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
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
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
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
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
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
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.
