When we talk about menstruation in our culture, we tend to focus on all the ways it can be seriously unpleasant and “gross”, with lots of attention paid to the emotional effects of premenstrual syndrome, or PMS (and the pain and angst that often accompany it), and almost none to what’s actually happening in your body every month. Board-certified reproductive acupuncturist Kirsten Karchmer, founder of Viv Wellness, believes that for most women, PMS is a critical tool in deciphering overall health—and it doesn’t have to come with every period, or at all, if you pay attention and learn to pull the right levers. “I’ve been working with women in my clinics for almost twenty years, and while a lot of them come in with PMS and cramping, by the time they’re done with treatment, a significant majority are symptom-free,” she says.
Below, Karchmer’s take on period health, and her advice on how to gain control—plus, our round-up of items to make periods a little more comfortable, including 100 percent organic tampons delivered straight to your door. (For another perspective on period health and more helpful tips, see our Q&A with OB-GYN Dr. Caitlin Fiss.)
A Q&A with Kirsten Karchmer
What are some of the most persistent myths about periods/period health?
I have heard so many unbelievable myths about periods—cramps are punishment for being a woman, PMS is all in your head, you can’t swim in the ocean while you have your period because sharks will attack you. In nearly the first 3,200 years of written language, there isn’t a single mention of the menstrual cycle. Now that it’s 2018, we have made some progress, but I’d say 90-percent of the women I talk to believe one period myth or another—and it’s because we’re not talking about periods enough, or in the right way.
The biggest myth of all: PMS and cramping are normal, and there’s nothing you can do about it. More than 80-percent of women report significant PMS and menstrual cramping, which makes those conditions incredibly common, but they are NOT normal. You’re probably thinking, “not my cramps!” Yeah girl, your cramps too. Every aspect of your menstrual cycle—the length, volume of blood, color of blood, timing of ovulation, basal body temperatures, PMS, and cramping—gives you important information about your health and provides a valuable feedback mechanism to measure your progress in getting healthier.
What’s going on when we experience PMS?
First off, it’s important we talk about what PMS is and what it isn’t. PMS (premenstrual syndrome) is a cluster of symptoms that can occur from ovulation—usually about two weeks after your period—until your period starts again. It can involve breast tenderness, bloating, constipation or diarrhea, mood changes, irritability, migraines, fatigue, cravings, anxiety, and insomnia, all of which are related to your body’s response to hormonal fluctuations.
Think of PMS like a monthly stress test on your body: Each PMS symptom, and its severity, gives you information about how your body systems are responding to the additional stress of the hormonal fluctuations associated with the second half of your cycle. During the end of your cycle, your body does some heavy lifting to break down extra hormones still floating around the bloodstream. If everything is working ideally, these hormones are processed by the liver and cleared efficiently, resulting in a PMS-free cycle.
What can different PMS symptoms tell you about what’s going on in your body?
When your body has a hard time responding to that changing hormonal environment, it creates physiological stress that can impact a variety of organ systems. Like any other system under stress, the weakest parts are usually the first ones to break down:
Do you tend to get cravings, nausea, or have bowel changes before your period? That’s a really good sign that your digestive system is on the weak side.
How about breast tenderness, headaches, or irritability? That tells us that your body’s detox system is down and isn’t doing a great job of cleaning up your hormonal leftovers.
Are you fatigued or having trouble sleeping? Feeling anxious? These are important indicators that you’re running low on resources in general and that your body is in desperate need of a boost.
All of this information is super important for two reasons: First, by supporting and strengthening the body systems that are breaking down, we can get rid of those PMS symptoms. Second, and maybe even more important, if we can strengthen those systems now, before real, chronic disease sets in, you can live an all-around happier, healthier life. For most women, giving these vital body systems a boost doesn’t require a complete overhaul, just attention to basic things like sleep, nutrition, exercise, mindfulness, hydration, and supplements.
What does a healthy cycle look like?
After helping more than 10,000 women improve their menstrual cycles, I’ve identified the basics of a healthy cycle: You may think that your cycle could never look like this, but I assure you that the vast majority of women can get pretty close to this ideal. Here’s what that looks like: A regularly occurring period that comes about every twenty-eight days. That period should include four days of bleeding in which you soak a tampon, pad, or menstrual cup every four hours, not more or less. You shouldn’t have any cramping or spotting. If you’re tracking ovulation, you should be ovulating on cycle day fourteen, and you should notice abundant, stretchy “egg white” cervical fluid on or before ovulation. Also, you shouldn’t have any PMS symptoms before your next period starts.
Are there certain foods that are most likely to influence your period/PMS?
Food is the first medicine and absolutely can affect your reproductive health, but it’s not just what you put in your mouth that matters.
We have a saying, “You’re not what you eat, you are what you digest.” A strong digestive system means that your body is efficient at breaking food down into components that it can actually use. If you tend to have digestive issues or have a lot of food sensitivities, it’s important to address these first to make sure you’re getting the nutrition you need. After you’ve made sure your gut is in check, you’ll want to be sure you are eating a wide range of seasonal, organic foods as the foundation for a healthy cycle.
It’s impossible to always make the right choice, especially when we are PMS-ing, but here are a few foods that PMS and cramp sufferers might want to especially avoid:
Caffeine: I know that getting out of bed on your period is hard enough, but caffeine has been shown to make PMS worse. Caffeine causes your blood vessels to constrict, including the ones that supply blood to the uterus, which can make cramps even more killer. Caffeine may also increase irritability, which is usually the last thing you need this time of the month.
