Fact-checked by Dr. Anthony Gustin, DC, MS.
Written by Emily Ziedman
Headaches, cramps, brain, and mood swings. As many as three out of four women experience symptoms like this and more during that time of the month[*].
When your hormone levels are out of balance, it can feel like your whole life is out of balance. Whether its insulin sensitivity, PCOS, or high estrogen levels causing symptoms of PMS, cleaning up your diet is a crucial step if you want to feel your best.
You may turn to birth control to try to manage the unpleasant symptoms that come along with your period, but a low-carb diet may be a more natural alternative with far fewer side effects.
Let’s explore how the keto diet can affect women’s health, and why you might want to try it to help with some common PMS symptoms.
PMS, or premenstrual syndrome, brings up a different picture for almost everyone. For some, it’s a time when women just get a little moody or “spicey.”
For others, PMS results in debilitating symptoms that require days in bed, making them miss work or time with loved ones.
In reality, PMS is an epidemic issue in the United States.
Premenstrual syndrome is a catch-all term used for a wide range of symptoms that many women experience about a week to two weeks before their period starts.
It affects millions of women in the U.S. and is a combination of both physical symptoms, like headache and breast tenderness, and emotional symptoms, like anxiety, depression, and irritability.
The amount of discomfort you feel from PMS symptoms can vary greatly, depending on the status of your health and hormones. Some women can go for a walk to de-stress and find their balance, while others feel like they’ve been hit by an 18-wheeler.
- Breast tenderness
- Constipation or diarrhea
- Bloating and gas
- Sleep issues
- Food cravings
- Trouble with concentration
- Poor memory
- Mood swings
- Low libido
Although the medical community has yet to name the exact cause of PMS, it’s well understood that a disruption in normal hormone balance is behind many of the unwanted symptoms.
The two key sex hormones, estrogen and progesterone, are often at the root of many of the symptoms associated with PMS[*].
So what causes this disruption in hormone balance in the first place?
Research suggests that lifestyle factors like stress, diet, and exercise all impact PMS symptoms. Also, environmental factors like toxins can create a burden on the body that may lead to hormone imbalance[*][*][*][*].
Hormonal imbalances related to PMS mostly show up as estrogen dominance, low estrogen, or low progesterone.
Too much estrogen in your system is associated with either low progesterone or too much estrogen overshadowing progesterone and other sex hormones.
Symptoms of estrogen dominance include[*]:
- Breast tenderness
- Mood swings
- Painful periods
- Hair loss
- Foggy headedness
- Memory loss
- Heavy periods
Estrogen is depleted due to stress or other lifestyle factors like poor diet.
Symptoms of low estrogen include[*]:
- Hot flashes
- Night sweats
- Overactive bladder
- Vaginal dryness
- Low libido
- Painful sex
Can be due to too much estrogen (binding to progesterone receptors), or due to stress hormones using up progesterones precursors (too much cortisol).
Symptoms of low progesterone include[*]:
- Breast tenderness
- Irregular cycles
- Heavy period
- Sleep disruption
Progesterone and estrogen balance are crucial for overall hormone balance.
They work together in a dance that allows your uterine lining to build before your period, and then release when it’s time for menstruation. They’re so closely aligned that irregularities in either hormone will lead to an imbalance in the function of the other. They even share many of the same receptors on your cells[*].
Diet can play a huge role in your hormonal health, both directly and indirectly.
What you eat affects how your hormones behave and which hormones are predominant.
A few significant factors that affect hormone health is the maintenance of your blood sugar, systemic inflammation, your nutrient status, and current weight.
When you’re blood sugar is high from eating too many carbs or sugar, your pancreas releases the hormone insulin to shuttle that excess sugar out of your blood and into your cells.
This system exists so that your blood doesn’t become too saturated with glucose, which can lead to a host of health issues.
Insulin, like every other hormone in your body, doesn’t work in a vacuum. In fact, quite the opposite is true. When your body releases insulin, it affects many other hormones in your body, like estrogen, testosterone, and progesterone.
Here’s how it works:
When insulin is high, it leads to lower levels of a protein called sex hormone binding protein(SHBP).
SHBP does exactly what its name implies — it binds to, and decreases, the levels of estrogen and testosterone in your body. You always need checks and balances with hormones to make sure they don’t go too high or too low. SHBP does a fantastic job of this…when it can do its job,
As you learned above, estrogen dominance is highly associated with the symptoms of PMS, and this increase in estrogen via high insulin can further push your body towards estrogen dominance.
Keep your blood sugar and insulin response low, and SHBP stays at healthy levels, which keeps all of your hormones in a more balanced state.
Another issue that can result from eating too much sugar is magnesium deficiency. Magnesium plays a vital role in hormone health, and low levels of magnesium are associated with symptoms of PMS[*].
