PMS

A joke recently doing the email rounds describes PMS as shorthand for “preposterous mood swings” and “punish my spouse.” The truth is that women who experience the cyclical symptoms of PMS aren’t laughing; but they can break the cycle.

Simply asking a woman if she has premenstrual syndrome doesn’t get to the heart of the issue, because many women require a better understanding of the condition. Interestingly, some women believe it refers only to mood changes prior to their period, while others think the symptoms of water retention, sore breasts, and irritability are a normal part of their cycle.

What is PMS?

PMS involves many different symptoms that can last a few days to weeks prior to the onset of menses. The symptoms, along with their intensity, can vary from month to month, but usually end after the first or second day of bleeding when the follicular phase of the menstrual cycle begins. The time before the menstrual flow, coinciding with PMS, is called the luteal phase. It begins at ovulation and continues until the first day of bleeding.

We know that about 75 percent of women have PMS and that it’s most likely to affect those between their late 20s and early 40s. Out of these sufferers, about eight to 10 percent require medical intervention to manage their mood and behavioural changes.

Some women with PMS experience premenstrual dysphoric disorder, a form of premenstrual syndrome associated with severe depression, hopelessness, anger, anxiety, and low self-esteem.

There are five types of PMS characterized by distinct symptoms related to their underlying cause(s). Understanding the type of PMS you experience will help you to find relief.

Get Specific; Address Your PMS Type

PMS A is caused by a deficiency of progesterone which can be replaced with the daily use of the herb Chaste tree (Vitex agnus-castus) or by using a compounded natural progesterone creme from ovulation to the first day of bleeding. Breast tenderness, anxiety, sleep disruptions, headaches, and menstrual irregularities such as spotting, infertility, or a shortened cycle can improve with these treatments.

Chaste tree, in addition to raising progesterone, reduces prolactin and raises dopamine to further assist with the hormonal imbalances of PMS. Indol-3-carbinol and calcium D-glucarate are also recommended to assist with related estrogen dominance.

PMS C can be treated by aiding blood sugar regulation which reduces cravings, hypoglycemia, and appetite. Frequent, balanced meals are a must, while supplements of chromium, magnesium, zinc, and green tea can also be beneficial.

PMS H should be treated as for PMS A, although with additional emphasis on sodium and potassium balance for fluid regulation. Include dandelion leaf tea and potassium-rich foods (bananas, avocados, apricots, cantaloupe, and broccoli) to increase potassium and reduce water retention.

PMS D is helped with foods (soy, flaxseeds, and fennel) and herbal
medicines such as black cohosh, licorice, red clover, and angelica. These products are high in phytoestrogens that can improve deficiency symptoms of estrogen. For additional anti-depressant action, include foods high in tryptophan or supplements of 5 HTP to raise serotonin.

PMS P can be managed through favourable prostaglandin production. Follow the recommendations below for best results. Anti-inflammatory herbs such as turmeric, white willow bark, feverfew, or devil’s claw may also be useful.

Detox

Restrict unhealthy foods Remove alcohol, caffeine, sugar, processed flours, and inflammatory fats such as those found in full-fat dairy products, red meats, peanuts, margarines, shortening, and hydrogenated oils from your diet. Limit salt to reduce fluid retention.

Eat a balanced diet Include lean protein (organic chicken, turkey, tempeh, nuts, omega-3 eggs), healthy fats (olive oil, avocado, nuts, etc.), and complex carbohydrates (kamut, beans, rye, oats, fruits, vegetables) every three to four hours during the day. This will maintain blood sugar levels and avoid undue stress and hormonal imbalance because of skipped meals.

Use herbs Promote the flow of bile–naturally high in estrogen byproducts–with milk thistle, dandelion root, beet leaf, or artichoke. Probiotic supplements will establish healthy bacterial balance in your digestive system and further support the breakdown and elimination of estrogen.

Address constipation Less than one bowel movement per day can significantly contribute to toxicity, hormonal imbalance, and future risk of disease. For constipation, take 3 Tbsp (45 mL) of ground flaxseeds daily.

Take the Right Supplements, Daily

A high potency multivitamin with breakfast and dinner prevents nutrient deficiency, maintains metabolism, and improves energy.

Calcium/magnesium citrate should be taken in a 1:1 ratio with vitamin D₃. Magnesium helps fluid retention, breast tenderness, anxiety, fatigue, and bloating, while calcium assists with cramping and other PMS symptoms.

Vitamin B complex (preferably higher in vitamin B₆) can reduce water retention, breast tenderness, irritability, and depression symptoms.

Essential fatty acids Fish oil (EPA/DHA) and evening primrose oil taken daily may reduce breast tenderness, mood changes, weight gain, abdominal pain, and cravings associated with PMS. These fats influence the production of prostaglandins that regulate pain and inflammation in the body and aid hormonal balance.

