Women may think there isn’t much they can do to keep premenstrual syndrome (PMS) under control. It turns out that there are natural ways to control symptoms, such as exercise and a healthy diet.

Exercising and eating right can control the bloating, depression, irritability and mood changes associated with PMS. I recommend 30 to 45 minutes of exercise, four to five days per week.  I also suggest these 11 dietary shifts:

1. Reduce salt. Cook your own food rather than eating fast food or processed food because salt, like sugar, is hidden in a thousand places. Eating less salt is particularly recommended for patients with bloating, breast tenderness or swollen hands.
2. Eat a variety of fruits and vegetables; focus on leafy greens. You want to “eat from the rainbow” of different types and colors for more nutrients. Vegetables like kale, turnip greens or Swiss chard are rich in iron and B vitamins, which can help ward off fatigue. Try sautéing the greens in olive oil and sprinkling in some fresh minced garlic, chopped onion and a splash of balsamic vinegar.
3. Drink plenty of water. I recommend that women drink at least 64 ounces of water daily to help reduce bloating, aids in digestion and has a number of other health benefits. You can also flavor your water with lemons, limes or cucumber slices.
4. Eat more calcium/low–fat dairy. Some studies suggest that eating more calcium — in foods like yogurt, milk, soy products and low-fat cheese — can reduce a variety of PMS symptoms.
5. Get your vitamin D. Besides supplements, vitamin D is found naturally in foods like sardines, oysters and salmon. Upping your vitamin D can help reduce PMS symptoms.
6. Snack on nuts. Instead of reaching for a bag of chips or that candy bar, snack on unsalted, raw nuts. Nuts are rich in omega-3 fatty acids and help you feel full longer. Try a variety of nuts like pecans, walnuts, almonds and hazelnuts.
7. Eat complex carbs. Foods that have complex carbohydrates consist of three or more natural sugars and are rich in fiber. These foods enter the bloodstream gradually, causing only a moderate rise in insulin levels, which can help stabilize your mood and keep your cravings under control. Try sweet potatoes, squash, pumpkin, lentils, potatoes and unprocessed oats.
8. Eat whole grains. Swap any processed grains for whole grains such as whole grain breads, pastas, cereals and brown rice. Shifting levels of estrogen and progesterone can decrease amounts of serotonin in the brain, which can affect your mood and trigger depression, anxiety or irritability. I recommend my patients eat whole grains when they feel down, rather than using sugar to boost mood.
9. Limit alcohol. While it’s tempting to have a drink to help you relax, alcohol can disrupt your sleep. Some patients either sleep too much, or they have problems sleeping. Some women will have a glass of wine at 8 at night, and they’re wide awake at 2 in the morning once the alcohol wears off.
10. Limit caffeine. It’s easy to reach for some hot coffee to get us going, but too much caffeine can also disrupt sleep and contribute to PMS symptoms.
11. Eat iron-rich foods such as lean meats. You need to increase iron intake before and during your period to replace what you lose each month. A diet that includes iron-rich foods may help you avoid anemia. Choose lean cuts of meat and cut away any excess fat before cooking. If you eat red meat, you should get enough iron from your food. If you’re a vegan, or just don’t like red meat, ask your doctor about taking an iron supplement.

In some cases, eating right and exercising aren’t enough to help women and doctors may recommend Prozac® or other serotonin-enhancing medications.

When PMS really impacts women’s work, and they’re about to get fired because they’re screaming at people, or they’re having marital or relationship problems, some patients do really need medical therapy, either cyclically or throughout the month.

Sometimes, women say they have PMS when, in fact, they are depressed.

The word ‘PMS’ is more acceptable. But with PMS sufferers, as soon as their period starts, they feel better. There’s usually a week of feeling wonderful. When someone who tells me every day of the month they’re feeling depressed, that is not PMS. But sometimes, that’s an easier word than saying they’re depressed.