PMS and Eating Disorders
Eating disorders and premenstrual disorders, including PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder), are often closely connected. For many individuals, the hormonal and emotional changes that occur in the days leading up to menstruation can intensify eating disorder thoughts, increase urges to engage in eating disorder behaviours, and make recovery feel significantly more difficult.
In this article, we will explore why this happens and how PMS and PMDD can affect eating disorder recovery.
PMS and PMDD:
PMDD affects approximately 3–8% of women, while PMS affects an estimated 20–32%. The symptoms of both conditions, which I will explain in more detail below, occur during the luteal phase of the menstrual cycle - the 12 to 14 days leading up to 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 who experience a significant increase in appetite and food cravings during the luteal phase are more susceptible to binge eating. In addition, bloating, water retention, and temporary fluctuations in weight can intensify body image distress and trigger urges to restrict, binge, and/or purge. These behaviours are often closely connected, with one frequently leading to the next.
A very common eating disorder symptom during the luteal phase, particularly for those struggling with PMS or PMDD, is an increase in negative body image. This can lead to more body checking, weighing, intrusive thoughts, and a strong urge to “fix” what feels wrong through eating disorder behaviours.
At the same time, many individuals experience increased anxiety and a greater tendency to withdraw socially, often in direct correlation with heightened body image distress and body dysmorphia.
Beyond the physical ways that PMS and PMDD can trigger eating disorder symptoms, the psychological symptoms can be equally impactful. Feelings of sadness, hopelessness, anxiety, depression, stress, and irritability can lead individuals to engage in eating disorder behaviours, such as binge eating and/or purging, as a way of coping with these difficult emotions.
How This Awareness Supports 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 learn more about our services and the types of support we offer, we invite you to reach out. We offer complimentary discovery calls and would be happy to connect, learn more about what you are struggling with, and discuss how we may be able to help.