Both insulin and glucose are essential regulators of magnesium metabolism. Several studies have found a correlation between low magnesium and occurrence of insulin-resistance. As insulin resistance increases, urinary loss of magnesium also increases[*].
Magnesium plays a crucial role in phase II liver detoxification — a crucial mechanism that removes excess estrogen and its metabolites from your body.
When working smoothly, it helps manage your estrogen balance by pulling out what you don’t need. When this system is not functioning due to low levels of magnesium, you’re more prone to estrogen dominance[*].
Diet is one of the main factors that can cause chronic inflammation. Inflammation is bad news for your entire body, but it’s especially rough on your hormones.
To assess the link between inflammation and symptoms of PMS, researchers looked at the C-reactive protein (CRP) levels in a group of 2,939 women and measured these levels against their PMS symptoms. CRP is a marker for inflammation made in your liver.
The researchers found that several PMS symptoms were significantly correlated with high CRP levels. The symptoms most strongly associated with inflammation were cramps, back pain, mood swings, bloat, and an increase in appetite[*].
Inflammation has also been strongly correlated with insulin resistance. As you learned above, insulin resistance has its own effect on your hormones, often leading to estrogen dominance[*].
When you have too much glucose in your blood — a state called hyperglycemia — your immune system goes on the defense, releasing a cascade of inflammatory chemicals. These inflammatory compounds are what lead to inflammation and potential organ damage.
Inflammation may affect your sex hormones by either increasing estrogen or decreasing it.
And low estrogen has been associated with a decline in cognitive functions like memory.
The enzyme aromatase is an essential enzyme that’s involved in estrogen production. It assists in the conversion of testosterone to estrogen and is located in the estrogen-producing cells of the adrenals, ovaries, placenta, adipose tissue, and brain.
When working properly, this enzyme helps you maintain a steady state of estrogen by catalyzing the production from testosterone. But too much inflammation can over-activate aromatase — leading to excess estrogen production and subsequent estrogen dominance[*].
Rapid Weight loss
While slow and steady weight loss can enhance your health in many ways, losing weight too quickly has some downsides — loss of menstruation or irregular periods being a couple.
Rapid weight loss can lead to amenorrhea (loss of menstrual cycle). This is likely due to a drop in the hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH hormones trigger ovulation, the release of the egg from your ovaries. They’re also involved in the production of estrogen and progesterone[*].
One study looking at the correlation of weight loss and amenorrhea found that when women lost significant amounts of weight, they had a proportional decline in menstruation.
Along with amenorrhea, they saw a considerable decrease in LH, FSH, and estrogen. They also showed an increase in cortisol — which can further drain your body of estrogen and progesterone[*].
Many women struggling with hormone imbalances find it difficult to either fall asleep or stay asleep. If you’ve ever struggled with sleep issues, you know that a bad night’s sleep can ruin the entire next day.
Some people experience sleep disturbances during the first couple of weeks of a keto diet. That’s due to your body’s transition from a glucose-burning state to a fat-burning, ketone-producing state.
And it’s totally temporary.
In fact, most people report much better sleep quality once they’re officially in ketosis. And that may be due to a compound called adenosine.
Adenosine is known as a neuromodulator and plays a number of important roles in the function of your central nervous system. Well understood as an anticonvulsant for people with epilepsy, adenosine is also an essential chemical for moderating sleep behavior[*].
#2: Balancing Insulin
As mentioned earlier, keeping your insulin in check is crucial for the balance of your sex hormones. Your hormonal system is like a Jenga tower — when one piece falls out of place, the whole thing can collapse.
Okay, that was a bit dramatic, but the point is that nothing happens in your hormonal system in isolation.
Being in ketosis means that you’re limiting the amount of glucose in your blood. When glucose is low, insulin follows and will also stay low. The absence of excess insulin gives your sex hormones a chance to find their natural balance[*].
One of the most common PMS symptoms is cravings. Whether it’s for sweets, salt, fat, or all of the above, something about getting your period makes many women feel out of control with food.
Ketosis can help with cravings in a couple of different ways. First, by lowering your carb intake, you’ll automatically control your blood sugar, a common sweets cravings culprit.
And second, being in a state of ketosis may help lower your “hunger hormone,” ghrelin[*].
You produce ghrelin in your stomach and that’s what stimulates your appetite. Its job is to signal you to increase your food intake and fat storage.
By managing these two hormones, insulin and ghrelin, you’ll have a leg up on those pesky cravings that pop up once a month. Without those cravings whispering in your ear, you’re much more likely to make positive food choices and reap the benefits of avoiding the greasy, sugary meals that only offer temporary relief.
The ketogenic diet is highly anti-inflammatory. As you learned above, inflammation can wreak havoc on your hormonal system and cause fluctuations in your hormones that could lead to massive PMS symptoms.
