Premenstrual Syndrome (PMS)
Premenstrual syndrome, more commonly known as PMS, is a disorder that affects high numbers—almost 75 percent—of menstruating women. It usually occurs a week or two before bleeding begins and is characterized by a wide range of symptoms, including (but not limited to) bloating, breast tenderness, emotional changes, cramps, and fatigue. Some women with PMS experience just one or two of these symptoms and ﬁnd them quite mild and tolerable; others are hit with several symptoms, each so intense as to be incapacitating. Most women’s symptoms exist somewhere between the two extremes, producing a moderate level of discomfort and at least some disrup- tion of daily activities.
Because so many women experience PMS, Western medicine long considered most PMS symptoms a normal part of womanhood. If a woman had debilitating PMS, she was likely to be dismissed—to a Western doctor, her symptoms were clearly “all in her head.” We now know that PMS is a physical disorder—and a highly treatable one, at that.
Each month, a woman’s hormones follow a predictable cycle of change. Some ﬂuc- tuation is absolutely normal and necessary, but when the ups and downs become severe, or when the different kinds of hormones needed to regulate body functions are knocked out of balance, the result is water retention, cramps, fatigue, or any of the other symptoms of PMS. Hormone imbalance is a common problem with PMS. While excessive estrogen and progesterone def iciency (or an imbalanced ratio between the two) are believed by many practitioners and researchers to be the key imbalance, there can also be issues with elevated prolactin (pituitary hormone), increased aldosterone (adrenal gland dysfunction), serotonin deﬁciency, and thyroid abnormality (usually, low thyroid). One must also consider the role of the liver with PMS, as it is responsible for metabolizing hormones. Improving liver function with natural therapies often helps to lessen the symptoms of PMS.
Poor diet and nutritional deﬁciencies can be root problems of PMS as well. One must also consider the role of “hormone disrupters” in the environment, such as pes- ticides and herbicides.
In addition, PMS can be caused or aggravated by food allergies, seasonal affective disorder, stress, and depression; a wise course of treatment will address each of these potential triggers. If you have severe PMS that is not resolved by using the home treat- ments suggested here, consult with a holistic doctor. You may have an underlying dis- order, such as hypoglycemia or an underactive thyroid.
• Irritability • Bloating
• Tension • Weight gain (ﬂuid)
• Anxiety • Breast tenderness
• Mood swings • Headache
• Aggression • Pelvic discomfort and pain
• Loss of concentration • Change in bowel habits
• Depression • Increased appetite
• Forgetfulness • Sugar cravings
• Mental confusion and fatigue • Generalized aches and pains
• Insomnia • Physical tiredness
• Change in libido • Weakness
• Crying spells • Clumsiness
• Hormonal imbalances
• Poor diet
• Food allergies
• Seasonal affective disorder
• Thyroid problems
• Environmental toxins (e.g., pesticides)
• Poor liver function
• Nutritional deﬁciencies
The following tests help assess possible reasons for PMS:
Hormone testing (thyroid, DHEA, cortisol, testosterone, IGF-1, estrogen, progesterone, prolactin)—saliva, blood, or urine Detoxiﬁcation proﬁle—urine
Vitamin and mineral analysis (especially magnesium, calcium, B6, B12)—
blood Food and environmental allergies/sensitivities—blood, electrodermal
A diet that’s high in meat, fat, sugar, and salt will make hormones ﬂuctuate out of con-
trol and will intensify the symptoms of PMS. It has been shown that vegetarian women have much less circulating free estrogen in their blood than nonvegetarian women do. This does not mean you have to become totally vegetarian. However, it does suggest that a diet that focuses on plant foods leads to less circulating estrogen, thus decreas- ing one’s susceptibility to PMS. A good, wholesome diet can signiﬁcantly reduce or even eliminate problems altogether.
Meals based on whole, high-ﬁber foods will balance your blood sugar, ease digestive problems, and reduce stress on your liver. Vegetables, fruits, whole grains, legumes, herbs, nuts, and seeds should be plentiful in the diet.
Fermented soy products, such as tofu, tempeh, and miso, can also help prevent
PMS, due to their hormone-balancing phytonutrients.
Make sure your animal products (meat, poultry, etc.) are hormone free.
Eat at least two servings of green leafy vegetables every day. They’re a good source of calcium, which supports and calms the nervous system, and they also have a diuretic effect.
Essential fatty acids, found in cold-water ﬁsh, ﬂaxseeds, and ﬂaxseed oil, will reduce inﬂammation.
