Ailments and Situations - Premenstrual Syndrome or PMS

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Ailments and Situations - Premenstrual Syndrome or PMS
- Symptoms and Signs
- Causes - Type A
- Causes - Type C
- Causes - Type H
- Causes - Type D
- Acne and Dysmenorrhea
- What to Expect
- Remedies
- Actions and Remedy Listings
- See also
All Pages

 

(also referred to as...)
PMS
 

Description

Premenstrual syndrome is the most common physical problem affecting young women today. The symptoms usually begin ten to fourteen days prior to the onset of the menstrual period and become progressively worse until the onset of menstruation, or for some women progressively worse until several days after menstruation. For many women this means more than half of each month is spent feeling sick and utterly miserable.

Four subgroups exist that depict the different types of PMS that women tend to complain of and have been classified accordingly.

Type A (for "anxiety): anxiety, irritability, mood swings

Type C (for "carbohydrates" or "cravings"): sugar cravings, fatigue, headaches

Type H (for "hydration" or "heavy"): bloating, weight gain, breast tenderness

Type D (for "depression"): depression, confusion, memory loss

There are two other common subgroups:

Dysmenorrhea: cramps, low back pain, nausea and vomiting

Acne: pimples, oily skin and hair

There are several factors that increase ones risk of experiencing PMS and they are as follows:

  • Being over thirty (the most severe symptoms occur in women in their thirties and forties)
  • Women experiencing significant emotional stress
  • Side effects from the birth control pill.
  • Women who have difficulty maintaining a stable weight.
  • If you do not exercise
  • If you are married
  • If you had a pregnancy complicated with toxemia
  • If you have children (symptoms are more severe with more children)

 


 

Symptoms and Signs:

Symptoms can be both internal and external. External symptoms include acne, boils, allergies, hives, water retention, abdominal bloating, breast tenderness and swelling and weight gain.

Internal physical symptoms include cramps, depression (occasionally quite severe), physical pain in the lower back and/or abdomen, joint pain and swelling migraines and headaches, dizziness, fainting, bladder infection, sore throat, rhinitis, hoarseness, and constipation.

Internal emotional/psychological symptoms and behaviours include mood swings, irritability, anxiety, nervousness, depression (occasionally quite severe), bingeing, sugar cravings

Not all of these symptoms are experienced by every woman, these are just some of the more common complaints. Also many of these symptoms can co-exist in the same woman. One should be aware that during this time it has been reported that women are most sensitive to extremes of behaviour and are at increased risk of accidents, alcohol abuse, suicide attempts and crimes. Although this is a rare phenomenon, women have described themselves as experiencing personality metamorphosis such as those exemplified in Dr. Jekyll and Mr. Hyde.

 


 

Causes:

Type A (Anxiety)

This subtype occurring in more than 80% of women has been found to be the most common. Symptoms worsen in the days prior to the onset of menses and are relieved only with its onset. The most likely cause for these symptoms is the imbalance between the body's estrogen and progesterone levels. An excess of estrogen tends to result in anxiety-like symptoms and too much progesterone tends to result in depressive symptoms.

The balance of these hormones depends on two factors:

  1. How efficiently the hormone is produced by the ovaries and
  2. How efficiently the hormone is broken down by the liver

 
Any problems in these two areas will cause an hormonal imbalance. For example, too much fat or alcohol in the diet can overwork the liver and decrease its capacity to remove the hormones. A vitamin B deficiency (caused by either poor nutrition or emotional stress) also affects liver function. Without proper liver function it is near impossible to have equal levels of hormones circulating in our bodies. Other researchers have linked the anxiety symptoms to a lack of serotonin and the amino acid that is needed to manufacture serotonin (i.e.: tryptophan). One would expect to see sleep disorders and irritability along with anxiety in those with a serotonin deficiency as the root cause of their PMS symptoms.

 


 

Type C (Carbohydrates, Cravings)

Sixty percent of women have increased cravings for refined carbohydrates, particularly sugar, chocolate, alcohol, white bread, white rice and noodles prior to menses. Researches believe this is due to some women having an increased insulin sensitivity the week before menses. Meaning that more sugar is transported out of the blood and into cells. This leaves less circulating glucose for the use by the brain (as glucose is the only fuel source that can be used by the brain) and a subsequent increased craving. This craving intensifies under stress and with nutrient deficiencies such as magnesium, B vitamins and chromium.

It is interesting to note the significant number of women who crave chocolate just before their menses. Chocolate is a rich source of magnesium and phenylethylamine (a potent anti-depressant) and hence such a craving may be a sign that the body is seeking out the nutrients that it is deficient in. However, it is important to remember that chocolate also contains a number of ingredients that worsen PMS.

 


 
Type H (Hydration, Heavy)

 

Forty percent of women experience this type. The bloating and weight gain is usually no more than three pounds and often more of a subjective sensation. These women tend to retain excess fluid and salt by the kidneys, which occurs in response to pituitary and adrenal hormone stimulation. Other hormonal imbalances also contribute to the fluid retention, such as prolactin and the series II prostaglandins which are also responsible for menstrual cramping.

