PMS: the Hormonal see-saw
by Lynn Hinderliter CN, LDN

I recall when I was a young woman, my boss called me in one day to say that I simply had to do something about my regular monthly absences: to him, it was an inconvenience, showing how ill-fitted women were for higher managerial positions: to me, it was the inevitable time each month when I was fit for nothing.

 If only I had known then what I know now!

PMS does not come in only one flavor, however.  It is defined by letter as PMS- A for Anxiety, PMS- C for Cravings, PMS- D for Depression, and PMS-H for Hyperhydration.  See table below:

PMS-A PMS-C PMS-H PMS-D
Anxiety Crave sweets Weight gain Depression
Irritability Increased appetite Breasts tender Forgetfulness
Insomnia Eating sugar causes: Bloating Confusion
Depression- late headaches Edema of: Lethargy
palpitations face
fatigue/fainting extremities

Two new groups, Acne (pimples, oily skin and hair) and Dysmenorrhea (cramps, low back pain, nausea) have not yet been designated letters. A new name was recently given to a certain grouping of mostly psychological symptoms, PMDD, or Pre-Menstrual Dysphoric Disorder. My belief is that this set of symptoms was singled out and named specofocsally so that anti-depressants could be prescribed .. but that’s another story, and certainly some of us can attest that the condition exists!

The most common reason for PMS is a hormonal imbalance, most frequently estrogen dominance;  but nutrient deficiencies, poor dietary choices, thyroid imbalance and  serotonin deficiency can also be factors.

Dietary changes are the first line of defense to cope with this. 
  • Make sure your diet contains between 30 and 50 grams of fiber each day. This inevitably means other healthy changes will follow, since the best sources of fiber are fruits and vegetables, and whole grains. The added fiber lowers the estrogen levels in your blood: it appears that lack of fiber and an  excess of animal fats together  promote the presence of bacteria in the colon which, instead of allowing estrogen to be eliminated, in effect change conjugated estrogens into free estrogens, which are re-absorbed and recirculated.
  • Second, concentrate on fresh vegetables and fruits for the folic acid and phytonutrients they contain.  Juicing makes extra sense at around this time, but go easy on the sweet things:   I recommend a blend of carrot, celery, ginger, lemon and apple.  Add a little parsley if you tend to retain water.
  • A short course of pro-biotic supplementation is also  recommended and if your type of PMS appears to be related to estrogen dominance, the use of a natural progesterone cream can be enormously helpful. While the creams made from Wild Yam may help a little, I recommend the use of the ones that actually contain natural progesterone such as  Pure Essence’s FemCreme.
  •  It is not a good idea to use progesterone for PMD-D, unless you have had your hormone levels measured and determined a deficiency exists.
  • Limit salt – studies have shown that women susceptible to PMS use 78% more salt.  Consider herbs and spices in your cooking, parsley, paprika, sage and cayenne are good choices.  A little soy sauce could replace some of the salt, but of course, it is also high in sodium so go carefully.
  • Taking birth control pills can cause higher requirements of magnesium and B6, but these nutrients are also sensitive to consumption of excess sugar and/ or alcohol. Some nutritionists theorize that a craving for chocolate signals low levels of magnesium, since this nutrient is present in chocolate in high amounts. Conversely, supplementing with magnesium ( and chromium) can reduce cravings for sweets and chocolate.
  • Adding some soy to the diet, whether as tofu, soy milk,  or a soy drink not only helps mediate the symptoms of PMS, but appears to have long-term benefits as well.  A study** published in Cancer (2002;94:1166-1174.) by a Dr. Kimar and colleagues determined that the use of soy also slightly lengthened  the menstrual cycle, and therefore lessened women’s exposure to the “bad” estrogens, estradiol and estrone.  Using other plant phytoestrogens may have  the same effect.
  • There a number of herbal teas which can be both comforting and therapeutic at this time.  Some companies make specific blends, such as Traditional Medicinals’ PMS blend; otherwise sage, red raspberry, dandelion, ginger and Eleutherococcus (formerly known as Siberian Ginseng) are good choices.
  • Taking some things OUT of the diet can be as important as adding the right foods.  Many women are sensitive to foods containing Solanin ( the nightshade family) such as potatoes, tomatoes, peppers, and tobacco.  These, with Sugar, alcohol and caffeine* are  inducers of the inflammatory cascade which can seriously affect PMS status. Arachidonic acid is also a precursor to the inflammatory prostaglandins, and is found mainly in meat and dairy products.  Limiting these foods during the days before your cycle may pay dividends.
Those of you who are limiting your fat intake thinking to control weight, need to be aware of the importance of  Essential Fatty Acids (EFAs)

PMS is affected not only by an excess of the wrong Fatty Acids, but also by inadequate intake of supportive EFAs : dry skin, poor hair growth, low energy levels and other more serious health problems can result.

