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
brain.
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.