Ask a naturopath: PMS
Home » Blog » Eric Bakker » Ask a naturopath: PMSEric explains how to minimise premenstrual syndrome.
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"Ever since having my third child (who is now two) I have suffered from really bad PMS for a week or two each month. I currently take evening primrose oil to help alleviate the symptoms. Is there anything else I could try to help make my family’s life and mine more bearable?" —Saskia
Many women suffer PMS and in fact it is one of the more common reasons they will come to a naturopathic clinic. The terms PMT and PMS are interchangeable. Some people use the term PMT (premenstrual tension) to describe the emotional problems faced with premenstrual problems such as tension, anxiety, irritability are tearfulness. The acronym PMS (premenstrual syndrome) more accurately describes the fluctuating syndrome many women experience before their period involving a combination of both emotional and physical complaints.
It is now widely recognised that some women with premenstrual disorders experience a markedly compromised quality of life and ability to function normally in daily life, so let’s have a look at this common complaint and how we can offer assistance with natural medicine.
Likely Causes of PMS
PMS is primarily associated with hormonal imbalances, burn-out and adrenal fatigue (a very common syndrome in working women today), hypoglycemia (blood sugar fluctuations) and nutritional deficiencies, all of which are preventable.
Many of the short-lived symptoms are caused by too much estrogen (the female sex hormone) and lack of progesterone (another hormone secreted by the ovaries and adrenal glands). Decreased levels of neurotransmitters, primarily dopamine and serotonin, are other very important factors. These two hormones are called the “feel good” brain chemicals. Stress once again underpins fluctuating neurotransmitter levels.
Women in the Western world are under increasing emotional, physical, nutritional, psychological and toxic stress. Many now work full-time just to make ends meet, eating on the run and have multiple and continuing stresses in their lives just trying to juggle their occupation and busy family life. Add to this the widespread consumption of refined foods, sugars, caffeine and alcoholic beverages, some of the primary culprits of the modern woman's monthly woes. Is it any wonder she develops PMS?
PMS Symptoms
The symptoms of PMS can also be related to other conditions women may experience, such as ovarian cysts, endometriosis, thyroid problems, uterine fibroids and adrenal fatigue. It is important for this reason to check in with your doctor for a referral to your gynecologist for a thorough check-up to exclude any underlying reasons for your cyclical health problems, and a blood test and pelvic exam are always recommended.
The most common symptoms of PMS I see in the clinic include headaches, sweet cravings (chocolate!), bloating, irritability, mood swings, weight gain and changes in appetite. PMS symptoms may also commonly change following an event such as childbirth, which can be quite confusing. I also see PMS symptoms appear or exacerbate in some women after a separation or divorce, job loss, moving to another country or other such similar stress. This leads me to believe that the underlying stress mechanism in her body is having a hard time coping, reflecting in an hormonal imbalance, which is what PMS is all about really.
Hormonal imbalances are very difficult to define medically, and probably the most difficult conditions for your doctor to fully and accurately assess. Hormones work with such an amazing precision and balance in your body, with such a complex interplay, that the best Western medicine can do to balance them is still a very crude offering in comparison with what your body is capable of when it is in a healthy state. Did you know that there are almost 180 hormones so far discovered in the human body?
Australian doctor John Harrison wrote an excellent book some years ago called Love Your Disease, in which he stated that a doctor working on a woman’s hormone cycle with drugs is akin to “working on a fine piece of jewellery with a pick-axe”.
Despite a true medical lack of understanding of the real primary causes of PMS, a great deal is known about how PMS makes a woman feel. An amazing 150 various symptoms have been recorded in association with PMS. Thank goodness no woman will experience them all at the same time!
Common physical PMS Symptoms
- Abdominal distention, bloating, swelling and discomfort
- Breast swelling, pain, tenderness, discomfort, lumpy breasts
- Abnormal appetite, sweet cravings: alcohol, carbs, breads and/or fatty foods
- Fatigue and weakness
- Weight gain of more than 2kgs
- Fluid retention
- Premenstrual acne flare-ups
- Joint pains or aches
- Pelvic discomfort
- Premenstrual herpes outbreaks
- Recurrent vaginal thrush
- Change in bowel habit: constipation or diarrhea
- Palpitations, dizziness or fainting
- Libido: up or down, or totally flat.
Emotional and Mental PMS Symptoms
- Nervous tension
- Irritability
- Tearfulness
- Anxiety
- Mood swings
- Confusion
- Depression
- Aggression, anger
- Poor concentration
- Forgetfulness
- Insomnia
The five Common PMS Categories
Most commonly we see groups of complaints appear in clusters. While you can treat PMS as a condition, better results will be achieved by targeting the underlying syndrome with more precision. In 1983, GE Abraham devised five separate sub-categories of PMS.
