Premenstrual Syndrome (PMS)

by Renee Lang, ND

Etiology

Premenstrual Syndrome (PMS) affects up to 75% of women during their reproductive years.  Only 20-40%of women actually experience difficulty due to the symptoms, and an even smaller percentage, 2-5%, suffer from discomfort severe enough to interfere with daily life.  PMS occurs most often in women in their late 20’s to early 40’s, in women with at least one child, and in women with a family or personal history of depression. 

PMS is defined as the regular occurrence of symptoms beginning 5 to 11 days before menstruation, and ending on, or shortly after menstruation.  The most common PMS symtpoms include: headache, anger and irritability, depressed mood, cramping, breast tenderness, back pain, food cravings, fatigue, and a change in bowel function. However, over 150 symptoms have been associated with PMS.  The consistent timing and regular of occurrence of symptoms is more important in determining the existence of PMS than the combination of symptoms.

No universally accepted explanation of what causes PMS exists.  Some believe depression causes the symptoms, while others suggest an estrogen dominance.  In actuality, the causes of PMS are multifactorial and varied, and are unique to each woman.  Cultural beliefs, dietary choices, and lifestyle factors, all contribute to the occurance of PMS.  Due to its cyclic nature and connection, there is definitely a hormonal aspect to PMS.  However, determining the causes of the hormonal imbalance is what is important in designing treatment.

Treatment

PMS responds best to a comprehensive approach that optimizes health, rather than a symptom-specific approach.  Exercise, healthy dietary choices, proper sleep, and stress management all contribute to a decrease in PMS symtpoms.  Women who exercise regularly have milder and/or fewer PMS symptoms.  Symptoms improved the most with frequent aerobic activity versus intense strength training.  Although the exact mechanism is not understood, the benefits from exercise are probably due to an increase in endorphins, a decrease in estrogen levels, a decrease in inflammatory markers, and an improvement in blood sugar regulation.

Dietary choices also play a role in the amount and severity of symptoms. Specifically, women who eat more refined carbohydrates and sugar, dairy, and salt, have a greater incidence of PMS.  Cutting out or decreasing the above foods, and choosing whole grains and fresh vegetables will likely decrease symptoms.  Additionally, taking 1-2 tablespoons of ground flaxseeds daily will reduce the severity of PMS.  Ground flaxseeds act as both a fiber source, promoting regularity, and as a hormone balancer, by increasing bound estrogen in the blood to facilitate its removal by the liver.  Flaxseeds can be purchased at the Brattleboro Food Coop or your local health food store.

Excessive stress, poorly managed stress, and a lack of quality sleep all increase inflammatory markers in the body.  These inflammatory markers, prostaglandins, contribute to PMS symptoms.  This explains why anti-inflammatories like ibuprofen successfully treat symptoms in many women.  Proper management of stress, and getting quality sleep aid in decreasing symptoms. 

Natural dietary anti-inflammatories include wild-caught, cold-water fish, ginger, pineapple, and turmeric.   Dietary anti-inflammatories do not provide relief as quickly as ibuprofen and should be eaten on a regular basis for their beneficial effects.  For non-pregnant woman, the recommendation for fish is 2-3 times per week.  However, due to high mercury levels, minimize or avoid shark and swordfish.

Dietary intake of ginger and turmeric is a safe way to use these herbs.  However, herbal preparations should only be used under the supervision of a  naturopathic physician or trained herbalist. If the above suggestions do not adequately address your symptoms, consider seeing a naturopathic physician or other alternative health care provider for additional treatment options.