Consume 1 tablespoon of ground ﬂaxseeds daily, along with 10 ounces of water, to promote healthy estrogen metabolism.
Vitamin B6 has been shown to signiﬁcantly reduce the symptoms of PMS. Add wheat germ or brewer’s yeast to one of your meals every day.
Studies show that women who consume more sugar also suffer from more severe PMS symp- toms. A study in the Journal of Reproduc- tive Medicine that included 853 female university students investigated the impact of a high-sugar diet. Researchers found a strong corre- lation between high sugar consumption and PMS.
Food to Avoid
A diet that’s low in saturated fat (the type found in red meat and dairy products) helps reduce excess estrogen levels. It is also important to avoid harmful fats, such as trans-fatty acids, which occur in margarine and partially hydrogenated oils. Studies have shown that women who follow a low-fat diet experience a reduction in PMS symptoms.
Food allergies often mimic the symptoms of PMS or make existing symptoms worse. Consult the Food Allergies section, and use the elimination diet on page 253. If you can identify foods that give you trouble, eliminate them from your diet completely.
Sugar throws blood-sugar levels off balance, promoting mood swings and tension. Excessive consumption of highly reﬁned sugar can deplete valuable reserves of chromium, magnesium, zinc, manganese, and B vitamins. These nutrients are nec- essary for the metabolism of sugar. Sugar also worsens symptoms of hypoglycemia (low blood sugar), especially premenstrually, resulting in symptoms of irritability, poor concentration, sugar cravings, and headaches. Restrict your intake of sugary food throughout the month, and eliminate it during the two weeks before your period.
If you retain water, drastically restrict your consumption of sodium. Processed and junk foods are the highest sources of salt in the American diet.
Restrict caffeine-containing products, such as coffee, soft drinks, chocolate, and some pain relievers. Caffeine worsens PMS symptoms, such as anxiety, depression, and breast tenderness. Instead of coffee, we recommend that you focus on herbal teas, such as peppermint and chamomile.
Alcohol has a dehydrating effect, which only makes many PMS symptoms worse. It also wreaks havoc on your blood-sugar levels. Avoid it during the two weeks before your period.
Every month, plan a vegetable juice fast for one to two days before your symptoms usually begin. If they don’t begin at a predictable time, do the fast two weeks before your period starts. This fast will help eliminate the toxins, especially the environmen- tal estrogens, that make PMS worse, and it also gives your liver a break from process- ing hormonal imbalances.
Super Seven Prescriptions—PMS
Super Prescription #1 Vitex (chasteberry)
Take 40 drops of tincture or 180 to 240 mg in capsule form of a standardized extract of 0.6 percent aucubine or 0.5 percent agnuside. Take it daily for four to six months. Vitex is the most well-studied herbal treatment for PMS. Improvements are usually noted within two cycles. Do not take it if you are using the birth control pill.
Super Prescription #2 Homeopathic Combination PMS Formula
Take as directed on the container. It contains a blend of the most common homeopathic remedies for PMS. It’s very effective for acute relief or can be used preventatively.
Super Prescription #3 Vitamin B6
Take 50 mg daily. Numerous studies have found vitamin B6 to help PMS. It works synergistically with magnesium as a cofactor for estrogen metabolism by the liver.
Super Prescription #4 Magnesium
Take 250 mg twice daily. Magnesium is a cofactor required for the metabolism of estrogen, and it relieves cramping.
Super Prescription #5 Natural progesterone cream
Apply 1/4 teaspoon (10 mg) twice daily to areas of thin skin, such as the insides of your forearms and your wrists, beginning after ovulation (approximately Day
15 if you have a regular 28-day cycle) until one day before your period begins. Nat- ural progesterone is a stronger therapy for women with severe PMS.
Super Prescription #6 Calcium
Take 500 mg twice daily. Studies have shown that this mineral prevents PMS.
Super Prescription #7 Dong quai (Angelica sinensis)
Take 300 to 500 mg twice daily, on the last seven days of your cycle. Dong quai reduces the painful cramps and the breast tenderness that are associated with menses. It is thought to relax the smooth muscles of the uterus, thereby relieving cramps.
Passionﬂower (Passiﬂora incarnata) gently relaxes the nervous system and improves symptoms of restlessness, irritability, and insomnia. Take 2 ml or 300 mg three times daily for anxiety and irritability.
Dandelion leaf (Taraxacum ofﬁcinale) lessens the water retention that is associated with PMS. Take 3 ml or 300 mg three times daily for the one to two weeks before your cycle when you experience water retention.
