Premenstrual Syndrome: The Curse Within the Curse

In this guest article, Mill Valley naturopathic doctor Lisa Brent, ND, LAc offers some suggestions for treating PMS.

If you are a woman who suffers from premenstrual syndrome (PMS), it might be helpful to know that you are not alone. Of course, if you are a woman who is experiencing PMS as you are reading this, you probably don’t care at all that many other women have similar issues. You may just want to shout some expletives at your computer and then burst into tears. That’s usually how I behave right around the third week of every month. (Well, at other times, too, but I can’t blame that on my period.)

Just for the record, approximately 80% of women experience emotional or physical changes before their menses; among these women, about 20–40% have functional difficulties that have a negative impact on their work, relationships or home lives. More than 150 symptoms have been attributed to PMS. The most common are anxiousness, irritability and anger or mood swings among all three. Some women feel very sad; others feel tired and lethargic. Physical changes include bloating, breast tenderness, food cravings, headache and intestinal upset. There is also a group of women who experience positive changes before their period: enhanced creativity, heightened sexual desire, intellectual clarity and feelings of happiness. But we don’t need to talk bout them.

Why, oh why does this happen?
If you visit your doctor to seek help with this syndrome, she will probably tell you that the diagnosis is clinical. That means there are no definitive blood tests to confirm it. The best way to evaluate and diagnose PMS is to use a diary that correlates your symptoms to your menstrual cycle. However, blood tests can be helpful to rule out thyroid and blood sugar problems and to look for hormonal imbalances. Psychological evaluation should also be considered to reveal co-existing depression and anxiety.

It is difficult to identify the cause in a condition that affects so many and has such a wide variety of symptoms. PMS encompasses a complex interaction of factors—both physiological and social. A pattern of “estrogen dominance” is often implicated. While absolute levels of estrogen and progesterone are not different in PMS sufferers, we know that in women in whom both hormones are pharmaceutically blocked, PMS diminishes by 75%.

It is important to rule out other possible causes of the symptoms and to be aware of medical conditions that might be magnified during the premenstrual period. Women with migraines, epilepsy, herpes or eating disorders will often notice that their symptoms get worse before their period.

Let’s get rid of it already!
The most common conventional medical approaches to difficult periods are to offer women the birth control pill or an antidepressant. While these treatments will suppress the symptoms in many cases, they bring with them a host of potential side effects and, more importantly, they do not address the cause of the PMS. That said, many women choose to use these methods and that is completely understandable. Busy mothers, especially, have little room in their lives for untimely emotional breakdowns and debilitating physical symptoms.

Natural medical treatments are aimed at relieving symptoms and while addressing possible causes of the PMS. Many natural alternative therapies are available, including diet and lifestyle changes, vitamin and mineral supplements, herbal medicines and natural hormones. The key is that PMS treatment needs to be customized for each woman. What works for one person is different than what works for another. We are all individuals with our own unique physiology, stressors and psychological makeup.

If the pattern of PMS has not yet become severe, preventative medical recommendations might help to rebalance the cycle quite easily. These include a whole foods diet with minimal sugar, refined carbohydrates, dairy, caffeine and saturated fats; increased fiber from whole grains; increased essential fatty acids from nuts seeds and fish; regular aerobic exercise and weight loss. Of course, this is challenging when all you want to do is curl up in bed with a pint of Ben & Jerry’s.

The Chocolate Cure
Which brings us to the issue of chocolate. As it turns out, there is good scientific evidence to explain why we crave (and feel better from eating) chocolate when we are premenstrual: hormonal changes associated with the menstrual cycle affect serotonin activity. Studies have shown that when premenstrual women eat carbohydrates, their brain cells make more serotonin and this chemical messenger brings women back to feeling normal. Actually, all carbohydrates except fructose (fruit sugar) will produce the same beneficial effect on premenstrual mood. However, chocolate in particular possesses qualities that have been shown to improve mood and balance emotions.

The best way to indulge in carbohydrates while keeping your blood sugar in check is always to combine them with protein, i.e. toast with peanut butter, pasta with meat sauce, crackers with cheese, chocolate with almonds, etc.

If the chocolate cure does not do the trick, then more aggressive natural treatment approaches may be in order. These include more specific dietary changes; nutritional supplements such as vitamin B6, vitamin D, vitamin E, essential fatty acids, magnesium, calcium; herbal remedies, including chaste tree berry, ginkgo biloba and St. John's wort; exercise and natural progesterone.

And so, the point is...
Mainstream medicine has not been able to offer a known cause for PMS, nor can it offer a treatment approach except for pharmaceuticals, which often come with as many effects as relief. One of the biggest benefits of treating PMS with natural approaches is that it often motivates women to make lifestyle changes that have a positive effect on their overall health. And this makes us more fun to be around all month long.

Lisa Brent, ND, LAc is a naturopathic doctor and licensed acupuncturist specializing in women’s health and integrative gynecology at the Owning Pink Center in Mill Valley, CA. She can be reached at (415) 746-6140 or drlisabrent@gmail.com.