 


 
Type D (Depression)

 

This type only occurs in five percent of women and is primarily due to a decrease in estrogen levels that does not counterbalance the increased levels of progesterone. This type is dangerous as women can become suicidal in severe cases. The depression may also cause the women to become withdrawn and then are less likely to seek medical attention.

 


 
Acne

 

This subgroup is a result of an increased surge in the male hormones (androgens) from the adrenal glands just before their periods. This causes a change in the pH of the skin as well as an increase in the skin's oil secretions.

 

Dysmenorrhea/Menstrual Cramps

 

See section on Menstrual Cramps for more information.

One of the main causes of PMS is a hormonal imbalance and/or liver toxicity. Hormonal imbalance can be due to stress, poor diet and post-use of oral contraceptives. A women also detoxifies during her menstrual cycle. If the liver is already toxic, it cannot deal with the extra load and this can result in some of the symptoms listed above.

 


 

What to Expect:

PMS usually ends once a woman's period is finished.

 


 

Remedies

One of the basic foundations of alternative treatment for PMS is the liver's role in detoxification. When the liver is not working optimally there is insufficient estrogen metabolism and a consequent excess of estrogen leading to an estrogen dominant state. A "sluggish liver" is addressed through dietary and lifestyle changes as well as through various herbs that gently detoxify and support the liver.

 

- Food Supplements -

Food Supplements

Essential Fatty Acids such as black currant seed oil, flaxseed oil, and primrose oil are helpful if taken throughout the month. These oils help balance hormone levels. If using liquid form, take two tablespoons daily. If using flaxseed oil capsules, take 2 to 3 capsules daily, in the morning. If using evening primrose oil capsules take 1 500mg capsule daily, in the morning

- Herbs -

Herbs

Chaste Tree (Vitex-Agnus Castus) berries have been shown to enhance the production of progesterone and is extremely important for those women whose PMS is due to an estrogen dominant state. This herb also inhibits the production of the hormone prolactin, where elevated levels have been shown to be a factor in PMS. If using a tincture, take 20 drops three times per day throughout the month. If taken in capsule form, take 400 to 500mg three times per day throughout the month. If you use a standardized extract, take 175mg for the same period of time.

Dandelion leaf helps relieve water retention and weight gain. Dandelion root or milk thistle in tea, capsule, or tincture form taken a week before your period assists the liver in detoxification.

Dong Quai is a general herb used to relieve many problems related to menstruation, including cramps, irregularity, delayed flow, and weakness during mensturation. If using a tincture, take 20 to 40 drops 3 times daily. If preparing a decoction (tea), bring 4 cups water and 3 teaspoons root to a boil and simmer 10 to 15 minutes. You will likely be left with 3 cups of decoction, as 250mL often evaporates during the process. Divide decoction into 3 doses daily.

In addition to hormonal balance, Evening Primrose oil helps relieve cramps and water retention if taken throughout the month. Take 1,000mg capsules three times per day.

Ginkgo Biloba has been used successfully with women who complain of congestive symptoms particularly breast pain or tenderness and fluid retention. Take 80mg of standardized extract twice daily.

Kava kava is used when PMS is associated with anxiety.

St. John's Wort can be taken for depression. Take 300mg capsule three times per day a week prior to and during the week of your period.

- Homeopathy -

Homeopathy

Certain remedies can be used in acute situations if your symptoms fit the symptom picture of the remedy. For dosages, see the dedicated section on Homeopathy. Consult your homeopath or naturopath to determine your constitutional remedy: the remedy that best fits you as a whole person. Your homeopath or naturopath will take a complete case history considering all of your mental and physical ailments and match these symptoms with the symptom picture of the remedy.

Colocynthis: For severe menstrual cramps that are made better with heat and pressure or bending over. Person is angry and irritable.

Chamomilla. Person is very irritable and impatient before or during menses. Severe pain in the lower abdomen that can extend to thighs. Nipples are inflamed and tender to the touch. Blood is dark and clotted.

Natrum Muriaticum: Menses are irregular. Presence of bearing-down pains, especially in the morning. Dryness of the vagina. Person is irritable and depressed.

Pulsatilla: "Menses of Pulsatilla" are irregular, easily suppressed, and short in duration Dysmenorrhea (pain associated with menstruation) and amenorrhea (the absence of menstruation) begin at puberty. Person is sensitive, depressed, moody, and weepy.

Sepia: "Menses of Sepia" could occur too early with abundant flow, or occur too late with little flow. Possible stitching pain up the vagina and feeling of heaviness in the pelvic area. Person is irritable and easily offended.

- Lifestyle -

Lifestyle

A dietary survey of 39 patients with PMS and 14 women without PMS revealed that women with PMS consumed five-fold more dairy products and three-fold more refined sugar than those women without PMS.

It has been shown that dairy products and calcium from dairy sources interfere with magnesium absorption (a mineral that decreases cramping, helps glucose metabolism, and stabilizes mood swings) and refined sugar increases the urinary excretion of magnesium. In addition, refined sugars cause sodium retention leading to swelling in the hands and feet, abdominal bloating, breast swelling and tenderness.

