PMS? Oral Contraceptives Not The Only Option!

PMSPre-menstrual syndrome (PMS) is thought to affect about 90 per cent of women at some point in their lives, with a significant proportion of these suffering regularly from severe and debilitating symptoms.  PMS is typically the result of abnormal hormone fluctuations, such as elevated prolactin levels, or low progesterone during the second half of the menstrual cycle.  Another possibility is estrogen dominance, where the liver has a difficult time metabolizing estrogen, leading to a disproportionate amount of estrogen in the system.  And these are just a few of the possible scenarios that can lead to PMS.

So why, then, does conventional medicine treat virtually every person with PMS the same?  Oral contraceptives are prescribed almost exclusively to treat this issue, regardless of the cause.  While oral contraceptives may be a magic bullet in some instances, the list of potential side-effects is long, and includes an increased risk of breast cancer, cervical cancer, stroke, acne, yeast infections, and weight gain.  Therefore, why subject so many people to these side-effects, when there may be other, more natural cures that not only alleviate the symptoms, but address the root cause?

One of the most established natural treatments for PMS is an extract of an exotic fruit known as Agnus castus. Research from Germany shows that Agnus castus (also known as Chasteberry, Monk’s pepper and Vitex) can reduce prolactin levels and increase the production of progesterone. These effects help to correct the hormonal imbalances common in PMS, thereby helping to ease its symptoms.

Earlier this year, the British Medical Journal (BMJ) published a study which proved the effectiveness of this natural remedy in the treatment of PMS. Over half the women in this study had significant improvement in their symptoms, and the treatment was found to be safe and generally free of side-effects. This recent study is not the only evidence which supports the use of Agnus castus in PMS. Last year, the Journal of Women’s Health and Gender Based Medicine published a study which examined the effect of Agnus castus in more than 1600 women. The study lasted three months, after which time 93 per cent of the women reported an improvement in or elimination of their PMS symptoms. Four out of five women rated themselves as ‘much better’ or ‘very much better’.

Naturopathic doctors can also perform specialized hormone testing that can help to pinpoint specific imbalances, which in turn can be corrected with nutritional and herbal therapies.  This allows each case of PMS to be treated uniquely, rather than treating everyone the same.  If PMS is something you’ve been suffering from for years, and birth control isn’t the answer you’re seeking, seek out a qualified naturopathic physician who can help to get your symptoms under control.

Understanding and Effectively Treating PMS

Premenstrual syndrome (PMS) is one of the most common female problems, affecting 30-40% of
women during their reproductive years. The most severe cases occur in approximately 2% of
women between the ages of 26 and 35. PMS is characterized by recurrent symptoms that appear
7-14 days before a woman has her menstrual period. These symptoms often include decreased
energy, irritability, increased appetite (usually sugar cravings), acne, and bloating. Menstrual
cramps (dysmenorrhea), while technically a separate diagnosis, can also be attributed to the same
hormonal fluctuations that cause PMS.

PMS symptoms can be divided into 4 distinct categories:

1. PMS-A (A = anxiety) includes symptoms of anxiety, irritability, and emotional instability.
It encompasses the most common PMS symptoms and is found to be strongly associated
with excessive estrogen and deficient progesterone.
2. PMS-C (C = carbohydrate craving) includes symptoms of increased appetite, craving for
sweets, headache, fatigue, fainting spells, and heart palpitations. Although there is no
clear mechanism of cause for these symptoms, they seem to be related to an excessive
insulin response to sugar consumption.
3. PMS-D (D = depression) is the least common category of symptoms and is associated
with low levels of estrogen, leading to increased breakdown of neurotransmitters in the
4. PMS-H (H = hyperhydration) is characterized by weight gain greater than 3 pounds,
abdominal bloating and discomfort, breast tenderness and congestion, and occasional
swelling of the face, hands, and ankles. These symptoms are attributed to an increase in
the hormone aldosterone, which increases fluid retention.

Usually, a woman will have a combination of symptoms from the different categories of PMS.
The categories are used as general guidelines to help address the underlying problems related to
the syndrome. It is important that your doctor rule out underlying medical conditions, like
hypothyroidism, anemia and depression, to make sure they’re not responsible for any PMS-related symptoms.

