When the Pandemic Makes PMS Stress Worse, Seek Carbohydrates

COVID-19 stress is exacerbating pre-existing conditions.

Posted Sep 10, 2020

Should it be surprising that the symptoms of Premenstrual Syndrome (PMS), those monthly changes in mood, appetite, sleep, and energy occurring a few days before the end of the menstrual cycle, may be affected by the stress of the pandemic? Research suggests that any extraneous stress may worsen the symptoms of PMS, and few of us have escaped the stress of COVID-19 these many months.

PMS may start as early as adolescence and last until the onset of menopause. Not all women experience PMS; some may experience PMS erratically with no symptoms some months and have mild to severe symptoms other months. The number of days the symptoms last can vary to less than one (just a few hours) to as many as 10 days or more, and the symptoms vary widely. The symptoms disappear with the onset of menses (bleeding).

According to the American College of Obstetrics and Gynecology, premenstrual symptoms may include depression, anger, irritability, crying, anxiety, confusion, lack of focus and concentration, and physical symptoms as well, such as disrupted sleep, food cravings, breast tenderness, bloating, and weight gain.

The cause of these repetitive changes in physical and mental well-being was misunderstood for centuries, and even as the late 20th century, interventions were being suggested that were useless or made the symptoms worse. Gynecologist Robert Frank first labeled the monthly changes in mood premenstrual tension and believed the "tension" was due to the accumulation of a sex hormone (estrogen) produced by the ovaries. When his simple remedies of diuretics (such as coffee or tea) didn’t seem to help, he X-rayed or removed women’s ovaries. What he did not know at the time was that estrogen levels naturally decrease by end of the menstrual cycle.

Many decades later, a similarly erroneous treatment for PMS became very popular. In the late l990s and early 21st century, it was believed that low progesterone levels were responsible for the symptoms of PMS, and countless women were treated with this hormone. Many studies later, it became clear that there was no relationship between the levels of progesterone in women who did or did not have PMS symptoms.

What is agreed to by experts (the women who have PMS) and those who study it is that women may feel exceptionally stressed. In the chapter Premenstrual Syndrome and Criminal Responsibility, the author describes how women in the UK had their violent murder convictions reduced to manslaughter because it was held that PMS stress diminished their ability to act rationally. Similar defenses have been used in cases in the U.S. involving homicide.  

Although these are extreme and rare examples of the toll PMS can take on behavior, women are advised to avoid, if possible, situations that may exacerbate stress: presentations at work, important financial or lifestyle decisions, buying a house, or having a mother-in-law as a house guest. A friend who was in charge of the computer systems for a major university told me she dreaded emergencies when she had PMS. “It was extremely difficult for me to control my emotions,” she told me.

I remember having to give a presentation at a scientific meeting and not being able to communicate what my slides were depicting. I realized after I stumbled through my talk that I had PMS. My memory had disappeared, and I simply could not focus. 

The neurotransmitter serotonin appears to be responsible for many of the behavioral changes of PMS, although probably not the physical ones, such as bloating. Women who suffer from a severe form of PMS called premenstrual dysphoric disorder (“PMDD”) have been treated with antidepressants such as Sarafem, Zoloft, Paxil, and Celexa because they increase serotonin activity. The drugs act quickly and need not be taken for more than a couple of weeks each month.

However, most women turn to carbohydrates when they are premenstrual, often sweet carbohydrates like chocolate, but starchy ones as well. Are they doing so because of the taste (creamy chocolate, salty crunchy chips) or because the effect of consuming carbohydrates is to make them feel better due to increased serotonin activity? A study looking at the effects of consuming carbohydrate or protein (the latter prevents serotonin synthesis) found significant improvement in the moods, focus, and cravings only after carbohydrate consumption.

These results suggest that the natural, non-drug “remedy” of eating carbohydrates is an effective way to decrease the behavioral and appetitive symptoms of PMS, certainly when the symptoms are mild to moderate. But is this sufficient when the normal stress of PMS is exacerbated by the additional stress of social isolation, anxiety, boredom, financial worry, in addition to months more of working from home with children learning online at home, and on and on? A supper consisting only of popcorn drenched in hot fudge sauce may seem the perfect answer but is clearly at odds with eating a healthy diet

A nutritional compromise may be the solution. A workable menu to relieve PMS and COVID-19 stress might look like this:

On particularly bad PMS days, breakfast should provide as much nutritional value as possible. Foods high in protein, especially those high in calcium such as high-protein yogurt, should be eaten, along with nutrient-dense fruit such as oranges, blueberries, strawberries, and bananas.

Lunch may coincide with a worsening of the PMS symptoms, and relief may be found in eating complex carbohydrates: brown rice, quinoa, beans, lentils, farro, sweet or white potatoes, couscous, pasta, or oatmeal. Consuming them will ensure serotonin synthesis and take the edge off of the PMS/COVID-19 stress.

If the stress becomes much more intense by late afternoon or early evening, an irresistible need to eat sweet carbohydrates, especially chocolate, may arise. The nutritionally responsible thing to do is ignore these cravings. Yet doing so may worsen the PMS stress; acknowledging them and giving in will reduce the stress and make the evening bearable.

A supper of popcorn with melted chocolate chips, toast, and honey, or toaster waffles with maple syrup should hasten serotonin synthesis, as these carbohydrates are digested rapidly and bring out much-sought-after relief due to the rapidly increasing serotonin. No, this is not a nutritionally sound meal, but for the stressed premenstrual woman, it may be emotionally sound. And that is what is needed at this time of the month.


“Perceived stress and severity of perimenstrual symptoms: the BioCycle Study,” Gollenberg A, Hediger M, Mumford S, et al., J Womens Health. 2010; 19:959-967.

“Fenfluramine suppresses the increased calorie and carbohydrate intakes and improves the mood of women with premenstrual depression,” Brzezinski, A. Wurtman, J. Wurtman, R. et al., Obstet. & Gynecol., 1990; 76:296-391.