driven by cyclical hormonal changes, particularly the rise and subsequent withdrawal of progesterone following ovulation, alongside fluctuating oestrogen levels. Importantly, it is not just absolute hormone levels but the relative balance of oestrogen in relation to progesterone.

In many cases, oestrogen levels can be within a normal range, but if progesterone output or activity is comparatively lower, this can create a situation of relative oestrogen dominance. This altered ratio is thought to influence symptom expression, particularly in relation to mood, fluid balance and neurochemical sensitivity.

Progesterone is often described as having a calming, neuromodulatory effect via its metabolite allopregnanolone ('AlloP'), which interacts with GABA-A receptors. When progesterone activity is reduced relative to oestrogen premenstrually, this can alter GABAergic and serotonergic signalling, contributing to mood changes, irritability, low mood and heightened anxiety. Dopaminergic tone may also be affected, influencing motivation, reward processing and perceived stress resilience.

There is also evidence to suggest that glucose regulation can become less stable in the luteal phase, with some women experiencing reduced insulin sensitivity, which may increase the likelihood of elevated blood glucose levels. This can contribute to cravings, energy fluctuations and changes in appetite regulation.

Importantly, these shifts do not occur in isolation. They interact with baseline factors such as nutrient status, inflammation, sleep quality, genetic predisposition, gut health and stress load, which may help explain why symptom severity varies so widely between individuals.

You may be interested in reading the DR.VEGAN^® PMS Survey results.

Are there particular foods or nutrients you prioritise when supporting women with PMS?

I always start with blood sugar regulation and nervous system support, because both have a direct influence on hormonal signalling and symptom expression. From a dietary perspective, this means prioritising adequate protein, healthy fats and fibre with each meal. Around 90% of people do not meet recommended fibre intake, and improving this alone can have a meaningful impact on symptoms.

From a micronutrient perspective, B vitamins are a key foundation due to their role in neurotransmitter synthesis, stress regulation and hormone metabolism. Chromium can also be a useful addition to support glucose regulation, particularly in individuals experiencing cravings or energy dips.

Agnus Castus is a botanical with one of the stronger evidence bases for PMS, particularly for cyclical mood and physical symptoms. Ashwagandha may also be helpful in supporting HPA axis regulation and reducing perceived stress load, which can indirectly influence symptom severity.

Supporting gut and liver function is also important, as efficient oestrogen metabolism and clearance rely on detoxification pathways. When these systems are suboptimal, symptoms may become more pronounced.

From a testing perspective, continuous glucose monitoring (CGM) can be a useful tool to observe metabolic patterns across the menstrual cycle. Some individuals notice a clear correlation between PMS symptoms and glucose levels, which can help to guide personalised dietary interventions.

Hormone metabolite testing, such as DUTCH or HuMap, is also a helpful tool to assess patterns of oestrogen and progesterone metabolites, cortisol rhythm and overall hormonal metabolism. It may help to provide additional insight into whether progesterone output, clearance or downstream metabolism may be contributing to symptom presentation in some individuals.

Many women are told their hormone levels are normal but still struggle with PMS. What's your perspective on this?

Keep investigating. 'Normal' on a standard blood panel doesn’t mean optimal, and it certainly doesn’t mean nothing can be done. There is so much that nutritional therapy can offer here, from blood sugar regulation to stress support and gut health; the levers we can pull are significant. 

How does stress influence PMS symptoms?

Stress is a significant factor in PMS. Many women find symptoms worsen during high-pressure periods because of increased neuroendocrine sensitivity and a lower threshold for stress reactivity. 

Cortisol plays a central role, as it influences blood glucose regulation, thyroid signalling, and inflammatory activity. When cortisol is elevated or dysregulated, it can destabilise blood sugar levels, increase cravings and energy variability, and impair sleep quality, all of which feed directly into PMS symptom expression.

There is also a bidirectional relationship between stress and sex hormones, whereby elevated stress can impact ovulatory function and progesterone output, while the natural luteal phase hormonal shifts can increase sensitivity to stress itself. This creates a compounding effect, where stress and PMS symptoms can reinforce each other.

For this reason, stress regulation is not simply supportive in a general wellbeing sense, but clinically relevant within PMS management, particularly in individuals with more severe or cyclical symptom patterns.

You may be interested in reading DR.VEGAN's free Stress Practitioner Paper.

How do you assess the quality of a PMS supplement? 

• B vitamins are often at the top of my list. Vitamin B6 in particular has solid evidence for reducing PMS symptoms, and the B vitamins collectively support mood, energy, sleep and hormone metabolism. 
• Agnus Castus is one of the most well-researched herbs for PMS, helping to support hormonal balance across the cycle via dopaminergic modulation, with particular evidence for reducing breast tenderness, mood changes and irritability. 
• Chromium is useful where there is a requirement for blood sugar support, with symptoms such as food cravings or energy dips. And ashwagandha can be helpful with HPA axis dysregulation, as it can modulate the cortisol response.
• Vitamin D is another important consideration, as deficiency is extremely common and closely linked to worsening PMS. This is always worth checking and supplementing where indicated. 

What I love about PMS Hero^® is that it brings many of these key ingredients together. It feels like a considered, evidence-informed formula, that is built around the underlying physiological mechanisms of PMS, rather than just isolated symptom relief. The inclusion of nutrients that support neurotransmitter production, alongside botanicals that influence hormonal signalling and stress modulation, reflects a more systems-based approach to symptom management. At the same time, it still provides broader support for stress physiology and inflammation, which are often key drivers of symptom severity in practice. Learn more about PMS Hero^® in DR.VEGAN's PMS Practitioner Paper.

Bella Dorey, Registered Nutritional Therapist, BSc, mBANT, CNHC

Bella Dorey is a BANT-registered nutritional therapist with a First Class BSc (Hons) from the Institute for Optimum Nutrition. She has over six years of experience supporting adults with hormonal health, digestion, skin health, low energy and general wellbeing. She has a particular interest in hormonal health, and the way hormones, gut health, stress and lifestyle factors interact to influence how we feel throughout the month. Bella takes a root-cause, whole-person approach, helping clients understand what may be driving their symptoms and supporting them with practical, realistic changes that fit into everyday life. Her focus is on simple, personalised nutrition and lifestyle strategies that support long-term balance, without unnecessary restriction or complexity.

Visit her website: https://www.bellasnutrition.co.uk