After having heard the details of PMS (otherwise known as premenstrual syndrome) from hundreds of women over the years, I continue to be surprised about how most regard PMS as their lot in life and don’t seek any help for it. I guess most women believe there’s nothing they can do, and consequently they’re often amazed to learn that an integrated approach can really help. I am of the opinion, shared by many of my colleagues at WholeHealth Chicago, that getting PMS out of your life requires a strongly committed proactive “self-care” stance, something you can easily do without much reliance on your conventional physician. Generally the complexity of PMS–and there are numerous symptoms associated with it–takes a lot more time and attention than the standard 7-minute physician office visit can provide.
In a conventional approach, the options are often confined to prescription drugs, from pain relievers to antidepressants. Some medications are even related to barbiturates, which can be dangerously addictive. Before turning to such remedies, we think you should first consider your individual symptoms, and then review all the treatment options–including lifestyle changes–that might benefit you.
What is PMS?
The often distressing symptoms of premenstrual syndrome, or PMS, are familiar to many women. A week or two before their menstrual period, three out of every four women experience some combination of bloating, breast pain, fatigue, headaches, depression, crying, angry outbursts, or any of 200 other symptoms associated with PMS. For most women, the number and severity of symptoms varies from month to month, and most of the time PMS is no more than a bothersome inconvenience. But for another 5% to 10% of women, PMS affects body and mind so severely that it interferes with everyday activities.
At the same time, PMS can have a positive aspect. Some experts say that women who have PMS are very attuned to their surroundings and have a sharp memory, not just in the days or weeks immediately before their period but all month long.
- In the week or two before the menstrual period:
- Irritability, anxiety, depression, hopelessness, major mood swings
- Breast pain or tenderness, bloating, weight gain
- Insomnia, fatigue, lack of energy
- Headaches, backaches, joint and muscle aches
- Constipation, diarrhea, urinary disorders
- Food cravings, especially for carbohydrates.
What Causes PMS?
Scientists have never explained why some women have PMS and others don’t. Among the theories:
PMS may stem from an imbalance of the female hormones estrogen and progesterone following ovulation. (Ovulation occurs at the midpoint of the menstrual cycle.) When the estrogen overwhelms the amount of progesterone in a woman’s system, the brain has more difficulty producing chemicals that control mood and pain. This hormone imbalance may lead to the mood shifts and food cravings of PMS. It also may trigger the release of the hormone prolactin, which causes breast tenderness and blocks the liver from efficiently clearing excess estrogen from the body.
PMS symptoms may also be due to low levels of serotonin, a neurotransmitter, or brain chemical, that sends signals between nerve cells. Although serotonin studies have been inconsistent, many women report less trouble with PMS when they are under treatment to normalize serotonin levels. More efficient production and use of serotonin has been shown to help lift one symptom of PMS, depression.
Treatment and Prevention
There are conventional medicines for treating PMS symptoms, among them ovulation suppressors and medicines such as antidepressants that address specific complaints. But a number of nutrients and herbs, taken alone or in combination for part or all of the menstrual cycle, may also offer relief. Some of the herbs, such as chasteberry and evening primrose oil, are widely used in Europe and have withstood the test of time. Certain lifestyle measures can also help reduce symptoms.
If you are taking any medications for PMS, be sure to check with your doctor before adding supplements.
Just a reminder: If you have a serious medical condition or are taking medication, it’s always a wise idea to talk with your doctor before beginning a supplement program.
How Supplements Can Help
Chasteberry, also called Vitex, is a popular PMS remedy in Europe. It acts on the brain’s pituitary gland, which controls the production of estrogen and progesterone, and so may correct hormone imbalances.
Dong quai is an Asian herb that has little effect on its own, but it may enhance chasteberry’s activity. It often comes packaged with other herbs such as black cohosh. (In Chinese herbal formulas, a number of time-tested herbs act together to relieve symptoms.)
Vitamin B6 may work if chasteberry is not effective. It helps the liver process estrogen, increases progesterone levels, and stimulates the brain to make serotonin. A German study found that vitamin B6 is less effective than chasteberry for reducing PMS-related breast tenderness, swelling, tension, headache, and depression. For maximum relief, some practitioners suggest using both, starting at the time of ovulation and continuing until menstruation begins.
Evening primrose oil, or the less-expensive borage oil, both containing omega-6 essential fatty acids, may ease breast tenderness and take the edge off carbohydrate cravings. Like chasteberry and vitamin B6 evening primrose oil works best during the second half of the menstrual cycle.
Magnesium supplementation, taken daily, is well-known as an effective treatment for PMS. (Magnesium deficiencies have been found in the red blood cells of women who have PMS and this deficiency has been implicated as one of the causes of PMS symptoms.) You might consider getting magnesium in a bone-building supplement containing calcium as well. It’s never too early to begin preventing osteoporosis.
