If you are pregnant, breastfeeding, or taking anticoagulants, insulin-sensitizing medications, or sedatives, consult your healthcare provider before starting.

Many new prenatal vitamins have entered the market which have methylated folate instead of folic acid. Methylated folate is a downstream metabolite of folic acid. Although some people may have difficulty metabolizing folic acid (associated with a genetic mutation, MTHFR), it is very important to realize that only folic acid has been shown to prevent NTD (neural tube defects). Although methylated folate has been shown to result in sufficient blood folate levels, no study exists proving that methylated folate prevents neural tube defects or compares methylated folate vs folic acid. No study like this will ever exist because when something clearly prevents a bad outcome, like a birth defect, you would never allow a group of pregnant people to be at risk for this outcome when you could prevent it. I recommend you take at least 400 mcg of folic acid, in the form of folic acid. If you love a prenatal that has methylated folate, take an additional folic acid supplement. Methylated folate may help a small group of people who have problems metabolizing folic acid when they are not pregnant, but if you are trying to conceive, I recommend adding folic acid as well.

When it comes to managing PMS, I always remind my patients that lifestyle plays a huge role—this is not just about hormones, it is about how your entire system is functioning. PMS symptoms like mood swings, fatigue, bloating, and breast tenderness are driven by hormonal fluctuations, particularly estrogen and progesterone, and how your body responds to them. Supporting your body through nutrition, exercise, and stress management can make a real difference.

Start with food. Aim for a balanced diet with plenty of fiber rich vegetables, whole grains, lean proteins, and healthy fats. Reducing processed foods, caffeine, and added sugars can help minimize blood sugar swings and inflammation that often worsen PMS symptoms. Magnesium rich foods like leafy greens, nuts, and seeds can help reduce cramps and support mood. Staying hydrated and limiting alcohol and salt may reduce bloating and fluid retention.

Exercise is one of my favorite prescriptions for PMS. Movement helps with circulation, mood, and metabolism. Regular moderate exercise such as brisk walks, yoga, or strength training can help reduce irritability, improve sleep, and support hormonal balance.

Sleep is also critical. Your hormones regulate on a rhythm, so disrupted or inadequate sleep can worsen PMS symptoms. Aim for seven to nine hours per night, and create a calming evening routine. If you find your sleep impacted in the luteal phase, magnesium or melatonin support may be helpful, but start with good sleep hygiene.

Stress plays a huge role in hormonal health. Cortisol and estrogen share some metabolic pathways, so when stress is high, PMS symptoms can feel amplified. Mindfulness, breath work, journaling, or even scheduling time for fun and rest can help your nervous system recalibrate.

And most importantly, track your cycle. Knowing when symptoms tend to appear gives you the power to prepare. You are not imagining it. If your symptoms are interfering with your quality of life, there are ways to support your body and feel better. You do not have to just push through.