Zinc has been shown to be low in women with PMS. Take 15 to 30 mg daily as part of a multivitamin.
Vitamin E-complex helps to effectively reduce the breast tenderness that is asso- ciated with PMS. It has also been shown to signiﬁcantly reduce other PMS symptoms. We recommend 400 to 800 IU daily. Natural vitamin E (d-alpha-tocopherol), with a blend of mixed tocopherols and tocotrienols, is best.
Evening primrose oil (Oenothera biennis) is an excellent dietary source of GLA. This essential fatty acid is a precursor to prostaglandins, which have a regulating effect on hormones and other systems of the body. Some studies have shown the beneﬁts of evening primrose oil supplementation for PMS-related depression, irritability, breast pain and tenderness, and ﬂuid retention. Take 2,000 mg (200 mg of GLA) to
itex has a bal- ancing effect on progesterone levels, as well as on the hor- mone prolactin. A two-month study compared the effects of Vitex to those of the pharmaceutical anti- depressant Prozac. Both were found to be beneﬁcial overall. Researchers noted that Vitex was more helpful for physical complaints and Prozac more beneﬁ- cial for psychological symptoms.
Numerous double- blind, clinical trials on vitamin B6 have been conducted over the last twenty years. In one six- month, double-blind, crossover trial, 84 per- cent of the women undergoing vitamin
B6 treatment reported greater improvement than they did during treatment with a placebo. Another study found that vita- min B6 supplementa- tion improved premenstrual acne ﬂare-ups in approxi- mately 75 percent of women.
ne double-blind study looked at 497 women who were given either 1,200 mg of calcium or a placebo for three menstrual cycles. By the third month, a sig- niﬁcant improvement in four PMS symptoms (negative mood, water retention, food crav- ings, and pain) was experienced by the group taking calcium.
3,000 mg (300 mg of GLA), along with an oil blend that includes omega-3 fatty acids
(ﬂaxseed oil and ﬁsh oil).
D-glucarate is a phytonutrient that assists the liver in metabolizing estrogen. Take
500 mg twice daily.
Indole-3 carbinole assists the liver in metabolizing estrogen. Take 300 mg daily. Milk thistle (Silybum marianum) improves liver detoxiﬁcation. Take 250 mg of a
80 to 85 percent silymarin extract three times daily.
Dandelion root (Taraxacum ofﬁcinale) also promotes good liver detoxiﬁcation. Take
300 mg three times daily.
Crampbark (Viburnum opulus) is an herb that alleviates menstrual cramps. Take
3 ml or 500 mg every thirty to sixty minutes for acute menstrual cramps.
A high-potency multivitamin provides a base of nutrients that promotes hormonal health. Take as directed on the container.
The supplement 5-HTP reduces depression and anxiety associated with PMS. Take
50 to 100 mg three times daily for relief of symptoms. Do not use it if you are tak- ing a pharmaceutical antidepressant or an antianxiety medication.
Pick the remedy that best matches your symptoms in this section. Take a 6x, 12x, 6C,
12C, or 30C potency three times daily for acute symptoms or two weeks before the menses to prevent reoccurring symptoms. Consultation with a homeopathic practi- tioner is advised.
Bovista is a good choice when there is PMS accompanied by pufﬁness in the extremities and swelling. Another peculiar symptom is diarrhea that occurs before or during menses. The woman may feel very awkward and clumsy and have a tendency to drop things.
Calcarea Carbonica is indicated when a woman experiences fatigue, anxiety, and a feeling of being overwhelmed, along with PMS. Other common symptoms include water retention and breast tenderness. The period often comes early and lasts a long time. These women are usually chilly and have clammy feet and hands. They have a strong desire for eggs, dairy products, and sweets.
Chamomilla (Matricaria chamomilla) is a great remedy to relieve unbearable, painful menses. The woman feels irritable, angry, and very sensitive to pain. The symptoms are better with motion and worse with warm applications.
Cimicifuga (Actaea racemosa) is a remedy for a painful menses that gets worse as the ﬂow increases. The woman experiences cramping and shooting pains that go across the legs or the thighs. Headache stiffness in the neck and the back are common.
Lachesis is speciﬁc for the emotional symptoms of PMS, which include jealousy, irritability, suspiciousness, and rage. The symptoms improve once the menstrual ﬂow starts. The woman feels hot and is intolerant of anything touching her throat.
