PMS: What to do about it

If you have read PMS: The Underlying mechanism, you probably know what I think you should do. For those of you who want a quick answer, here it is.

  • Magnesium supplements:  Your daily requirement is about 600mg, and you need half of that from supplements. If you have constipation problem, start with a magnesium based laxative. It may take up to 2 month for the supplement to take full effect. Those who tend to have loose stool, divide the dose into small doses and take it through out the day. Mineral water is also good.
  • Probiotics: Yogurt is one of them. Or if you don't care for yogurt, there are a variety of probiotics supplements on the market. However, it is leafy greens rather than yogurt that promote healthy gut microbes (demonstrated in one of BBC health shows), probably due to the nutrients leafy greens provide. 
  • Progesterone in cream form (10 to 40mg/day): This is especially important if you tend to have diarrhea, menstrual cramps, heavy bleeding, or if you are in transition (over 35yrs old). For the detail of how to apply the cream, see How to use natural progesterone supplementation.
  • Reduce exposure to toxins:  Magnesium and Progesterone will help you cope with toxins, but it is very important not to accumulate more toxins in your body; including heavy metals such as lead and arsenic; and estrogen like substances such as solvents, herbicide, pesticide, Bisphenol A (BPA) in soft plastic such as water bottles and plastic wraps (avoid any food or drink heated or stored directly in such plastics as much as you can. You can smell or taste BPA when it is really bad). 
When it comes to nutritional supplements, it is best to cover all bases, and vitamin B complex is especially important to support your metabolism and brain functions.


  1. Hello Etsuko,
    I just discovered your hormone research blog and noticed you haven't posted since 2013. First, thank you for sharing your research. I'm 55 and started 0.05mg Mylan estradiol patch + 100mg micronized progesterone orally/day about 3 months ago to address hot flashes. In that time I gained about 15 lbs and my joints became very achy and stiff. I started wondering if one or both hormones was the cause and if I could lower my dose. After reading your blog I suspected the progesterone was too high and switched to cream. I felt much better withing a few days! I haven't tried DHEA, yet, but am considering. One question: I've read recommendations for both continuous use of progesterone cream or 25 days/month with 3-5 days off. Which to you use?

    1. At the beginning, I took a 3 day break each month, but now, progesterone cream is so much a part of my routine, I forget to take the break. For estradiol patch, I forget to replace it for a few days now and then. In other words, I am not concerned much about it. My feeling is it is more important during the transition and early post meno days to be consistent, especially if you have your uterus, to mimic the natural cycle.


Before you post your HRT questions, please try what I think safe and effective for at least 3 months: estradiol 0.025~0.050mg/day patch, with 20~40mg/day progesterone cream (about 1000mg progesterone in 2oz cream). You can also add DHEA 5~10mg /day.
That is the only recommendation you will get from me.