Premenstrual syndrome (PMS) Treatment in Toronto
Supporting patients living with PMS, PMDD, PCOS and endometriosis
PMS is not simply a normal part of the menstrual cycle – it often reflects underlying imbalances that can be identified and addressed.
A Root-Cause Approach to Premenstrual Syndrome
Over 20 years of clinical experience supporting hormonal health and complex menstrual concerns.
Struggling with PMS, mood changes, or painful periods?
Dr.Makoto Trotter, ND provides personalized, root-cause care for PMS and hormonal imbalances at our Toronto naturopathic clinic.
Rather than simply managing symptoms, we identify the underlying drivers of PMS such as hormone imbalance, stress response, blood sugar dysregulation, and inflammation.
The goal is not just symptom relief, but restoring a stable, predictable menstrual cycle and improving overall hormonal health.
Book a consultation today and take the first step toward lasting relief.
Who This Approach Is For
This approach may be helpful if you experience:
- PMS symptoms that disrupt daily life
- Mood changes, irritability, or anxiety before your period
- Bloating, breast tenderness, or fatigue
- Painful or irregular cycles
- Symptoms not improved with conventional treatment
What is PMS?
Premenstrual Syndrome (PMS) is a collection of physical and emotional symptoms that occur in the luteal phase of the menstrual cycle, typically in the 1–2 weeks before menstruation. Symptoms may include mood changes, fatigue, bloating, breast tenderness, and changes in appetite or sleep.
While PMS is common, it is not necessarily a sign of optimal hormonal health, and in some cases may reflect underlying imbalances in hormone signaling, stress response, or metabolic function.
What are symptoms of PMS?
Before and during your period, you may experience a variety of uncomfortable symptoms. These symptoms can vary in number, frequency, intensity and duration.
You may experience the following symptoms with PMS:
- Headaches
- Acne
- Mood changes
- Fatigue
- Bloating
- Bowel pattern changes
- IBS flare-ups
- Swelling
- Weight gain
- Hair loss
- Breast tenderness
- Food cravings
- Period pain
Menstrual cramping commonly associated with periods or occurring as a PMS symptom is termed dysmenorrhea. With dysmenorrhea, your period pain may be mild and manageable but may also be severe and debilitating. In this situation, you may require anti-inflammatory and/or pain medication to control your symptoms.
For long-term improvement, the natural treatment of PMS can be very effective. Essentially, the goal is to reduce or eliminate your cyclical symptoms and improve your quality of life.
Our naturopathic doctor successfully treats many patients with PMS, PMDD and menstrual irregularities.
Key Drivers of Premenstrual Syndrome
PMS symptoms are typically driven by a combination of the following factors:
- Hormonal imbalance (estrogen and progesterone)
- Neurotransmitter changes (particularly serotonin)
- Stress and nervous system dysregulation
- Blood sugar instability
- Inflammation and nutrient deficiencies
- Thyroid imbalances can influence mood, energy, and cycle regulation.
What Causes Premenstrual Syndrome?
PMS is not caused by a single factor. Instead, it reflects a complex interaction between hormones, the nervous system, and metabolic health. Key contributors may include the following:
1. Hormone Imbalance (Estrogen & Progesterone)
A relative imbalance between estrogen and progesterone – often referred to as estrogen dominance – can increase susceptibility to PMS symptoms.
2. Neurotransmitter Changes (Serotonin)
Hormonal fluctuations can affect serotonin activity, contributing to mood changes, cravings, and fatigue.
3. Stress & Cortisol Dysregulation
Chronic stress can disrupt hormonal signaling and worsen PMS symptoms.
4. Blood Sugar Instability
Fluctuations in blood sugar can contribute to irritability, fatigue, and cravings.
5. Inflammation & Nutrient Deficiencies
Underlying inflammation or insufficient nutrients may impact hormone metabolism and symptom severity.
Understanding these underlying drivers allows for more targeted and effective treatment, rather than symptom-based management alone.
What Patients Typically Work Toward
- More stable mood throughout the cycle
- Reduced bloating and discomfort
- Improved energy and sleep
- Less painful, more predictable periods
- Better hormonal balance overall
Not sure what’s driving your symptoms?
Book a complimentary 15-minute meet & greet to discuss your cycle and next steps.
4 Important Things to Know About Your Painful Period
Premenstrual Syndrome (PMS) and Menstrual Irregularities
Women can present with PMS or menstrual irregularities in different ways. For example, your cycle may not be regulated, it may can come too often, not often enough or menstrual flow volume may be too high or too low.
Additionally, many different problematic symptoms can occur before, during or after your periods. You may experience premenstrual bloating, breast tenderness, painful, irregular or heavy periods.
Fortunately, there are natural PMS treatment options available that can be safe and effective and without reliance on synthetic hormones.
