Written by:

Taylore A. Passero PA-C

Frank Michalski DC CFMP

Understanding PMS

All right ladies, let's talk about that time of the month! As women, we are blessed with the ability to reproduce and grow new life. With this blessing comes the oh so dreaded monthly periods. For some lucky ladies, their periods are very manageable and cause minimal disruption to their day to day life. However, for some women, their periods are a time of exhaustion, pain, and inconvenience. Along with their periods, most women will also experience PMS symptoms.  

PMS, also known as premenstrual syndrome, is a combination of both emotional and physical symptoms that women can experience during their cycle. To understand when and why PMS occurs, we must first have a basic understanding of the menstrual cycle in general. 

The menstrual cycle is more than just your period! Your period only accounts for the first couple days of your cycle.  During the entire month, hormonal signals are sent back and forth between the brain and the ovaries and are responsible for the changes that occur within the female reproductive tract. There are four separate phases during the cycle: Menstruation, the follicular phase, ovulation, and the luteal phase. The cycle starts with the first day of bleeding and continues for an average of 5 days.

During this time the endometrial lining is shedding. Next comes the follicular phase. In short, the follicular phase is the time between menses and ovulation. During this time, your pituitary gland within the brain releases a hormone called FHS (follicle stimulating hormone). FSH circulates to the ovaries and helps to mature the egg in preparation for ovulation. While this is occurring, estrogen levels begin to rise in the blood. Once estrogen levels peak, this triggers the release of another pituitary hormone called LH (luteinizing hormone). The spike in LH causes ovulation. Ovulation marks mid-cycle and typically occurs around day 14. After ovulation comes the luteal phase. During the luteal phase, the endometrium is preparing for implantation. When implantation does not occur, there is a drastic decrease in estrogen levels within the blood. This then triggers the onset of your next menses. 

Symptoms of PMS

Now that you have a general understanding of the menstrual cycle, you can begin to understand PMS. Symptoms of PMS occur during the luteal phase of the cycle and extend into the first couple days of menses. Therefore, women typically experience symptoms during days 14-28 and continue through days 1-4/5.

Symptoms of PMS occur due to the decrease in estrogen levels within the blood. As stated above, once estrogen levels start to increase, and menses begins, symptoms tend to level off, and women have a stretch of days without any symptoms.

Over 90% of females will experience symptoms of PMS during their reproductive life, which is considered the time between their first menstrual period and menopause. That's 9 out of every ten women! What most women don't know is that PMS encompasses a lot more than just mood swings. PMS is a combination of both emotional and physical symptoms. There are actually over 200 different symptoms that women can suffer experience! Some of the most common symptoms are: headaches, hot flashes, bloating, cramps, swollen and tender breasts, acne, muscular pain, back pain, constipation or diarrhea, fatigue, increased or decreased appetite, mental fogginess, anxiety, depression, sadness, anger/ irritability, insomnia, trouble concentrating, and reduced libido.

As you can see, PMS is no joke! As young women, we are busy juggling school, family, friends, social commitments, and careers. Dealing with PMS symptoms on top of this all can leave women frustrated and looking for relief.

Because there aren’t any physical tests or lab values that we can measure, PMS is very much a clinical diagnosis. I always encourage women to keep a menstrual diary and log their symptoms. As young girls, we were always taught to never talk about our periods. Even though having periods was inevitable, this subject was somewhat taboo. However, as you can see, if women do not pay attention to their bodies and talk about their periods, they would never know what is and isn't healthy. Although having your period is not the most pleasant experience, women should never feel like they are suffering. They should not feel like they are losing days out of the month due to their symptoms. 

To be diagnosed with PMS, women only need one symptom to occur for two months in a row during the luteal phase of their cycle. These symptoms must then resolve within 4-5 days after their next menses begins.

Now that you have a better understanding of PMS in general let's begin to discuss some of the treatment options.

CBD and other PMS treatments

Several different treatment options can help women who are dealing with PMS symptoms. Because the effects of PMS are so widespread, I like to use a layered approach when treating women. When talking to patients, I always start with recommending lifestyle modification such as healthy diet, exercise, yoga, the use of heating pads, smoking cessation, and decreased alcohol consumption. Next, I recommend incorporating vitamins into your daily routine. Magnesium is one of my favorite vitamins! Not only does it help reduce menstrual cramps, but Magnesium also helps to promote a healthy gut, helps to decrease hot flashes, helps to decrease headaches/migraines, helps to decrease anxiety, and helps to combat insomnia.

