The cost of being a menstruating female is ever increasing. You have to pay for sanitary products, suffer cramps like a champ and listen to male PT’s mansplain that it’s okay to be in pain during your period (arguably more painful than actually menstruating). In addition, some of us suffer from food cravings that can potentially hamper our goals. Thanks universe.

We are going to run through what science says about pre-menstrual syndrome (PMS) and food cravings.

Pre-Menstrual Syndrome: More Than Sobbing Over Dog Memes

The Menstrual Cycle

Before we discuss the role PMS plays in food intake, it is vital we have at least a basic understanding of the stages of the menstrual cycle.

The menstrual cycle is highly variable, and a “normal” cycle is rare. Add in some exogenous contraceptive hormones to an already complex mechanism, and it’s even more complicated and a challenge to understand!

However, whilst we can’t really define a “normal” cycle for everyone, we have a rough idea.

Some key concepts to appreciate as we dive deeper in to PMS:

• The average menstrual cycle lasts 28 days^[1], although a ‘normal’ cycle can be anywhere from 21 to 35 days.
• There are four stages in the menstrual cycle:

Phase 1: Menstruation

Phase 2: End of Period – Ovulation

Phase 3: End of Ovulation-Mid to End of Luteal Phase

Phase 4: Pre-Menstruation

– Each stage varies in length depending on the individual^[1].

What is Pre-Menstrual Syndrome?

Pre-menstrual syndrome (PMS) is defined in literature as a “common health problem in women of reproductive age”^[2]. It is important to appreciate that, aswell as the common physical symptoms that are often discussed, PMS includes a litany of emotional symptoms, and may not actually manifest physically at all^[2].

PMS occurs during the luteal phase (Phase 4) and can extend into Phase 1(menstruation) of the menstrual cycle. PMS is fairly common, affecting 30-41% of women of reproductive age^[3],[4]. PMS can manifest in a host of ways and symptoms range from moderate-severe.

Physical symptoms include:

• Fatigue
• Weight gain
• Aches
• Increased appetite
• Abdominal bloating
• Fluid retention in the extremities^[5].

Psychological manifestations include:

• Irritability
• Sadness
• Poor sleep quality/duration
• Depression
• Mood swings^[5].

As you can see, there are a whole host of unpleasant symptoms associated with PMS. Not everyone will experience them all, to the same intensity. As you no doubt appreciate by now, it is very individual.

How PMS Symptoms Influence Eating Behaviour

Psychological Features

As we have discussed, there are a huge host of psychological manifestations of PMS. Some of these symptoms may alter eating behaviour in certain individuals. Poor emotional regulation and alexithymia (difficulty labelling emotions) (common symptoms of PMS) are also associated with disordered eating behaviours, such as binge-eating^[6]. Similarly, anxiety and stress are also linked with altered dietary patterns^[7].

Of course, it is important to note that individuals can suffer from these psychological ailments at any stage in their life, nhey are not necessarily related to the menstrual cycle. In addition, suffering any of these symptoms does not necessarily mean you will have increased drive to eat. However, for some individuals it may shed some light on why you feel like snorting that entire bar of chocolate.

Physical Manifestations: Increased Appetite

Fatigue is a common symptom of PMS, and for some, may increase in line with sleep disturbances in Phase 3, but can also increase in severity during Phase 4 and into Phase 1 (particularly if you suffer from heavy menstrual bleeding which may put you at risk of having low iron levels)[8]. Poor sleep and tiredness are sometimes associated with increased calorie consumption and poor diet for males and females, and therefore could be a contributing factor to those menstrual cycle-related cravings [9].

Literature suggests an increase in resting metabolic rate (RMR) during the luteal phase of menstruation^[10]. This small increase in energy demand may account for an increased appetite. It must be noted however, for most women this increase in RMR is very minimal.

The Problem with Food Cravings: What the Science Says

Cravings or small, intense increases in appetite can be caused by a number of things – stress, dieting, energy intake, sleep, hormones (menstrual and non-reproductive related), exercise (to name but a few).

For this reason, it is hard to create studies that account for or control for all of these variables.

It is a common held belief that cravings are associated with the onset of periods. Many believe that this is related to physiological changes that occur around menstruation. The literature, however, is far less clear-cut.

Some literature suggests that cravings may increase in the luteal phase^[11], but other studies are less conclusive.

One study found that 97% of women experience food cravings, but only 32% of women believe their cravings are linked to their cycle^[12]. A 2004 study of American and Spanish women found that cravings for chocolate typically began 2-3 days before menstruation^[13]. However, these results were only statistically significant for the American women. Amongst college students, cravings did not differ depending on the stage of menstruation^[14].

This indicates that it is less likely to be a physiological change that drives cravings, and more likely cultural/psychological influences.