Avoiding refined carbohydrates and concentrating more on whole grains such as brown rice, oats, barley, millet, buckwheat, corn, rye and quinoa would help to eliminate most of these water retaining symptoms. Instead of cow's milk a great change would be to use soy milk, nut milks or potato-based milks. These alternatives are fortified with calcium and vitamin D. Other great sources of calcium include dark green leafy vegetables (collard, kale, mustard greens), beans, soybeans, sesame seeds, fish and chicken stock made with bones.

Breast symptoms tend to be aggravated by a substance called methylxanthines. This substance is found in coffee, black tea, chocolate and caffeine-containing soft drinks. Strictly avoiding these offenders will greatly improve breast-related symptoms.

Diets high in saturated fats and trans fatty acids contribute to the production of harmful prostaglandins (Pg) which have been implicated in the involvement of PMS. Arachadoninc acid, found mainly in animal fats and linoleic acid, is the precursor to Pg E2 or the "bad" prostaglandin. By reducing the amount of meat and vegetable oils eaten, Pg E2 production will be reduced and the severity of PMS will diminish.

- Minerals -

Minerals

Problems with calcium regulation may underlie some of the symptoms of PMS. A study showed that women who supplemented with 1,200 mg of calcium carbonate during the luteal phase (second half) of their menstrual cycle, had reduced water retention, food cravings, pain and mood disorders. Choose a more absorbable form of calcium such as calcium citrate or calcium hydroxyappetite.

Chromium helps alleviate sugar cravings by stabilizing blood sugar levels. Take 200mcg three times per day. If such cravings only occur during PMS, take chromium over the course of your period (1 week before period and during the week of). If such cravings occur throughout the month, you may supplement with chromium daily over the course of the month.

The role that magnesium plays in the treatment of PMS is not well understood. However, studies have shown that supplementing with magnesium from mid-cycle to the onset of menses have had dramatic effects on PMS. Also, chocolate cravings have been linked to low levels of magnesium and magnesium is known to be important in essential fatty acid metabolism and Vitamin B6 activity. Take 300 mg three times daily. Do not exceed 1000mg daily as you may diarrhea.

- Miscellaneous -

Miscellaneous

Natural Progesterone Cream

Controversy exists regarding the importance of progesterone in the treatment of PMS. Alternative health care practitioners believe that high levels of estrogen during the luteal phase (second half) of the menstrual cycle is a leading cause of PMS. Estrogen and progesterone clearly affect mood and if estrogen is unopposed by progesterone it tends to irritate the nervous system. Progesterone, on the other hand, is associated with tranquility and is a central nervous system relaxant. This may be the primary reason for its success in the treatment of PMS and mood-related symptoms. Natural progesterone also works well for women whose major premenstrual symptom is a migraine-type headache.

Natural progesterone is not the same as the synthetic progesterones (progestins) such as medroxyprogesterone acetate or Provera. There are no side effects with natural progesterone at the recommended dosage. It is available in oral form or as a skin cream by prescription.

Natural progesterone creams and the wild yam creams available over-the-counter are not the same. Wild yam extracts do not contain natural progesterone and it is NOT possible for the body to convert the diosgenin (the medicinal ingredient) to progesterone. Skin creams that contain natural progesterone can have as little as 2mg per ounce to more than 400mg per ounce. For PMS symptoms that have not responded to herbal, nutritional, or lifestyle changes, it is recommended to use creams with more than 400mg of progesterone per ounce. A 1/4 tsp. of natural progesterone cream is applied twice per day starting at mid-cycle and stopping the day before the menses is due (do not use during days 1 to 7 while bleeding).

Preferred areas for rubbing in the cream include the palms, inner forearms, chest and inner thighs. Better results are realized when the sites of application are rotated. Though these creams are natural, it is still a hormone and it is best to consult with your naturopath or other health practitioner who is experienced with its use.

- Vitamins -

Vitamins

Many studies have reported the benefits of vitamin B6 supplementation for depression associated with oral contraception. Since that time, there have been several other studies reporting the benefits of using this vitamin when PMS is accompanied by depression. Vitamin B6 increases the synthesis of neurotransmitters (serotonin, dopamine, norepinephrine, epinephrine, taurine and histamine) in the brain. Lower levels of serotonin and dopamine have been implicated in the etiology of PMS. This versatile vitamin has also been used successfully in reducing premenstrual acne and helps relieve water retention. In addition, the liver requires B6 (and B12) to break down and inactivate estrogen. Take 50 to 100mg twice daily. Do not exceed 200mg total daily intake.

 



Actions and Remedy Listings

 

Avoid Sugar

Calcium

Chaste Tree Berries / Vitex

Chromium

Dandelion Leaf

Dandelion Root

Dong Quai

Essential Fatty Acids

Evening Primrose Oil

Gingko Biloba

Kava Kava

Magnesium

Natural Progesterone Cream

St. John's Wort

Vitamin B6

 


 

See also

Acne, Menstrual Cramps

 


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