Lilium Tigrinum is a remedy for a premenstrual syndrome that’s characterized by great irritability, along with a sensation that the woman’s internal organs will prolapse through her pelvis. She crosses her legs to get relief from this sensation. Fresh air brings relief.
Lycopodium (Lycopodium clavatum) is for women who experience digestive upset, such as gas and bloating, especially in the late afternoon. They feel irritable and want to boss others around, although they lack self-conﬁdence. They crave sweets and have a large appetite.
Natrum Muriaticum is for a woman who feels depressed and lonely. She feels worse
when given consolation or sympathy. Migraine headaches or lower back pain that accompany the menses are common symptoms. There is a strong craving for salt and an aversion to being in the sun.
Nux Vomica is for emotional symptoms of PMS that include impatience, anger, and irritability. Constipation becomes worse with the period. There is a craving for alco- hol, coffee, spicy, or fatty foods. The woman often feels chilly and improves from warmth and rest.
Pulsatilla (Pulsatilla pratensis) is a great hormone balancer for women with PMS who experience mood swings, weepiness, and irritability. Their symptoms improve when they receive consolation and attention. They desire to be in the fresh air and feel worse in warm rooms. They have a strong craving for chocolate and sweets.
Sepia is for symptoms of irritability and fatigue that accompany PMS. There is a bearing-down sensation in the uterus, as if it is going to fall out, and painful breast tenderness that occurs before or with the menses. Exercise improves the symptoms. There is a strong craving for chocolate and sweets.
• Conception Vessel 4 and 6 will reduce the pain of menstrual cramps.
• Conception Vessel 6 also relieves diarrhea and constipation.
• For lower back pain, work Bladder 25, 31, and 40.
• Liver 3 eases tension and stress.
For back pain and cramps, have a massage that incorporates deep kneading. It will relax your muscles and improve blood ﬂow.
If you have cramps or digestive problems, try this self-massage: Lie down with your knees bent, and press the surface of your abdomen until you ﬁnd the spots that are most tender. Massage these points with the ﬂat of your hand, using ﬁrm but gentle pressure.
Work the areas corresponding to the uterus, the fallopian tubes, the endocrine glands, and the lower spine.
To improve circulation to the pelvic region and to ease cramps, you can use the con- stitutional hydrotherapy method. See pages 676–677 for directions.
Black pepper and rosemary have a warming, soothing effect on cramped abdominal muscles. Use either of these oils in a bath or a massage for best results.
Geranium and rose oils are known to balance female hormones. They also have an uplifting emotional effect. Add them to a massage oil or use them in a bath.
If you want to reduce stress, use geranium or rose oils, as mentioned earlier, or try lavender, bergamot, or jasmine. Use these oils in any preparation you like.
Patchouli and ylang ylang are traditionally used to ignite sexual desire. If PMS has depressed your sex drive, add a few drops of these oils to a bath or a room diffuser. You could also add them to a massage.
Although PMS is largely a physical problem, the techniques here will help you address any emotional components of your disorder.
General Stress-Reduction Therapies
Yoga serves a triple purpose for women with PMS: It relieves cramps, improves diges- tion, and releases stress.
Bach Flower Remedies
If none of the following suggestions suits your individual needs, Once you’ve chosen a remedy, place 10 drops of the liquid under your tongue. Hold the drops in place for thirty sec- onds and swallow. Use as often as needed.
If, in the weeks before your period, you ﬁnd yourself feeling lonely, obsessed with personal problems, and unusually talkative, Heather will restore your sense of inde- pendence.
Olive will relieve the deep fatigue and the exhaustion brought on by PMS. Scleranthus is for women whose mood swings render them incapable of making
a decision and sticking to it.
If PMS turns you into a fast-moving, hyperkinetic workaholic, with no patience for others, take Impatiens. It will encourage greater tolerance and a healthier pace.
Some women experience barely controllable, violent rage as a symptom of PMS. If this happens to you, Cherry Plum will help you resolve your tension.
• Women who exercise regularly experience fewer PMS symptoms than their sedentary counterparts do. A daily half-hour walk, even on days when you feel at your worst, can do wonders to both reduce symptoms and prevent them in the ﬁrst place.
• Place a hot compress on your abdomen to relieve menstrual cramps and gas- trointestinal troubles.
• Seasonal affective disorder has been linked to PMS. If your symptoms are worse in the winter, take walks in the morning sunshine, as suggested earlier, and try to spend your daylight hours near a sunny window. See Seasonal Affec- tive Disorder on pages 466–472 for more information and suggestions.