St. John’s wort is a useful addition to a daily program, especially when the primary PMS symptoms are emotional (mood swings, irritability, depression) rather than physical. The herb works best when taken continuously and may require two complete menstrual cycles before its full effect is noticed.
Kava, a mild and nonsedating tranquilizing herb, can be helpful for those PMS days when you’re feeling especially anxious and tense. It may work immediately and is not at all habit-forming.
Natural progesterone, either as a cream (available over the counter) or taken orally (by presciption only), acts to balance the excessive estrogen that contributes to many PMS symptoms. Progesterone supplementation should be used in the second half of the menstrual cycle, usually during the week to 10 days before your anticipated menstrual flow, stopped at flow, and restarted on approximately the same day every month.
Certain combination PMS herbal products are also available. These contain a variety of herbs, including chasteberry, dong quai, and others that help balance estrogen and progesterone. Just remember this combination is an alternative, not an addition, to chasteberry, dong quai or other “female” herbs.
Get supplement dosages and tips in our WholeHealth Chicago Supplement Recommendations for PMS.
Keep a symptom diary. Many women feel more in control when they note PMS symptoms as they ebb and flow. A written record may come in handy if things get bad enough that you need to talk with your doctor.
Regular aerobic exercise can help you restore a sense of balance and control and improve your mood. It also can help relieve water retention.
Learn to relax. Low levels of progesterone can leave you feeling more exposed to the stresses of life. But there are methods other than drugs to restore your physical and emotional reserves. Yoga, meditation, and progressive muscle relaxation can relieve stress-related symptoms.
Watch what you eat. Lifestyle decisions you make can put additional stresses on your system. Cut down on caffeine, refined carbohydrates, refined sugar, dairy, alcohol, and salt. If you smoke, stop. No one is certain how these changes affect the symptoms of PMS, but it may have to do with the overall toxin load on the body that reduces its ability to process estrogen. Or it may be the added stimulation these substances put on already reduced reserves. Nobody knows for sure, but virtually all women report significant improvement when they make healthy choices.
When to Call a Doctor
- If PMS is severe and includes deep depression, intolerable breast pain, or other symptoms that interfere with your quality of life.
- If symptoms seem to remain the same throughout your entire cycle. Clinical depression and an underactive thyroid are treatable conditions that resemble PMS.
From David Edelberg, M.D. at WholeHealth Chicago: The key symptoms of PMS occur most frequently between ovulation (mid-cycle) and menstrual flow and seem to peak during the last few days just before menstruating. What’s called “classic” PMS occurs during the five to seven days before flow begins. Women suffering from the most severe form of PMS may be experiencing symptoms already at ovulation and enjoy relief only when the flow starts. Some women have only one symptom-free week every month.
At WholeHealth Chicago we are so impressed by the numbers of women with classic PMS who are helped by these simple remedies that we’d like everyone to have this information.
Taken for part or all of the menstrual cycle, these treatments can relieve many if not all of your symptoms. One caution here, though: If you are taking any conventional drugs for PMS, check with your doctor before using supplements.
HOW TO TAKE THE SUPPLEMENTS
Most women will do nicely with just the calcium/magnesium, vitamin B6, and borage oil taken daily. These will effectively balance the two female hormones (estrogen and progesterone), and the relief they offer should be evident within two or three cycles.
If this strategy doesn’t bring enough relief or if your PMS is a notch or two above the “mild” range, try adding the herb chasteberry, which you should take throughout your cycle. It’s by far the most effective proven botanical for PMS and may be even more effective when combined with another herb, dong quai. These work at the level of your pituitary, the master gland in your body, to balance your female hormones, estrogen and progesterone. Alternatively, try using a PMS herbal combination product, which may contain a number of good herbs and nutrients, during the second half of your menstrual cycle.
If your type of PMS does not respond to these gentler methods, then balance your own progesterone by adding a natural progesterone cream; apply it to your inner forearms, inner thighs, or abdomen during the two weeks before your expected period. Always discuss your symptoms with your doctor.
If moodiness, depression, anxiety, and anger are the hallmarks of your personal PMS and the hormone-balancing measures aren’t working, I’d suggest adding St. John’s wort. Again, be patient, it may take two cycles to see benefits. And, since many women report insomnia just before their periods, melatonin can be very beneficial if you can’t sleep during your PMS days.
Of special interest
If you’re feeling especially anxious and tense during your PMS days, the mild and nonsedating tranquilizing herb kava (250 mg 2 or 3 times a day) can be very useful. It is quick acting and not at all habit forming.
If fatigue happens to be a component of your PMS, Siberian ginseng (100-200 mg twice a day) may be an herb for you to consider. By reinforcing the adrenal glands as well as your immune system and liver function, this herb may well enhance energy, stamina, endurance, and the ability to resist infections. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions. The Healing Path for PMS provides more extensive therapeutic information about this condition.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
David Edelberg, MD