Strategies for Managing Cravings

Armed with an increased awareness of the causes of food cravings, we can now discuss methods of managing cravings.

#1: Track your cycle.

This will be the most helpful strategy. With so many different influences on cravings, it can help to track your cycle and note the symptoms you have around your cycle. I use the FitrWoman app to do this. It is so straight-forward. Once we know what we’re working with, we can identify patterns and implement strategies where appropriate.

#2: Manage your stressors.

Bleeding from your reproductive organs is stressful enough for most of us. Add in reduced sleep, emotional chaos and increased anxiety and you have reason enough for stress eating. This style of emotional eating can be reduced by doing what you can to alleviate stress. Breathe, go for a walk, meditate, read, journal. Try to feel the feelings.

#3: Audit your behaviour.

It might be worthwhile to sit down and think about your cravings. Do you really always crave chocolate because your period is due? Or is it the other way around? Have you developed an identity that is based on a story you tell yourself, without genuinely asking if it’s true?

There is no right or wrong answer here, and I’m not going to womansplain your own period to you. But it can be a worthwhile exercise!

Does it need to be managed?

You might think that cravings are something that need to be stamped out right away. But is consuming a bit of extra chocolate two or three days a month really something you need to change in the grand scheme of things? Sometimes we have cravings because we’ve been restricting or because that’s what the body really needs! Consider this in the context of your goals. Through tracking your cycle and your nutrition, we get the data needed to make an informed decision.

Conclusion

Hopefully, you have an appreciation of just how complex PMS and cravings are, and how difficult it is to pin down an exact root cause. Everyone’s cycle is different, and the best advice I can give you is to track your cycle and make an informed decision from there.

You can download the FitrWoman app here.

References

1. Mihm, M., Gangooly, S., Muttukrishna, S. (2011) ‘The normal menstrual cycle in women’, Animal Reproduction Science, 124(3-4), pp. 229-236.
2. Direkvand-Moghadam, A., Sayehmiri, K., Delpisheh, A., Kaikhavandi, S. (2014) ‘Epidemiology of Premenstrual Syndrome (PMS): A Systematic Review and Meta-Analysis Study’, Journal of Clinical & Diagnostic Research, 8(2), pp. 106-109.
3. Zhao, G., Wang, L., Qu, C. (1998) ‘Prevalence of premenstrual syndrome in reproductive women and its influential factors’, Zhonghua fu Chan ke Za Zhi, 33(4), pp. 222-224.
4. Singh, B.B., Berman, B.M., Simpson, R.L., Annechild, A. (1998) ‘Incidence of premenstrual syndrome and remedy usage: a national probability sample study’, Alternative Therapies in Health and Medicine, 4(3), pp. 75-79.
5. Ryu, A., Kim, T.H. (2015) ‘Premenstrual syndrome: A mini review’, Maturitas, 82(4), pp. 436-440.
6. Wheeler, K., Greiner, P., Boulton, M. (2005) ‘Exploring Alexithymia, Depression and Binge Eating in Self-Reported Eating Disorders in Women’, Perspectives in Psychiatric Care, 41(3), pp. 114-123.
7. Canetti, L., Bachar, E., Berry, E.M. (2002) ‘Food and emotion’, Behavioural Processes, 60(2), pp. 157-164.
8. Kocaoz, S., Cirpan, R., Degirmencioglu, A.Z. (2019) ‘The prevalence and impacts of menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age’, Pakistan Journal of Medical Sciences, 35(2), pp. 365-370.
9. Chaput, J.P. (2014) ‘Sleep patterns, diet quality and energy balance’, Physiology & Behavior, 134, pp. 86-91.
10. Benton, M.J., Hutchins, A.M., Dawes, J.J. (2020) ‘Effect of menstrual cycle on resting metabolism: A systematic review and meta-analysis’, PLoS One, 15(7).
11. Trout, K.T., Basel-Brown, L., Rickels, M.R., Schutta, M.H., Petrova, M., Freeman, E.W., Tkacs, N.C., Teff, K.L. (2008) ‘Insulin Sensitivity, Food Intake, and Cravings with Premenstrual Syndrome: A Pilot Study’, Journal of Women’s Health, 17(4), pp. 657-665.
12. Weingarten, H.P., Elston, D. (1991) ‘Food cravings in a college population’, Appetite, 17(3), pp. 167-175.
13. Zellner, D.A., Garriga-Trillo, A., Centeno, S., Wadsworth, E. (2004) ‘Chocolate craving and the menstrual cycle’, Appetite, 42(1), pp. 119-121.
14. Apperson-McVay, M., Copeland, A.L., Newman, H.S., Geiselman, P.J. (2012) ‘Food cravings and food cue responding across the menstrual cycle in a non-eating disordered sample’, Appetite, 59(2), pp. 591-600.