- PMS – A (Anxiety) Nervous tension, moody, irritable, anxiety
- PMS - C (Cravings) Headaches, sweet cravings, increased appetite, palpitations, fatigue, dizziness, lightheaded
- PMS – H (Hydration) Breast tenderness, abdominal bloating, weight gain, swelling (lower body, legs, tummy, eyelids/face)
- PMS – D (Depression) Depression, crying, tearfulness, confusion, insomnia, forgetful
- PMS – P (Pain) Aches & pains, reduced pain threshold, painful periods (needing pain relief), cramping pain
If you do have PMS, you will typically lean towards one of these categories a bit more than the others, although you will almost certainly have symptoms of several of these categories.
For example, I would commonly see a woman who craves chocolate two days before her period, has bloating, irritability and may well have a degree of breast tenderness. Another woman may have increased anxiety, constipation, fluid retention and headaches. Yet another will have a terrible back pain each month, to the point where she will need to take one day off each month and stay in bed with an anti-inflammatory drug from her GP.
Conventional PMS Treatment
Standard medical treatments include pain medications, oral contraceptives, sleeping pills and antidepressants. Amazing as it may seem, severe forms of PMS are actually classified as mental disorders! For the many women I have seen, these treatments have very limited effectiveness, and they continue to suffer from at least some of the detrimental effects of PMS.
Unfortunately, all too many women seek no treatment at all, not realising that there are alternatives to conventional treatments. Fortunately, there are several natural alternatives which can help rebalance a woman’s hormone levels and eliminate symptoms of PMS.
What did women do many years ago, take drugs? PMS is nothing new; in fact a woman’s changes in mood and behaviour and physical complaints have been associated with menstruation for many thousands of years. The word hystera is Greek for uterus, and as recent as the Victorian times (1890s) women were thought to become “hysterical” before their period and even confined to bed!
More amazing to me is that as recent as the 1960s and even 1970s, conventional medical wisdom believed that PMS was a problem associated with a woman’s 'nerves' or 'failure to cope', and because medical science could not give a rational 'scientific' explanation, PMS was given very little credence and women were treated primarily with antidepressants (and unfortunately many with PMS still are today). The antidepressant fluoxetine (Prozac) is now marketed in America as Sarafem for treatment of PDD (premenstrual dysphoric disorder), another fancy word for PMS.
It kind of makes me wonder what the world would be like if men had menstrual periods and women were the first doctors.
But do you really need to take antidepressants, sleeping pills, pain pills or other pharmaceutical drugs for PMS? Not really. If we take into consideration the prevalence of women's health-related conditions, the potential for reliance and side effects of drugs and the high cost of not treating this condition effectively, it is critical to examine the best natural alternatives over the standard options provided by conventional medicine. You do have natural options: let’s have a look at what we can offer the woman who has PMS. First we would be best to chart her symptoms.
Chart Your Symptoms
I have always found that the he best way to determine any chronic condition like long-standing PMS is to 'chart' the signs and symptoms and to track them over a period of time. Do you suffer from PMS? Then why not chart what’s going on? Unfortunately there is no blood test or hormonal measurement can accurately pinpoint your PMS.
Here are a few guidelines for you just in case you have never chartered your symptoms before:
- Take careful note of the physical and emotional symptoms that are most severe or cause disruption in your life. You will know your chief complaints, like chocolate cravings, irritability, headache, bloating, bad mood swings, tiredness or bad fatigue, acne, anxiety, depression.
- Ask your partner to keep a close eye on you and make notes of your symptoms.
- Use a daily calendar or daily symptom record forms.
- Keep it simple, just use words like “headache” , “irritable”, “bloating”, etc.
- You can chart for example the physical complains in blue, mental/emotional in red.
- Set aside 5 minutes to chart symptoms every day.
By charting your complaints, especially before and during treatment, you will be able to see what works and what doesn’t. Your symptom chart provides you with a record of when symptoms occurred in relation to your ovulation and period and how closely your symptoms are related to your menstrual cycle.
Eric’s 4-Stage PMS Treatment
Organised self care is the cornerstone of any successful PMS management program. The right diet, regular exercise, effective stress reduction, and targeted nutritional supplementation provide significant relief from PMS symptoms. There are a few extra specific recommendations below for those who may feel they relate to one of the five main PMS categories as outlined above.
1. Healthy diet
- Eliminate refined sugar, other refined carbohydrates. The “feel good” hormone serotonin is stimulated by eating carbohydrates. This is one reason many women reach for the sugary foods: they increase serotonin and endorphin levels.
- Eat plenty of fresh fruits and vegetables, whole grain cereals especially quinoa, chick peas, millet, lentils, beans and brown rice.
