co-written by Rick Olazabal, BSc, BN
Over the past few years I’ve been asked to give several talks on women’s health issues. Being a topic that expends well across the realm of endocrinology I had no problem with it. The problem with that, however, is that I was “the guy” lecturing a group of women—the experts on this topic!
If you’re a lady, and most certainly you will be one if you’re reading this, I must apologize to you in advance. So, what can this guy tell you about PMS that you don’t already know? Well, let’s find out…
For starters, premenstrual syndrome (PMS) is not a diagnosis per sé, but a group of symptoms associated with fluctuating levels of estrogen and progesterone during the luteal phase of a woman’s cycle. Did I get it text-book perfect? Alright, so what does that have to you? Not every woman experiences the same symptoms onset and severity.
There are four groups of PMS symptoms:
- PMS-A: which includes anxiety, mood swings, nervousness, irritability;
- PMS-C: which is marked by cravings, as well as hypoglycaemic (i.e. low sugar) symptoms like headaches, dizziness, brain fog;
- PMS-D: which combines depression, insomnia, poor memory, heightened emotional states (e.g. crying); finally,
- PMS-H: where weight gain, edema, bloating, and hyperhydration are present.
So which PMS type are you, and what can you do?
It is especially important that you work alongside a qualified healthcare professional in order to determine whether conventional intervention is needed. This is done in order to rule out any underlying serious conditions (e.g. hypothyroidism, depression, etc.). The next step is minimizing any obstacles to your healing. This involves reduction of potential environmental contaminants, stress management, promoting proper digestion and liver function (for effective hormone excretion).
Some sources state that, when compared to symptom-free women, those with PMS tend to consume1:
- 62% more carbs
- 275% more refined sugars (including juice and sodas)
- 79% more dairy products
- 78% more sodium
- 53% less iron
- 77% less manganese
- 52% less zinc
While this may sound very appealing, it is not always that easy; it usually involves lifestyle modification and dietary changes (e.g. caffeine and sugar elimination). However, I could not stress it enough how important it is to adhere to such changes in order to see longstanding positive changes in your symptoms.
Your healthcare provider may request blood work, usually on day 3 or 4 of your cycle in order to see if there are any discrepancies with estrogen and progesterone levels. Acquiring a thorough history about the peculiar signs and symptoms can give further insight as to what PMS category you fall under and thus support those other systems.
It is important to rule out other conditions like endometriosis, fibroids, PCOS…the list is expansive! And most importantly, disclose any personal and/or family history of cancer. This makes it possible to come up with a safe, comprehensive and effective protocol.
Now on to the good stuff…
Clearance problem: If the PMS symptoms arise from a clearance problem, high-dose vitamin B6 may be prescribed alongside magnesium and vitamin E. Vitamin B6, in particular, is involved in estrogen clearance. It is theorized that estrogen alone is not the culprit, but the by-products of its metabolism—on other words, when your liver “deactivates” or changes estrogen from one form (e.g. estradiol) to another, this other form may be involved in exacerbating your symptoms, so it’s important to promote the excretion of these metabolites from the body.
Cramping, breast tenderness: If it progesterone appears to be lower than normal (as seen with cycle length variation, breast tenderness, cysts, cramping), chaste berry (Agnus vitex-castus) may be added to the protocol. Other herbs, like dong-quai (Angelica sinensis) could be included to ease cramping, and if water retention is an issue, licorice (Glycyrrhiza glabra) can be added.
Fatigue & Nervousness: If your symptoms include fatigue, an adaptogen like rhodiola (Rhodiola rosea), ashwagandha (Withania somnifora), and/or licorice (Glycyrrhiza glabra) may be added, but check first with a licensed naturopathic doctor if you have thyroid of blood pressure problems. For calming the mind, flowering oats (Avena sativa) could be considered.
Bloating: If bloating and indigestion is a problem, fibre, fermented foods, and probiotics may also be part of the protocol. Herbs that support liver function as well as those that help with stomach acid production (i.e. “bitters”) can help reduce symptoms of bloating and distention.
Perimenopause: For women entering perimenopause, black cohosh (Cimifuga racemosa) may be indicated as well.
Pain (general): Many people are not fans of needles, but it would be a great injustice not to give acupuncture merit when it comes to alleviating PMS pain. From a herbal perspective, devil’s claw (Harpagophytum procumbens) and nettle leaf have been shown to have broad anti-inflammatory properties; this is definitely something to consider if you wish to decrease the use of commonly prescribed—and over-the-counter—pain relievers (e.g. acetaminophen and/or ibuprofen).
Please note that while the herbs mentioned form part of a large repertoire of medicinal plants indicated for PMS symptoms no two cases are alike, so dosing, frequency and potency may differ from woman to woman.
In traditional herbalism, some herbs are more indicated in conditions of “excess” (e.g. cramping before the period, heavy flow) and others more so in conditions of “deficiency” (e.g. feeling drained, fatigued, hopeless). It’s not always easy deciding for yourself which is better for you, so do speak with licensed naturopathic doctor or a qualified health professional.
For women experiencing longstanding menstrual issues, it may be a good idea to check iron and its storages in case supplementation is needed.
If you feel like a chocolate bar, go ahead, don’t be ashamed, you’ve earned it. And if you feel like biting someone’s head off…they probably deserved it. But on a serious note, regardless of your PMS type, there is always a practitioner out there very happy to support you.
1- Pizzorno et al., 2008