Premenstrual syndrome or PMS is one of the most common conditions I come across in my practice.  PMS is the name given for the cyclic occurrence of specific physical and behavioural changes experienced by women, usually appearing two weeks before menses.  Symptoms can include — but are not limited to — headache, fatigue, fluid retention, constipation, weight gain, acne, abdominal cramps, sugar cravings, low libido and even panic attacks.  For most women in their reproductive years, it is easy to assume that PMS is just the burden of being a woman. But did you know that PMS is not a natural condition? In fact, PMS is often the result of a hormonal imbalance. One of its causes can be high and unopposed estrogen.  High amounts of estrogen in ratio to progesterone is associated with many of the following types of PMS.

Four types of PMS have been identified:

• PMS-A: This includes anxiety, emotional ups and downs and outbursts. This can be due to high copper and low zinc, which is especially common in women with a history of taking oral contraceptives.
• PMS-D: The “D” stands for depression, but can also include fear, paranoia, withdrawal and suicidal tendencies. This can be due to low serotonin.
• PMS-C: The “C” stands for cravings for food. This can be due to an over-secretion or increased binding of insulin and low serotonin.  This can be due to low magnesium or low prostaglandin levels.
• PMS-H: The “H” stands for heaviness or headache, which can include bloating, fluid retention, bloating and weight gain. This can be due to low magnesium and poor Vitamin B6 metabolism.

These four classifications were created as far back as 1931 and, yet, one can argue they are much more relevant today.  Nutritional deficiencies due to poor quality soil and a highly refined diet are contributing to more intense PMS symptoms.  Also, the use of oral contraceptives and the sheer amount of endocrine disruptors (or estrogen mimickers), whether in our exposure to toxic ingredients in cosmetics or the plastic in a water bottle, not to mention other stresses in our environment, are also tilting hormones to favour estrogen over progesterone.  As women get closer to menopause, progesterone declines even more dramatically creating an even higher ratio of estrogen to progesterone.  Consequently, women find that their PMS symptoms get worse as they get older.  Progesterone is essential to warding off PMS symptoms. One of its functions is to promote smooth muscle contraction which can prevent severe cramping. Meanwhile, too much estrogen can have the opposite effect leaving women to suffer with many of the classic symptoms of PMS.

Here are a few things you can do to help find some relief:

• Increase your intake of phytoestrogens. Some good sources include fermented soy products such as tempeh or miso.  Flax seeds, chia, sesame seeds, berries, oats, mung beans, alfalfa and lentils are also beneficial.  These foods will compete with receptor sites that might otherwise be taken up by endocrine disruptors called xenoestrogens, which will promote inflammation in the body.
• Stabilize your blood sugar by sticking to a low-glycemic diet. Eat whole, unprocessed organic foods.  Low glycemic foods will help increase serotonin levels and increase mood.
• If you are suffering from water retention, consider diuretic foods such as dandelion, asparagus, watermelon, grapes and cucumber.
• Constipation can be remedied by a combination of soluble and insoluble fibre. This includes fruit, vegetables and whole grains.
• Avoid stimulants like caffeine in tea, coffee, chocolate and soft drinks. Not only can stimulants affect blood sugar, but they can also lead to mood swings, anxiety and forgetfulness.
• Decrease dairy products and animal fats. Animal-based products can contain estrogen-like hormones and growth hormones.
• Increase your intake of dark, leafy green vegetables and chlorophyll-containing foods. This will provide much-needed B vitamins and help support the liver (which metabolizes hormones).

Here is a list of supplements* that might help, if a whole foods diet is not enough.

• Vitamin C, B complex, B5 and an adrenal glandular are important for supporting adrenal gland function. The adrenals are endocrine glands that play an essential role in healthy hormone balance.
• Vitamin B6 is a natural diuretic and is a vitamin that gets depleted with the prolonged use of oral contraceptives. When Vitamin B6 is combined with Omega-3 and Omega-6 fatty acids, zinc, magnesium, Vitamin B3 and Vitamin C, one can address prostaglandin imbalance. Prostaglandins are a group of cyclic fatty acid compounds, which have a variety of hormone-like effects in the body including promoting uterine contractions.  When out of balance, there will be more pain, clotting and inflammation.
• Constipation can be addressed with higher doses of Vitamin C and magnesium. Magnesium, in combination with calcium (2:1 ratio) can also address cramping, breast tenderness and muscular pain. Sugar cravings can sometimes be fully remedied with magnesium alone.  Taking a Mag/Cal supplement at bedtime can help promote sleep.
• Breast tenderness can be addressed simply by taking Vitamin E and iodine, which also protect the breasts from the potent effects of estrogen. Cabbage leaves applied directly to the breasts can also help.
• Headaches are alleviated by magnesium, vitamin B3, and potassium.
• Depression can be addressed with 5-HTP (a serotonin precursor), Vitamin B6, B2 and B3.
• Alternating flax seed oil (day 1-14 of menstrual cycle) with evening primrose oil (day 15-28 of menstrual cycle) can also help balance estrogen and progesterone.

*Keep in mind that many of these vitamins can be found in a multivitamin. However, depending on an individual’s unique requirements, additional vitamins and/or minerals may be required. Look for a whole food multivitamin when shopping at the health food store.

There are many other PMS therapies, including botanical remedies such as vitex, rosemary, cramp bark and motherwort as well as homeopathic remedies.  However, many of these remedies are highly individualized and would be best matched to a patient’s individual symptom picture by a skilled practitioner.

Good-quality sleep, exercise and meditation are also important for managing PMS symptoms.  However, it is important to note that the biochemical and endocrine picture can be complex.  PMS symptoms are not necessarily caused by one thing, such as a high estrogen to progesterone ratio.  There could also be high prolactin, high cortisol, low thyroid function, lower endorphins, reduced serotonin or impaired Vitamin B6 metabolism.  It is worth tracking your symptoms throughout the month, as well as keeping food journal, as it will provide invaluable information that you can go over with your practitioner.

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Sources:

Image courtesy of Ohmega1982 at FreeDigitalPhotos.net.

Lessard-Rhead, Brenda, “Nutritional Pathology,” 2013.