Mixed vitamin E (containing all the types of vitamin E) reduces the production of prostaglandins that contribute to cramps and breast tenderness.

Manage Stress

Sleep seven and a half to nine hours each night, in pitch black, to improve hormonal balance and stress recuperation.

Exercise 20 to 30 minutes at least three times per week to reduce stress and tension and to improve mood. Aerobic exercises such as cycling, walking, or running are best for enhancing mood and reducing pain.

Practise progressive relaxation exercises, meditation, yoga, or deep breathing to help stress-related symptoms such as headaches, anxiety, or sleeping troubles.

Pay close attention to your monthly menstrual symptoms. Self-care and awareness will lead to improved hormonal balance–and put the smile back on your face.

PMS Types and Their Symptoms

Although most women do not experience the same symptoms, there are five general types of PMS. They are characterized by distinct symptoms related to their underlying cause(s), although the manifestation of PMS varies greatly because presentation with one or more
PMS types is possible.

PMS A Anxiety, tension, paranoia, crying, emotionally labile (unstable, unsteady, not fixed), mood swings, and nervousness.

PMS C Cravings especially for chocolate or sweets, increased appetite or insatiable hunger, fatigue, headaches, blood sugar abnormalities like hypoglycemia; commonly occurs with PMS A.

PMS H Heaviness, hydration, headaches caused by water retention, swelling, breast tenderness, bloating, weight gain; may also occur with PMS A.

PMS D Depression, confusion, forgetfulness, clumsiness, withdrawal, insomnia, and, in severe cases, risk of suicide.

PMS P Pain caused by pro-inflammatory chemicals called prostaglandins, especially in the joints, lower back, or abdomen and headaches.

Causes of PMS

Although we don’t know a single definitive cause, many contributing factors for PMS have been identified.

Improper diet Excess sugar, salt, unhealthy fats, caffeine, or alcohol can contribute to hormonal imbalance, inflammation, weight gain, and nutrient deficiencies associated with PMS.

Progesterone deficiency Stress causes a depletion of the hormone progesterone. Naturally highest in the luteal phase of the menstrual cycle, progesterone works to prevent many PMS symptoms such as anxiety, headaches, sleep disruption, water retention, and breast tenderness.

Stress Stress also depletes serotonin and dopamine, two mood enhancing hormones involved in the prevention of PMS symptoms such as breast pain, digestive upset, cravings, depression, anxiety, poor concentration, and lack of motivation. Stress also raises the hormone aldosterone that contributes to water retention and magnesium loss.

Estrogen dominance Taking the birth control pill or other forms of medications containing estrogen can cause estrogen dominance which is linked to PMS as well as uterine fibroids, ovarian cysts, and risk of breast cancer. Abnormally high levels of estrogen in the luteal phase may also cause emotional symptoms such as irritability and aggression.

Nutrient deficiency Healthy levels of magnesium, vitamin B₆, calcium, folic acid, and essential fatty acids are important for the prevention and treatment of PMS.

Toxicity of the liver and/or digestive tract Yeast overgrowth, low fibre, or beneficial bacteria in the digestive tract compromise estrogen breakdown and elimination. Poor liver function or limited bile flow will also cause estrogen dominance because bile is high in estrogen metabolites.

Excess prolactin Some women with PMS have abnormally elevated amounts of prolactin, a hormone naturally produced when we breastfeed. High prolactin causes PMS symptoms including breast tenderness and swelling, anxiety, and irritability.

Underlying mental disorder As many as 50 to 60 percent of women with PMS have an underlying mental disorder such as depression or chronic anxiety. These mental conditions are usually associated with an increase in the production of stress hormones and depleted dopamine or progesterone, setting the stage for PMS.

Hormonal changes Puberty, pregnancy, menopause, hormone medications, or surgery involving the uterus or ovaries can lead to hormonal changes that may cause PMS.

Hypothyroidism Underactive thyroid disease should be considered as a possible cause of PMS symptoms. Progesterone (if deficient, causes PMS) is also necessary for healthy thyroid gland function.

Recognizing PMS

The symptoms of PMS can be both mental and physical.

Physical symptoms:

• headaches or migraines
• water retention
• swelling of ankles, feet, and hands
• backache, abdominal cramps, or heaviness
• abdominal fullness and bloating
• breast tenderness
• weight gain
• insomnia or sleep disruption
• acne or pimples
• nausea
• bloating
• constipation or diarrhea

Mental symptoms:

• food cravings
• anxiety or panic
• poor concentration and/or memory
• poor judgment
• depression
• irritability, hostility, or aggressive behaviour
• fatigue
• sex drive changes, loss of sex drive
• paranoia or increased fears
• low self-esteem and poor self-image