“Fake pills ease PMS symptoms even when you know they’re placebos,” read the headline for a writeup of a recently released randomized controlled trial finding that knowingly taking placebo pills (pills with no active ingredient) still led to marked reductions in symptoms for premenstrual syndrome sufferers [1]. On the surface, the study results confirmed the longstanding cultural trope that PMS, which an estimated 75% of women experience, is “all in your head,” aka “made up.”
Not so fast, the researchers said. They pointed out that even anticipating the placebo effect, whether subconsciously or consciously, may lead to pain-relieving endorphin release in the body. What’s more, as noted by a professor in the Department of Psychosomatic Medicine and Psychotherapy at the University of Freiburg, “Enrolling in a study and completing these daily diaries may make you feel better or pay more notice to when symptoms get better, so they see benefits even without taking any pills [with active ingredients].”
The most common PMS symptoms include bloating before your period, breast tenderness, carb cravings, an increase in mental health issues like anxiety and depression, headaches, and fatigue. Whether collectively and/or cumulatively, these symptoms can take a toll on women’s day-to-day functioning. When is it time to get help for PMS (or its more extreme cousin, premenstrual dysphoric disorder)? And how do you know whether it’s PMS— meaning that the symptoms start during the luteal phase and resolve once your period starts— versus another physical or psychological condition?
Fertility awareness method charting helps women identify when it’s time to get help for PMS
Fertility Awareness Method (FAM) charting is one tool that can help you determine when it’s time to seek outside help for PMS or another physical or psychological condition such as clinical anxiety and/or depression (which are constantly present, though they may worsen during the luteal phase, which are the days immediately preceding your period).
Instructors from NaPro, FEMM, Boston Crosscheck, Marquette, Billings, and Couple to Couple League were invited to submit written comments and/or charts for this article describing signs of concerning PMS in their particular FAM methods. We have included all the input we received.
FEMM
FEMM stands for Fertility Education and Medical Management. I myself am a FEMM instructor, and while FEMM charting does include a family planning component, it is primarily focused on the menstrual cycle as a marker of health. When a woman charts with FEMM, she looks for changes in cervical mucus, objective menstruation measurements, and she uses urinary LH strips to test for her LH surge in order to more accurately identify ovulation. FEMM has an app that can recognize irregular patterns in charting and direct its users to a FEMM instructor and medical management.
FEMM encourages women to chart their PMS symptoms on a scale of 1-10 in the notes on the charting app. If multiple PMS symptoms are charted throughout the cycle in more than three cycles in a year or two cycles in a row, especially if the symptoms are rated above 5 on a 10 point scale, that warrants concern and referral to medical management.
Boston Cross Check
Boston Cross Check teaches women how to chart cervical mucus, monitor hormonal levels, and monitor basal body temperature. The woman then has the option to choose which biomarkers to use to chart her cycles.
According to Boston Cross Check instructor Mikayla Dalton of Fig Leaf Fertility, “The other charted signs [besides cervical mucus, hormone levels, or BBT readings] aren’t normally considered fertility biomarkers for family planning purposes, but can be helpful to note on our fertility charts (such as pain, bloating, constipation, etc.).”
Dalton observed, “Natural Womanhood published Christina’s story, where her neurology care was assisted by her charting migraine incidents on her BCC charts, which enabled her doctor to determine her migraines were a non-hormonally-triggered type, and that aided appropriate treatment. So patterns of such things can be extremely helpful for medical professionals in shaping diagnosis, alongside other signs, symptoms, tests, and imaging!”
Charting for PMS may reveal hormonal imbalance clues
Dalton noted that PMS symptoms may reflect hormonal imbalances during the days leading up to menstruation, and these imbalances may show up in characteristic ways. “With PMS, women tend to have decreased levels of both estrogen and progesterone late in the luteal phase. So in regard to traditional charted signs, the lower progesterone levels mean we might see a shorter than usual luteal phase, a decrease in BBT after ovulation is confirmed, or a shallower temp rise.”
Dalton clarified that “BCC’s cervical fluid approach has been simplified for use as a cross-check, rather than a long-term stand-alone sign, so I’d defer to a dedicated mucus method such as Billings or Creighton for estrogen-specific PMS signs.”
Dalton added other symptoms that may not have family planning significance but are relevant when charting for health. They include “headaches, more frequent urination, acne, constipation, nausea, bloating, gas, weight gain, swollen, tender breasts, abdominal cramping, backaches, gum sensitivity, food cravings (especially for carbs), fatigue, sleeping changes (insomnia, or needing more sleep/naps), and diarrhea.”
Mental health-specific PMS symptoms may include “sadness, depression, anxiety, irritability, sudden anger, crying more than usual, confusion, difficulty concentrating, memory issues, clumsiness, decreased sexual desire, and not wanting to be around people.”
Duration of PMS symptoms matters
Dalton explained that duration of symptoms makes a difference in determining when it’s time to seek outside help, saying, “Some of these signs/symptoms are normal in the 1-3 days shortly before the onset of menses, so if they appear 4+ days before menses or are so severe that it’s affecting the woman’s ability to function normally, I’d refer them to seek medical advice.”
Couple to Couple League (CCL)/ The Symptothermal Method (STM)
The CCL/STM method observes three different biomarkers: cervical mucus, cervical position (optional), and basal body temperature. The PeakDay app was developed by the Couple to Couple League. It can be used for any FAM/NFP method, but it was created specifically with the CCL/STM method in mind.
According to CCL instructors Seth and Elizabeth Timpe, the chart below is for a woman experiencing PMS/PMDD plus thyroid issues. Her chart shows “tail-end brown bleeding, [and] weak temperature shift (low progesterone sign) that happened over at least 3 months. Notice in this chart there is no phase 3 established due to a weak/no temperature shift and there is tail end bleeding noted on the last day of the cycle.”
“This chart shows a chart where the temperature shift is not sustained and there is tail-end
brown bleeding without the start of the period. If this is consistently happening, we would
refer to a doctor to have progesterone and other hormone levels checked.”
The Timpes summed up, “The benefit of using the PeakDay app is that it will give alerts if the app notices that the chart is not ‘normal’ and will give alerts directing the person charting to submit a question or meet with a coach.”
The bottom line on FAM charting for PMS
Our hormones affect every area of our lives, and many women’s first introduction to this is through their experience of some degree of PMS. You might ask yourself questions like: Am I depressed or anxious or is it ”just” PMS? Am I sleep-deprived or is it my hormones? Thankfully, FAM charting can help you determine whether these issues are constant versus whether they fluctuate depending on where you are in your cycle. Working with a healthcare professional trained in restorative reproductive medicine is one way to address underlying hormonal or other medical issues that may be contributing.