- Have ample protein: it makes a big difference with PMS. The best protein sources for you will be nuts, seeds, chicken, free range eggs, fresh fish, venison and lean meats.
- Eat less dairy products (potential allergies, temporarily decrease to see the response). Milk may block magnesium absorption (which can increase pain).
- Avoid caffeine and alcohol as much as possible, they are often “stress props” and will make your PMS symptoms much worse in the long run. Avoid alcohol the week before your period especially. If you have more than two coffees before lunch you have adrenal fatigue generally. Studies show that women who drink large amounts of caffeine (more than four cups of coffee in a day) are four times more likely to have PMS.
- Not too much salt (unless you have low blood pressure or adrenal fatigue) as it may help to retain fluid. If you have fluid retention, avoid salt one week before your period.
- Food allergies may be present. Working with food allergies may be helpful in occasional cases (clinical observation).
- Be particularly vigilant what you eat from ovulation until your period, as many women are on “auto-pilot” premenstrually in terms of their diet.
2. Beneficial exercise
Get regular exercise. Walking is most beneficial, even if it only a few kilometres a day. Exercise helps burn off excess stress hormones like cortisol and adrenalin and keeps hormone levels stable in general. Physical activity is especially beneficial for women with PMS, and I have always noticed almost without exception that women report a significant decrease in all PMS symptoms once they start to exercise regularly. Just do it.
Your circulation will be improved, which helps relieve that bloating and puffiness. Moods will become more stable and upbeat, sleep improves and so does libido, which can be non-existent for many women. Blood sugar levels stabilise as insulin and cortisol become more effective with regular exercise too. Then there is the release of opiate-like endorphins during exercise which helps reduce a woman’s feelings of nervousness or anxiety.
Start with a mild, gentle 10–15 minute walk three times weekly and ensure you have good quality and comfortable shoes please. I also recommend that you have a few sessions with a personal trainer initially to get you into the exercise groove. This will ensure you do not develop many bad habits, work out a plan to suit you and remain motivated. There are plenty of places you can walk outside, and on rainy or cold days try walking inside in a large shopping mall. I love to walk and just watch people, their behaviours are fascinating.
3. Stress management
Along with a healthy diet and a regular exercise program, I cannot over emphasise the importance of stress release and relaxation when it comes to PMS. This is the number 1 folks, the big one. Some of the most common complaints I hear from women with PMS are anxiety, irritability, depression and tearfulness, and these complaints in particular will respond greatly to a stress management program such as outlined here:
- Check to see if you suffer from adrenal fatigue, which is a common underlying component of PMS. If you can recognise adrenal fatigue, it is best to treat this syndrome first. It may well be the reason you have PMS in the first place. This article is not about adrenal fatigue, you will be able to find out a lot more on the internet about this common complaint and take the appropriate measures to treat it successfully. Get this right first!
- Take more frequent mini-breaks during the day, and learn to say no to people, especially if you are already overworked. Try not to multitask continually and make more effective use of time management. This will allow you to prioritise your daily tasks and significantly reduce your anxiety levels.
- Have a15 minute power nap in the afternoon between 3 and 4pm. Best before the kids come home from school, or if you are in an office or work environment, take a coffee break and relax fully for 15 minutes (lying down on a carpeted surface is best). This will make a huge difference in time. In addition, try to have at least 30 minutes of a pleasurable, relaxing activity such as reading, listening to music, or writing every day. Spending time on the phone talking to a friend is beneficial too, especially if they are a good listener!
- Take regular holidays or weekends away. Do you? Leave your mobile devices, laptops and electronic gadgets at home. Spend time with a partner, not a screen. Other suggestions are tai chi, yoga or another type of “meditation in motion” programme. I love tai chi, and believe it is one of the most sublime ways to relieve stress and tension.
- More stretching, deep breathing, laughing and slowing down when you eat! These things all increase the ability of your adrenal (stress) glands to relax, making you feel less tired, more focused and improving your sleep. Try them, they work.
4. Nutritional supplementation
With PMS, I always recommend two things first: a top-quality multivitamin and mineral formulation, along with a top quality Omega 3 supplement. Take two or three multivitamins daily and two capsules of fish oil daily. Try this for three months first; this may be all you need do to correct any underlying deficiencies initially. Then progress to a top quality B-complex, along with a good calcium/magnesium supplement. That should be it. Stop there: don’t spend anymore than you have to.
But wait, there’s more! You may relate to one of the categories below. Take a look below at some more specific recommendations for the individual PMS categories.
PMS – A (Anxiety)
- Hydroxy-tryptophan (5HTP): A dosage of 100–500mg, three times per day, a good choice if you can relate to PMS–A and PMS –D. It helps relieve premenstrual psychological symptoms (dysphoria, mood swings, tension, and irritability). Lower doses are also effective in many cases. Don’t take if you are already on an antidepressant, see your naturopath first.