When you’re in a state of ketosis your blood is flooded with ketones. And ketones are not only a fantastic alternative energy source to glucose, but they’re also anti-inflammatory.
Since many of the symptoms associated with PMS are also associated with inflammation, high levels of BHB may help to mediate some of the discomfort that comes along with your menstrual cycle[*].
#5: Trouble With Concentration And Memory
There’s nothing more frustrating than sitting down to do some work when you’re brain is clouded and foggy. Hormone imbalance, especially estrogen dominance, can result in brain fog and poor memory.
Ketones are like little superheroes for your brain. They’re anti-inflammatory, and your brain can use them even more efficiently than it does glucose.
In fact, during brain injury, the uptake of ketones by the brain increases significantly[*].
Many people report better memory, concentration, and learning when following a ketogenic diet. This is most likely due to an increase in the protein brain-derived neurotrophic factor (BDNF) as well as the enhanced bioavailability of ketones to the brain[*][*].
Don’t give up if you don’t see results right away. Your hormonal issues didn’t manifest overnight, and unfortunately, you won’t cure them overnight either. It may take a few cycles to get back into balance, so before you throw in the towel, try these tips that may help you stay the course:
#1 Keep A Hormone Journal
You’re going to want to track your progress as you go. It can be very easy to forget how bad your cramps were a couple of months ago when you’re not feeling them anymore.
Or to completely forget how you once woke up in a sea of sweat when you’re now sleeping through the night.
Track any symptoms you’re currently feeling, old and new, through the month and pay attention to where you are in your cycle. This way, you’ll be able to identify the subtle changes that are happening in your body.
#2: Test Your Thyroid
As mentioned earlier, none of your hormones work in a vacuum. When one is off, the others are most likely off as well.
One of the common hormones that can fall out of balance is your thyroid hormone. Low levels of thyroid hormone can reduce sex hormone binding globulin (SHBG), which is responsible for binding to estrogen and testosterone. When SHBG is low, estrogen dominance can occur due to a decrease in binding[*][*].
Studies have shown that eating a super low-carb diet may cause an even more dramatic imbalance in your thyroid hormone. The thyroid needs a certain amount of carbohydrates to function optimally.
This may sound counter-intuitive since you’ve just learned about all the ways that low-carb can support hormone health, but even just 50 grams of carbs a day should be enough to keep your thyroid happy[*]. And that will definitely keep most people in a state of ketosis.
If you’re feeling very lethargic or know that you have a thyroid issue, try increasing your carbs slightly.
#3: Move More
If you’re not moving your body in some way or another (walking, running, yoga, soccer, whatever floats your boat) every day then you’re missing out on an important aspect of hormone balancing.
Exercise can also help you balance your blood sugar. Female athletes following a ketogenic diet have higher levels of glucagon, a hormone involved in controlling blood sugar. As mentioned throughout this article, maintaining balanced blood sugar is a crucial cornerstone of hormone health[*].
#4: Add Krill Oil
Krill oil has a whole host of health benefits due to its high omega-3 content. From heart health, to brain function, to hormone balance, if you aren’t taking krill oil already you may want to grab a bottle[*][*].
One study with 70 female participants found that supplementation with krill oil resulted in lower stress levels, enhanced mood, lowered irritability, and decreased use of pain medication[*].
Another chemical that can wreak havoc on your hormones is cortisol.
When you’re stressed out, cortisol increases a response known as the “fight or flight response.” This is an adaptation meant to protect us from over-thinking in situations where running or fighting are better than thinking and planning — like when a lion is chasing you.
Fortunately today we don’t encounter many lions in our day to day life, but our stress response hasn’t adapted to modern stressors like deadlines, traffic, and difficult bosses. So whether we like it or not, when we feel stressed our body wants to run from a lion.
The big issue with cortisol and hormone balance is that your sex hormones share the same precursor as cortisol — pregnenolone. When your stress is high, you use more pregnenolone to make cortisol, leaving little left for your sex hormones. This is often referred to as the “pregnenolone steal.”
Finding ways to deal with your stress so it doesn’t create the fight or flight response can be vital for balancing your hormones.
PMS has been normalized in our culture, but it’s far from normal to be in pain every month.
The good news is — you can make some huge strides in symptoms management just by changing your diet and lifestyle. You may even lose some unwanted body fat along the way.
If you experience symptoms of PMS, then you need to look to your hormones. Estrogen and progesterone are the two main culprits, and you need to make sure these are in balance if you want to look and feel your best.
A low-carb, high-fat diet supports hormone health and symptoms of PMS in a variety of ways including; blood sugar control, anti-inflammation, balancing cravings, helping with brain fog, and enhancing sleep quality.
The transition period known as keto-adaptation or “keto flu” may feel like you’re taking a step back, but if you stick with it, there are some fantastic benefits on the other side.