The causes of PMS can be numerous, but hormonal imbalances are often revealed with the appropriate laboratory testing, with an excess of estrogen and deficiency of progesterone being the most common.  The liver’s ability to breakdown excess hormones is often a culprit as well, leading to an increased response to otherwise “normal” hormone levels.  Diet also plays a major role, particularly since foods such as caffeine, alcohol, and excessive animal proteins put further strain on the liver, increasing the likelihood of PMS.

In my experience with patients, diet and lifestyle modifications alone will significantly reduce the severity of symptoms associated with PMS.  Mainly, a high fiber, low animal fat diet, combined with the avoidance of caffeine, alcohol, and refined carbohydrates, is critical for symptomatic relief.  Exercise is also recommended, as it will help to reduce fluid retention, breast tenderness, depression, and stress.  Nutritional supplements, particularly evening primrose oil, magnesium, and vitamin B6, will often help to diminish PMS symptoms, as women diagnosed with this condition tend to utilize these nutrients more rapidly.  There are also several herbal interventions available for correcting hormonal imbalances associated with PMS.

Ultimately, it’s important to recognize that PMS is not a “one-treatment fits all” scenario.  By taking a thorough diet and lifestyle history, and performing a thorough laboratory evaluation, the causes of your symptoms can be narrowed down, and treated effectively with non-pharmaceutical interventions.

PMS and Essential Fatty Acids

Yet another case of naturopathic medicine being way ahead of the curve when it comes to using treatments for years before they’re eventually “proven” effective. 
Up to 95% of women suffer from at least one PMS symptom, and more than a third of these women have PMS severe enough to interrupt their routine activities. Fortunately, a new study may offer a way for women to get some much-needed relief from monthly bouts of PMS.
The exact causes of PMS aren’t known, but health experts suspect that certain essential dietary fats, called polyunsaturated fatty acids, or PUFAs, may play a role. Not getting enough of and the right types of PUFAs may worsen PMS symptoms.
Researchers set out to test this theory by enrolling 120 women into a six-month study. The study authors randomly selected the women to receive a daily 1- or 2-gram PUFA supplement, or a placebo (no fatty acids).
Blood levels of cholesterol and prolactin, a hormone produced in the body that may affect PMS, were tested before and after the study. The women kept symptom diaries to track the details and severity of their PMS from month to month.
After 6 months, the researchers found that compared with the initial PMS ratings:

• Women taking the PUFA supplements had significant decreases in PMS symptoms at three and six months.

• Women taking 2 grams of PUFAs, the highest amount given, experienced the largest decrease in PMS symptoms over time.

• Women taking the placebo h
ad a small decrease in PMS symptoms at three months, but no improvement of symptoms at six months.

None of the women in the study experienced significant changes in blood levels of cholesterol or prolactin. This suggests PUFA supplements do not raise cholesterol in otherwise healthy women experiencing PMS, nor exert their anti-PMS effects through changes in prolactin levels.

Getting your essential PUFAs

If you are interested in trying a PUFA supplement, keep the following tips in mind:

• Talk to your doctor about whether PUFA supplements are right for you. Dietary supplements can interfere with medications, so err on the side of caution when adding new supplements to your self-care routine.

• The 2-gram PUFA supplements used in the study provided 420 mg of gamma linolenic acid, 350 mg of oleic acid, 690 mg of linoleic acid, 500 mg of other PUFAs, and 40 mg of vitamin E. Ask your doctor or dietitian to help you find a supplement with a similar mix of PUFAs.

• You can get more PUFAs from the food you eat as well. Try walnuts and other nuts and seeds, ground flaxseed, green leafy vegetables, tofu and other soy foods, and fatty fish, such as wild-caught salmon.

• Other lifestyle changes that may help ease PMS symptoms include getting enough sleep (seven to eight hours), exercising regularly, limiting intake of caffeine, alcohol, and sweets, and eating a healthy diet based around vegetables, fruit, whole grains, and legumes.

(Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Accessed January 20, 2011; Available at: NewsRelease_Essential_oil pill_prevents_PMS.pdf)