PMS and Eating Disorders

What does PMS have to do with eating disorder recovery? 

Eating disorders and premenstrual disorders, including PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder), are quite connected in that the symptoms of premenstrual disorders can trigger eating disorder behaviors and exacerbate eating disorder symptoms.  Read more to learn why this happens and how PMS and eating disorders affect one another.  

PMS and PMDD: 

PMDD affects 3-8% of women, and PMS affects 20-32% of women.  The symptoms of both (which I will explain in more detail below) show up in the luteal phase of a woman’s menstrual cycle, which is the 12-14 days before menstruation. 

Your Luteal Phase Explained: 

In the luteal phase of your menstrual cycle, there are some important hormonal shifts that happen.  I would like to take a moment to explain these to you in a little bit more detail, as it will help to understand why we can also see a surge of eating disorder symptoms at this time, specifically in women who experience PMS and PMDD.  

The luteal phase of a woman’s cycle begins after ovulation (your fertile window) and occurs before menstruation (your period).  The follicle that contains the egg transforms into corpus luteum and begins to produce both progesterone and estrogen. Progesterone levels peak midway through this phase.  If the egg is not fertilized (meaning there is no pregnancy), the corpus luteum will start to break down, resulting in a drop of estrogen and progesterone levels, which will eventually lead to menstruation.  

Due to these hormonal fluctuations, cortisol (stress hormone) increases, as well as one’s metabolic rate.  Energy demands (caloric needs) increase as well, which leads to an increase in hunger and appetite.  If someone is not giving their body what it needs (restriction, food rigidity, food rules), this can lead to higher cravings and urges to eat more food and certainly can trigger an increase in binges which can then trigger purges in those within binge-type eating disorders.  The fluctuations of estrogen and progesterone as described above also affect serotonin, which is the hormone that stabilizes mood, happiness and feelings of well- being.  Lower serotonin will lead to more mood swings and a decreased feeling of well-being which can exacerbate eating disorder symptoms and urges to engage in such. 

Symptoms of PMS and PMDD: 

Psychological Symptoms: 

• Mood swings 

• Angry outbursts 

• Irritability

• Anxiety

• Depression 

• Poor body image/ body dysmorphia 

• Trouble sleeping/ fatigue 

• Reduced concentration 

• Restlessness 

• Confusion 

• Social withdrawal 

• Lack of interest in usual activities 

• Feeling hopeless 

• Suicidal thoughts 

Physical Symptoms: 

• Abdominal bloating 

• Abdominal cramps

• Changes in bowel movements 

• Water retention

• Weight gain/ fluctuations

• Breast tenderness or swelling 

• Changes in appetite 

• Food cravings 

• Changes in libido 

• Headaches 

• Nausea 

• Joint or muscle pain

• Hot flashes 

• Acne 

While I have listed the symptoms of both PMS and PMDD together for the sake of this article, as many symptoms do overlap, it is important to note that PMDD is a more severe form of PMS.  Women experiencing PMDD will have more extreme mood changes, and depression and/or anxiety that intensifies significantly right before the start of menstruation. They will also have more drastic changes in appetite and physical symptoms (such as digestion, fatigue and concentration). 

The connection between PMS/PMDD and Eating Disorders:

PMS and PMDD can exacerbate symptoms of eating disorders, specifically binge- type eating disorders such as bulimia nervosa and binge eating disorder. 

The physiological and psychological symptoms associated with these premenstrual conditions can be a trigger for binge eating and/ or purging.  

These potential triggers include: 

• Bloating 

• Weight gain/ weight fluctuations 

• Water retention 

• Increased appetite and hunger

• Increase in food cravings 

• Anxiety, depression

• Mood swings 

Women with a significant increase in appetite and food cravings in their luteal phase are much more susceptible to binge eating.  Additionally, feeling more bloated and experiencing some water retention and or fluctuations in weight can warp body image and trigger the urge to restrict, binge and/or purge (these behaviors are often connected together as one usually leads to the next).  A very common eating disorder symptom in the luteal phase, and specifically for those that struggle with PMS/ PMDD is an increase in negative body image.  This leads to more body checking, weighing, intrusive thoughts and the urge to “fix” it through eating disorder behaviors.  There is also an increase in anxiety and an urge to withdraw socially in correlation with negative body image/ body dysmorphia.

Beyond the  physical ways that PMS and PMDD symptoms can trigger eating disorder symptoms, its psychological symptoms also can.  Feeling sad, hopeless, anxious, depressed, stressed, and angry can trigger the individual to engage in eating disorder symptoms (such as binge eating and/ or purging) as a coping mechanism.  

How awareness around this connection can support eating disorder recovery: 

If you, or your loved one, is someone who struggles with PMS or PMDD, none of these symptoms will be new information.  You will have nodded your head while reading this all, thinking how familiar it sounds to your personal experience.  

Similar to my articles on ADHD and Eating Disorders, and IBS and Eating Disorders, it is so important to address these concerns at the same time as the eating disorder.  We should never dismiss one condition on behalf of the other as many co- conditions are intricately connected with the eating disorder.  PMS and PMDD are no exception to this.  

At The Holistic ED Recovery Center we take a holistic approach to eating disorder recovery, and this means looking at the whole picture of what the individual is struggling with, including hormones.  Premenstrual conditions (PMS and PMDD) can not only trigger an existing eating disorder due to the severity and nature of their symptoms, but may also be part of what causes the eating disorder, as part of the bigger clinical picture.  It is so important that it is addressed and supported appropriately as part of your eating disorder recovery treatment (mental and physical), and is absolutely not something to wait until after recovery to treat and support but rather work on concurrently in your eating disorder recovery.  

As always, if you would like to connect and learn more about our services, and what types of support are offered, reach out! We always offer free calls and are happy to connect and help support in any way we can.