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Causes
Water retention during the premenstrual cycle can be linked to the use of oral contraceptives. This is due to them containing estrogen and progestin. Synthetic progestin lack the ability to antagonize mineralocorticoid receptors leading to more sodium and water retention and subsequently, weight gain. In addition, estrogen is known to interfere with the renin-angiotensin-aldosterone-system (RAAS) since high concentrations of estrogen causes the release of more angiotensin II and aldosterone. As a result, more sodium and water is retained leading to symptoms of premenstrual water retention.

Exercise
In a study, it was shown that people experiencing PMS symptoms had a decrease in water retention and breast tenderness when they exercised regularly compared to those who did not. Aerobic exercises were more effective in relieving symptoms of bloating.

Traditional Chinese Medicine
Acupuncture has been traditionally used as a Chinese medical treatment for over 2000 years in Asian countries to relieve PMS symptoms. It has been speculated to work by altering blood flow, inflammatory markers, and prostaglandin levels. Especially because inflammatory markers is the main pathway in decreasing premenstrual physical symptoms such as breast tenderness and water retention.