- Vitamin B Complex, 1–3 times per day: A high-potency B-complex vitamin will help a lot here. Start on one and build up to three daily, one with each meal. Best taken with foods.
- Vitamin E, 200–600 IU/day. Vitamin E is particularly good if you have benign breast problems and pain, it also improves tension, irritability, poor coordination and many of the physical symptoms associated with PMS. This vitamin also improves the estrogen/progesterone ratio.
- Magnesium, 300–600 mg/day. PMS sufferers often have low Mg levels and more prone for this reason to pain, cramps, depression, irritability, mood swings and fluid retention.
- Best herbs: Valerian, Chamomile, Rhodiola, Siberian ginseng, Vitex agnus castus. See your herbalist
- Restriction of full fat dairy products and refined carbs in particular.
PMS – C (Cravings)
- Vitamin E, 200-600 IU/day.
- Vitamin B Complex, 1–3 times per day: A high-potency B-complex vitamin will help a lot here. Start on one and build up to three daily, one with each meal. Best taken with foods.
- Magnesium, 300–600 mg/day. Mg along with Zinc and Vitamin B6 are crucial for correct blood sugar stabilisation.
- Chromium 200–500mcg twice daily with meals. This will help a lot with sugar cravings. Take one capsule twice daily for one week leading up to your period.
- Essential fatty acids: Evening Primrose oil, 3000 mg/day, relieved physical and psychological symptoms of PMS. Use long-term for best results (6 months)
- Restriction of animal fats, sugars and salt. Eat more fresh fruits, vegetables and meats.
- Eat smaller meals more frequently. Be mindful of sweet cravings a few days before your period. Eat more protein. No alcohol!
PMS – H (Hydration)
Same treatments for PMS–A, plus:
- Vitamin E, 200-600 IU/day. Vitamin E is particularly good if you have benign breast problems and pain, it also improves tension, irritability, poor coordination and many of the physical symptoms associated with PMS.
- Vitamin B Complex, 1–3 times per day: A high-potency B-complex vitamin will help a lot here. Start on one and build up to three daily, one with each meal. Best taken with foods.Essential fatty acids: Evening Primrose oil, 3000 mg/day, relieved physical and psychological symptoms of PMS. Use long-term for best results (6 months)
- Best herbs: A good kidney or fluid retention formula. Good herb is Taraxacum officinale leaf (dandelion leaves)
- Avoid too much salt, so keep away from take-away foods!
PMS – D (Depression)
- Vitamin B Complex, 1–3 times per day: A high-potency B-complex vitamin will help a lot here. Start on one and build up to three daily, one with each meal. Best taken with foods.
- Magnesium, 300–600 mg/day. PMS sufferers often have low Mg levels and more prone for this reason to pain, cramps, depression, irritability, mood swings and fluid retention.
- Calcium, 200–400mg/day. Has a calming influence, especially if taken with magnesium. Improves sleep too.
- Hydroxy-tryptophan (5HTP): A dosage of 100 – 500mg, 3 times per day. It helps relieve premenstrual psychological symptoms (dysphoria, mood swings, tension, and irritability). Lower doses are also effective in many cases. Don’t take if you are already on an antidepressant, see your naturopath first.
- Best herbs: St John’s Wort. Take the 5HTP for a few weeks first; if no benefit then try St John’s Wort. Don’t take both together. Some PMS women will benefit from one, some from the other. It is trial and error. Withania, Cicifuga, Wild yam and Licorice are all good choices. See your naturopath or herbalist.
PMS – P (Pain)
- Vitamin B Complex, 1–3 times per day: A high-potency B-complex vitamin will help a lot here. Start on one and build up to three daily, one with each meal. Best taken with foods.
- Magnesium, 300–600 mg/day. PMS sufferers often have low Mg levels and more prone for this reason to pain, cramps, depression, irritability, mood swings and fluid retention.
- Essential fatty acids: Evening Primrose oil, 3000mg/day, relieved physical and psychological symptoms of PMS. Use long-term for best results (6 months)
- Zinc (15mg/day) is worth taking, helps to work with B Vitamins and evening primrose oil to increase the production of the series 2 Prostaglandins (the body’s own anti inflammatory agents)
Conclusion
To summarise, by adopting a positive attitude and taking care of yourself with regard to having an optimised diet, sufficient sleep, regular exercise as well as carefully managing your stress, you can alleviate the severity of symptoms of PMS.
Unlike the “old days”, thankfully today there is an increased understanding of the natural hormonal influences on the body and mind of the 21st century woman. Natural medicine can improve a woman’s PMS outcome without the side effects commonly experienced in conventional medicine. My advice is to always initially opt for healthy dietary and lifestyle changes before going for pharmaceutical cures.
