Gill Stannard

Monday, September 29, 2008


What is Premenstrual Syndrome?

As the name suggest PMS refers to symptoms that reoccur in the second half of the menstrual cycle (also known as the luteal phase). The most common types of PMS include:

Anxiety, depression, mood swings, aggression, tearfulness
Changes in energy – fatigue or increased energy and insomnia
Feeling more stressed
Cravings – for specific foods such as sugar or carbohydrates, or just greater quantities of food
“Hyperhydration” – i.e.: fluid retention: increased breast size, breast pain, general weight gain, being clumsier (possibly due to very slight fluid retention in the brain)
Flares of chronic conditions such as migraines, acne etc

Symptoms can technically occur any time from ovulation (mid-cycle) to the beginning of menstruation but in more commonly starts from one week to one day before the period. Once bleeding is established the symptoms usually disappear but may come back again the next month.

Any condition which is termed a “syndrome” tends to mean a cluster of symptoms which is not medically fully understood.

What causes PMS?

The common answer is a hormonal imbalance but in blood tests most women with PMS will show sex hormones within normal range A current theory suggest this is due to an increased sensitivity to circulating progesterone and its metabolites rather than abnormal concentrations of hormones. The role of neurotransmitters such as serotonin are also being considered

Conventional treatment tends to use drugs to override an individual’s hormone response through the oral contraceptive pill (also implants and injections), antidepressants and diuretics. Research on the pill as a treatment for the condition tends to suggest that 1/3 of women will have less PMS, another 1/3 will have more and the rest will have no change in their condition.

Naturopathy concentrates on other triggers that may cause the hormonal sensitivity in the first place – such as nutrition, diet and lifestyle.

What is a natural approach to PMS?

Early research has identified low B6 and Magnesium to be significant triggers for PMS (both nutrients important in the health of the nervous system). But I’d caution against taking B vitamins on their own (i.e. not without all the other B’s) as this may cause other deficiencies. Look for a good multivitamin with at least 50 mg each of B6 and magnesium plus calcium and Vitamin E.

The herb Chaste Tree berry (Vitex agnus castus) has been proven to help regulate a variety of sex hormone related conditions. Dose is usually 1-2 gm a day and needs to be taken every day for at least 2-4 consecutive menstrual cycles. Do not take chaste tree if on the pill or other hormonal medication.

St Johns Wort (Hypericum perforatum) may help with mood changes, insomnia, stress and recurrent conditions like migraines due to its positive influence on serotonin. Like Chaste Tree it should be avoided when taking the pill etc (and check these other possible drug interactions) and needs to be taken for at least 3 months. The two herbs can be taken together but it is best to consult a qualified herbalist to make sure you are getting the best quality herbal preparation and in the correct quantities.

For fluid retention drinking 2-4 cups a day of nettle and/or dandelion leaf tea is effective.

Evening Primrose oil is another commonly prescribed remedy but this needs to be taken with other nutrients for it to have the desired effect so always take with a strong multivitamin. Therapeutic dose for EPO is very high; 6 grams a day, so make sure you are taking enough.

So called “natural progesterone” creams have been touted for the treatment of PMS but this is a misnomer. Straight Wild Yam creams (the unadulterated herb in a cream base to rub onto the skin) are ineffective as despite the herbs potential to be a starting point for a particular steroidal action (influencing the hormones) the body is unable to metabolise these starting blocks unaided. Other so-called natural creams begin with the herb in the laboratory and are then altered to create a pharmaceutical drug. While these may have some therapeutic effect these are no more “natural” than a type of hormone replacement therapy. (For more information see this article on bio-identical hormones)

Is there a special diet for PMS?

While supplementing with vitamins is a good place to start treatment, long term dietary change is the key to controlling this condition in the long term.

Wholefoods – raw nuts, seeds, legumes, unrefined grains (eg: oats, brown rice, millet, quinoa etc) plus fish and lots of fruit and vegetables are the key.

Foods to avoid include refined foods (especially sugar), caffeine, alcohol and salt.

It is important to eat like this the whole month not just in the second half of the cycle.

What are some other ways you can create a PMS-free life?

Anything that reduces background stress can reduce PMS, so all the tried and true stress busters such as regular exercise, meditation, yoga, tai chi etc are worth giving a go. Consider simplifying your life.

Nicotine and other recreational drugs tend to worsen PMS, if you need help to give up cigarettes or work with other addictions, I would recommend seeing a registered psychologist who specialises in hypnotherapy.

If you have emotional symptoms and the same issues arise for you every month, take a note of what your recurrent themes are. Take a look at them a week or two later when not feeling premenstrual and see if there are any emotional issues that still resonate with you. For example – if your self-esteem takes a dive, old grief arises, the same relationship issues come up, although these may be magnified out of proportion in the second half of the cycle they could be pointers to work on in therapy.


Henriette said...

Nice post - but have you tried 2-3 gm of vitex a day? It tastes _ghastly_.
Better to do 10-15 drops of a nice 1:2 95 % tincture a day.

Even then, vitex just shifts the nutrients around a bit, and - if you don't ALSO do magnesium, B6, fish oil, etc. with the vitex - after a while, depression sets in.

Cos vitex depleted the lot, and now you don't have the building materials for dopamine etc. anymore.

Gill Stannard Naturopath said...

Thanks for popping by Henriette. It's lovely to have another herbalist's perspective. The vitex dosing is reflective of the what I'd call "the Kerry Bone school of prescribing". There are some followers who use even higher doses. Though some Australian herbalists do use that kind of drop dosing, it is not as common. If someone is on vitex for months I'd usually prescribe it as tablets.

I agree with you about nutrition. I fundamentally believe so much of PMS is a deficiency state.

Gill Stannard Naturopath said...

And taste: I'll never forget the time I helped harvest vitex years ago. I can smell it now just thinking about it. It gave me one heck of a headache!

Henriette said...

I gave powdered vitex seeds to a client years ago, cos she said she couldn't do tinctures.

About a week in, she asked about the drops ...

I think that 1-2 seeds, chewed, would do the same as tablespoons of the stuff. It's certainly strong enough for that.

Nice taste (and scent) in moderation, though. Mmm.