Frequently Asked Questions About PMS
Is PMS normal?
While common, PMS is not necessarily a sign of optimal hormonal balance.
What is the main cause of PMS?
PMS is typically driven by a combination of hormonal fluctuations, stress, and metabolic factors.
Can PMS be treated naturally?
Yes, many patients see improvement with a personalized approach addressing root causes.
Testing to Identify Underlying Causes of Premenstrual Syndrome
In some cases, targeted functional testing can help clarify underlying hormonal and metabolic patterns contributing to PMS symptoms. Testing is recommended based on your individual history, symptoms, and treatment goals.
DUTCH Hormone Testing
The DUTCH test is a comprehensive hormone assessment that evaluates estrogen, progesterone, cortisol, and hormone metabolism patterns. It provides insight into how hormones fluctuate throughout the cycle, as well as how the body processes and clears them.
This information can help identify imbalances in hormone signaling, stress response, and detoxification pathways that may be contributing to PMS symptoms.
Bloodwork Review and Functional Markers
Reviewing existing laboratory testing from your GP or specialist can help identify contributing factors such as thyroid function, blood sugar regulation, iron status, and inflammation. If you are unable to get comprehensive blood tests from your doctor, we also offer Lifelabs blood tests.
In some cases, additional functional markers may be considered to further assess metabolic and hormonal health.
When Testing Is Helpful
Testing may be considered if:
- PMS symptoms are persistent or severe
- Cycles are irregular or difficult to track
- Symptoms do not improve with initial treatment
- There is suspicion of conditions such as Polycystic Ovary Syndrome or Premenstrual Dysphoric Disorder
Not all patients require testing. Recommendations are individualized based on your presentation and clinical goals.
Irregular Periods
Your periods typically occur about once a month. A normal variation of your menstrual cycle is if it is a few days early or late. However, you may also experience other abnormal variations from this pattern.
Menstrual cycles may be much longer or shorter from one period to the next. As well, your period may occur sporadically and unpredictably. Your cycle can deviate from your typical pattern by coming later or earlier than expected; or, you may even skip your period altogether. Stress is a common origin of these irregular menstrual patterns.
Stresses can include emotional stresses, such as at your work or in your personal life. Additionally, they can be physical stresses such as an imbalanced diet, poor lifestyle habits, sleep insufficiency or chemical stressors.
Premenstrual Dysphoric Disorder (PMDD)
PMDD is a more severe form of PMS characterized by significant mood-related symptoms, including irritability, anxiety, and low mood during the luteal phase of the menstrual cycle. While hormone levels may be within normal ranges, individuals with PMDD often have an increased sensitivity to hormonal fluctuations, particularly in how they affect neurotransmitters like serotonin.
A root-cause approach focuses on supporting nervous system regulation, stress response, and overall hormonal balance to help reduce symptom intensity and improve emotional stability.
Polycystic Ovary Syndrome (PCOS)
PCOS is a common hormonal and metabolic condition that can affect ovulation, menstrual regularity, and androgen levels. Symptoms may include irregular cycles, acne, changes in hair growth, and difficulty with weight regulation.
Because PCOS often involves insulin resistance and metabolic dysfunction, a comprehensive approach looks beyond hormones alone – addressing blood sugar balance, inflammation, and underlying metabolic patterns that may contribute to PMS-like symptoms.
Endometriosis
Endometriosis is a chronic inflammatory condition in which tissue similar to the uterine lining grows outside the uterus, often causing pelvic pain, painful periods, and digestive symptoms. While estrogen can play a role, endometriosis also involves immune and inflammatory pathways.
Management focuses on reducing inflammation, supporting hormonal balance, and improving overall physiological regulation, rather than addressing a single factor in isolation.
How is PMS controlled conventionally?
Most commonly, your doctor will prescribe oral contraceptives to alter hormones in the body in order to regulate your menstrual cycle, premenstrual syndrome or its associated symptoms.
Oral contraceptives, may be effective for regulating your menstrual cycle timing and may address some symptoms associated with your period, such as period pain or PMS symptoms.
For some women, oral contraceptives may create new intolerable symptoms or provide inadequate relief. Other women prefer to choose natural treatments.
Also, your doctor may prescribe other medication to control specific symptoms related to your periods.
Other Menstrual Irregularities
Amenorrhea (Absent Periods)
- Primary (never started) or secondary (stops after being regular)
- Common drivers:
- hypothalamic suppression (eg. stress, under-fueling, overexercise)
- thyroid dysfunction
- PCOS
When a woman does not menstruate for a prolonged period of time, this pattern is termed amenorrhea. Amenorrhea can happen because of hormone imbalances, medication, chronic stress, being underweight, over-exercising or from malnutrition. The underlying reason is typically because your body is in a deficient state and your hormones are conserving energy such that it does not prioritize having a menstrual cycle.