Many women benefit from the use of Evening Primrose oil, or other sources of GLA such as borage or black currant.. PMS sufferers who use 500 mg 3 x daily of GLA & DGLA show improvements in all areas, specifically depression, irritability, breast tenderness and fluid retention.

The Omega 3 fatty acids in fish oil have been studied for helping depression, and would definitely be a good addition in the case of PMS-D. I have heard PMS defined as “inflammation without infection”, and since Omega 3s control the inflammatory cascade,  their use may have benefits in other areas of swelling and tenderness as well.

A good multi vitamin throughout the month can promote significant improvement in PMS symptoms by ensuring the availability of the many nutrients that play a part in hormonal control.   Available also are formulas combining beneficial herbs with extra Magnesium and B6 for the days of the cycle.

If you are plagued by the psychological symptoms mentioned above, you may find relief by adding L-Tryptophan, an amino acid which is the natural precursor to Serotonin, at a dosage of 1 to 3 500 mg capsules daily. Remember that B6 is necessary for this function!

In Europe, health oriented physicians have for many years made use of a herb called Agnus Castus, sometimes marketed as Vitex or Chasteberry. . Several studies have shown that it helps control acne by normalizing sexual hormones, but a German study, using a liquid extract of Vitex, rated its effect as very good or good in 92% of PMS cases. A significant reduction was noted in such symptoms as headaches, bloating, fatigue, breast tenderness, nervousness & irritability. It is also helpful for correcting menstrual abnormalities because of its influence on the luteal phase defect. Chasteberry influences the pituitary gland to regulate the balance between estrogen and progesterone.

Pycnogenol (a patented pine bark extract) has been studied for relief (http://www.pycnogenol.com/pdf/Pycnogenol%20for%20PMS.pdf) from the physical symptoms of PMS, with excellent success in controlling cramps and discomfort.

Using other herbs such as Dong Quai (an anti-spasmodic which helps prevent cramping), Licorice Root (helpful for stress and digestion, and Ginger (an anti-inflammatory) is also helpful, and there are teas containing them which are effective and comforting.

Many experts have concluded that the strength of the bone that has been laid down in adolescence is a direct indicator of how the aging body will cope with bone loss:  and while no one dwells on  that in their early years, it helps to know that the dietary changes recommended here will also make sure that your body is stronger to resist the demands of child-bearing years and the aging process.

In short, PMS is classic case of a problem where it is possible for you to take charge, and in a non-invasive, self-enhancing way – improve your quality of life through natural help.


* A Study has found a strong association between caffeine and PMS: 61% of women who drank 4 to 15 caffeine containing drinks daily experienced symptoms:  only 16% of women who did not ingest caffeine had symptoms.

**An increase in menstrual cycle length would reduce the number of menstrual cycles during a lifetime, thereby reducing the total number of times the breast is exposed to estrogen,” Dr. Kumar’s group points out. Furthermore, “women will spend more days in the increased follicular cycle, when proliferation is at its lowest.” They continued: “These effects are mediated by the pituitary gland, and long-term effects on the pituitary gland may result in an overall antiestrogenic effect and, thus, in a lower risk for breast carcinoma.”

A note here on endometriosis, a serious condition which affects many women and which is addressed frequently by a hysterectomy, and/or hormone injections.

Before you go that route, which brings its own problems in its wake, you may be interested to learn that Pycnogenol (already, as mentioned above, studied for certain PMS symptoms)  turns out to be as effective a treatment as the injections.  http://www.eurekalert.org/pub_releases/2007-03/mg-nsp030707.php

Find the recommended supplements here
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More sensible Guidelines to help yourself with PMS http://www.williams.edu/admin/health/ephnotes/notes022.html

Important information: ANY woman who is on birth control, and has received the report of an  atypical Pap smear needs to know about this.  http://researchnews.osu.edu/archive/thinprep.htm

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