Another great vitamin is vitamin E oil. As many women know, breast tenderness is a common PMS symptoms. Taking vitamin E oil daily can help to alleviate some of this breast tenderness. After recommending healthy lifestyle changes and vitamins to patients, I then recommend starting a form of hormonal birth control. Birth control is one of the most common pharmacological agents used to help control PMS symptoms. After starting birth control, I then tailor my treatment plans to each patient. If women are complaining of mood issues, we can consider starting an antidepressant such as an SSRI or an SNRI. If women are complaining of menstrual acne, we can consider starting a medication called spironolactone. If women are complaining of headaches or migraines as can considering starting a medication called sumatriptan. The list of pharmacological agents goes on! 

Last on the list of treatment options is supplementation! Supplementation is one of my favorite conversations to have with women because of the effectiveness of treatment and the minimal amount of side effects. CBD oil is a fabulous option for women suffering from PMS.


Your endocrine system regulates much of what occurs during the menstrual cycle. The endocrine system is responsible for many of the hormonal changes that occur in a female's body. Did you know that the endocannabinoid system (ECS) has a significant impact on the function of your endocrine system? It may surprise you, but cells found in the uterus, reproductive system and within the endocrine system all have endocannabinoids. This intimate connection between your endocrine system and ECS explains why CBD oil could benefit those suffering from PMS. This information is nothing new!

In 1989 doctor J. W. Farlow described using cannabis suppositories to ease menopausal symptoms: "the irritability, the pain in the neck of the bladder, flashes of heat and cold, according to my experience, can be much mitigated." Even Queen Victoria in England was prescribed cannabis for dysmenorrhea. 

Much like menopause estrogen levels have a significant impact on PMS symptoms. Estrogen stimulates the ECS. As levels of estrogen change, so does the response of the ECS. As estrogen levels decrease and progesterone increases symptoms of pain, mood swings, fatigue, and bloating may occur. Taking a CBD supplement appears to help balance the ECS, in lieu of the hormonal changes. When the ECS is balanced a healthy mood, sleep-wake cycle, stress response, and energy levels are also promoted. CBD adds balance to the bodies systems. Can you think of a better time to find balance than when a female is going through her monthly cycle?

What about the period cramps? Many women I have worked within the past report that applying a small amount of CBD cream to the lower abdominal region goes a very long way. I recommend the 3.8oz 500mg cream.

The serving size will vary greatly. Most women will find that a serving of 5-100mg should do the trick. Recall as estrogen levels change, so may your serving size. Start slow, monitor your symptoms, and be patient. Each month we receive such positive feedback on using CBD for women's health.

Side Note:

CBD and birth control are there any interaction? Like most things, there is a small chance that CBD may interfere with some birth control medications. For most is you are consuming less than 35mgs of CBD a day this "most likely" is not an issue. For those of you using estrogen-based BC pills be aware that CBD combined with BC may increase breakthrough bleeding and decrease BC effectiveness. If you are using a progesterone-based BC, the chances of interactions are less likely. The relationship between BC and CBD is poorly understood, and more research is warranted. For many people, the benefit of CBD may outweigh the risk, consider your options, and go from there. Again, I would like to emphasize in serving sizes less then 40mg daily this is “most likely” not an issue.

Lastly, if you are concerned that your hormonal levels are "off," seek out the care of a functional medicine physician today. Instead of guessing what is high and what is low seek testing! Saliva testing can provide an excellent snapshot of active hormonal changes.

As you can see, PMS can cause significant distress for females. As women are leading busier lives, they do not need their periods bringing them down! I urge you to pay attention to your bodies and talk to your local health care provider if you believe you are suffering from PMS. 

*This content is strictly the opinion of Dr. Frank Michalski and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Frank Michalski nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.




  • CBD A Patients Guide to Medicinal Cannabis by Leonard Leinow & Juliana Birnbaum


Written by,  

Taylore A. Passero PA-C

Frank Michalski DC CFMP