Oligomenorrhea (Infrequent Periods)
- Cycles longer than ~35 days
- Often overlaps with:
- PCOS
- metabolic or hormonal dysregulation
When your menstrual flow is very light or your periods are infrequent on an ongoing basis, it is called oligomenorrhea. This may have underlying causes similar to that of amenorrhea, or it may stem from other hormonal imbalances.
Menorrhagia (Heavy Periods)
- Excessive or prolonged bleeding
- Can relate to:
- estrogen dominance
- fibroids
- clotting factors
Menorrhagia occurs when your menstrual flow is unusually heavy or prolonged such that blood loss is substantial enough for you to become anemic. This heavy bleeing may be a part of PMS, endometriosis, or PCOS (polycystic ovarian syndrome) which are all associated with hormone imbalances.
Dysmenorrhea (Painful Periods)
- Primary (no pathology) vs secondary (e.g. endometriosis)
- Mechanism:
- prostaglandins
- inflammation
Dysmenorrhea may stem from or be associated with other conditions such as PMS, endometriosis or PCOS. The conventional approach involves treating the cramping and pain with antiinflammatories or analgesics to relieve the symptoms – which can be useful to manage symptoms – but does not address the underyling reason.
Luteal Phase Defect
- Short luteal phase / insufficient progesterone
- May affect:
- cycle regularity
- fertility
Perimenopausal Cycle Changes
- Irregular cycles in late reproductive years
- Perimenopause onset can vary from patient, ranging anywhere from late 30s to early 50s
- Hormonal fluctuation (estrogen/progesterone variability)
Fibroids (Uterine Leiomyomas)
- Not strictly a “cycle disorder,” but:
- strongly tied to heavy bleeding
- very commonly searched
For each of these abnormalities in menstrual flow, there may be different underlying reasons. Dr.Makoto will work with you in a detailed intake session to help you to understand factors that may be disrupting your cycle and develop a plan to correct these imbalances.
What is a naturopathic approach to treating PMS?
A naturopathic doctor assesses your overall health, diet and lifestyle, menstrual cycle pattern and any associated symptoms.
Initially, your naturopath will recommend dietary and lifestyle modifications which may lead to improvements in regulating your menstrual cycle or symptoms associated with your period.
At some point, you may discuss doing a DUTCH hormone test to better understand which hormones are sub-optimal, and to what degree. DUTCH hormone testing provides an assessment of bio-available hormones and in much more detail than a blood test would. Frustratingly, for many women with irregular menstrual cycles, painful periods, endometriosis, PCOS or PMS symptoms, the conventional approach puts little emphasis on proactively measuring hormones levels. Typically, symptoms are treated with birth control pills rather than understanding your hormone patterns and deficiencies first.
Based on the understanding of which hormone levels need normalizing, your naturopathic doctor may recommend nutrients, herbs, lifetsyle changes, stress management or acupuncture to help your body re-balance hormone levels naturally.
Alternatively, in some cases, you may be prescribed bio-identical hormone treatment to more directly target hormones that are very depleted. If bio-identical hormones are recommended, this will be done in an amount catered to your individual requirements. It is also recommended to re-test saliva hormone levels a few months after initiating bio-identical hormone therapy to ensure levels are at their appropriate optimal levels.
The more information we have about your hormones, the more effectively we can create a successful premenstrual syndrome PMS treatment plan. Consequently, if you are suffering from period pain or your menstrual cycle is overtaking your life, we can use safe and effective natural treatment options to restore your hormonal balance.
How would my visits work for the natural treatment of PMS?
- Comprehensive intake to discuss your menstrual cycle history, hormones, immune system, digestion and other body systems that may be impacting your hormones
- Review your diet to ensure it is appropriate to support your hormones
- Review previous diagnostic tests and reports relevant to your health
- Discuss test options that are relevant to balancing your hormones
- Recommend a diet and lifestyle plan that is designed to normalize your hormones, reduce inflammation, support immunity and optimize your menstrual cycle
- Recommend nutrients and supplements to restore your menstrual cycle
- Discuss herbal medicine options to improve your PMS symptoms and balance hormones
- Discuss the connection between emotions and your hormones and create strategies to improve your stress
- Potentially incorporate acupuncture to re-balance hormones and normalize your periods
Many hormone-related conditions overlap with digestive and metabolic health.
- Explore additional Conditions Treated for a broader view.
Looking for support with PMS symptoms?
PMS is often influenced by hormonal, digestive, and lifestyle factors. A personalized naturopathic approach can help identify your unique triggers and support more stable cycles over time.
👉 Book a consultation to get a tailored treatment plan.