Alcohol: When it comes to your period problems, drinking alcohol makes everything worse. Alcohol inhibits hormone regulation, so it can intensify both PMS and cramping. It also slows the emptying of the stomach, potentially increasing bloating. Worse, alcohol is dehydrating, so it can cause you to retain even more water, and you could end up with a hangover and PMS.
Salt: Salty foods only exacerbates bloating, by increasing water retention.
Red meat and dairy: They contain arachidonic acids that stimulate prostaglandins and intensify cramps. It is common for women to crave iron-rich foods premenstrually, but you can get your fix from veggie-based sources like chickpeas, beans, and lentils.
Sugar and refined carbohydrates: All inflammatory foods will make your PMS and cramping worse, but perhaps the biggest red flags are sugar and refined carbohydrates. They contribute to fatigue and bloating, and can impact estrogen, testosterone, and serotonin levels. Because they also impact blood sugar regulation, carbs can worsen the highs and lows of your PMS mood swings. Step away from the cupcake and no one gets hurt.
I promise I’m not here to make your life miserable, though. There are a few healing indulgences that can legitimately make PMS and your period more bearable:
Avocado: I know that I always crave something fatty like ice cream on my period. Avocado is great for satisfying those fat cravings in a totally healthy way. Plus, avocado contains plenty of potassium (more than a banana) which can help reduce cramping.
Chocolate: Yes, dark chocolate is totally good for you (in moderation). Dark chocolate contains magnesium, which is a great mineral for helping to decrease cramps. Eating chocolate can also release serotonin, which increases feelings of wellbeing. Here are three words that will change your life: avocado chocolate mousse. It’s easy to make, feels indulgent, and is perfect for combating period blues.
What other indulgence do I recommend for period relief? Your vibrator! A little “self care” at this time of the month is definitely well deserved and something you can easily do at home that will relieve cramps and improve your mood. Love thyself!
How does stress play a role in all this?
There are two kinds of stress: physiological stress (stress on the body) and psychological stress (stress on the mind). They both have a giant role in PMS and cramping, and they are super interrelated. In fact, your body doesn’t really even know the difference between physiological and psychological stress.
When we talk about stress in our culture, we tend to focus on just the psychological stress. Like, are we feeling stressed out? But here’s the deal: Your body has a finite pool of resources, like a bank account. You have to draw on that account for everything you do. Exercise, mental activity, digestion, having fun, hormone function, removing waste, reproduction—they all draw on that same account. In a perfect world, you don’t spend more than you make, and everything works just fine.
We don’t live in a perfect world, and the stress of living in 2018 has almost all of us running our bodies at a deficit. The more things we do that add physiological stress—not getting enough sleep, eating low-quality food, exercising too much or too intensely, working too many hours, taking on too many social obligations, not taking time for rest and rejuvenation—the larger our deficit spending becomes. It’s possible to overdraw this account for a little while, but sooner or later something has to give. If your menstrual cycle is sort of like a stress test for your body, when your body is strained, the weaker systems are affected first; they’re the ones that aren’t getting paid (sticking with our banking analogy). As you’d expect, the bigger the deficit, the more systems are affected, and the worse your symptoms become. That’s where PMS really comes into play, so those two weeks before your period (and especially the few days before) are your best guide to identify the systems that need a little extra love.
This doesn’t have to be all doom and gloom. If putting your body under stress is the problem, then relieving stress is the solution. There are tons of natural, easy ways to relieve both physiological and psychological stress. Get more sleep. Eat better food. Practice mindfulness. Exercise in a way that energizes you.
What are key metrics to assess when reviewing your cycle?
The first thing you need to do is identify the things that need to improve. It doesn’t take anything fancy, just keep a little period journal or make a note in your calendar when you experience something uncomfortable or that is unusual for you. You don’t really need an app to tell you when you have cramps!
Right now, I see a major problem with many health apps—they mostly want you to just collect a ton of data that doesn’t really matter, and offer no way of actually helping you get healthier. People need to understand that tracking your health data is just the first step, it’s what you do with that data next that really matters.
The goop PMS toolkit
Gentle, beautiful, and life-enhancing.
Penguin Random House
THE ART OF EATING WELL
A helpful place to start.
AvocadoBox, Starting at $15 per month.
Great any time of the month.
The Healing Mind, $12
Marty Rossman, M.D. on audio to help you deal with anxiety.
LOLA, starts at $8
Feminine care by women, for women.
JAMES DESERT TRIP FLEECE TOP
Cozy + chic.
JAMES DESERT TRIP
ROHM SOUND MACHINE
For your nighttime routine.
Yoga Wake Up App
Yoga Wake Up App, Free
Some in-bed poses to start your day off right.
WONDERLAND™ THE HEAVENLY HEART
10-FUNCTION SILICONE MASSAGER
Ultimate PMS self-love.
BAO Foot Spa, $25 for 30-minute session
You get the idea.
Kirsten Karchmer is a women’s health expert, health tech pioneer, and the founder of Viv Wellness, a company dedicated to improving women’s periods worldwide. She is also the founder of Conceivable, a technology enabled fertility solution. Kirsten is a board certified reproductive acupuncturist and her clinical practice has helped more than 10,000 women over the last twenty years.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.