Premenstrual syndrome (also known as PMT)

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Finding a good herbalist

Much of what's written in this article is entirely suitable for a person to work through themselves but, especially if things are quite bad, or you just know that you need further help, then there may be a great deal of benefit to you to go to whatever lengths necessary to find a good herbalist or truly holistic practitioner to guide you on to a safe and strong treatment program. There's a short write-up to suggest how you might go about finding such a person here

Different approaches for different women

Premenstrual syndrome (PMS) has been the main reason a woman has come to see me or a major part of the reason they've come in many hundreds of times. Women clearly experience PMS in distinctly different ways and it is essential to understand that different approaches are needed according to the woman herself as well as the kinds of symptoms she is suffering from.

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Premenstrual syndrome-A (PMS-A)

This type of premenstrual syndrome (PMS-A) is characterised by nervous tension, mood swings, irritability and anxiety. Research shows it appears to be caused by an imbalance of oestrogen and progesterone, with a relative excess of oestrogen and a relative deficiency of progesterone. In turn, this imbalance is believed to be caused by a poor liver clearance of oestrogens and/or a low level of progesterone production.

It has taken a long time for these, primarily emotional, symptoms of PMS to gain a fair recognition within medicine. During the 1950’s 60’s and 70’s conventional medical wisdom decided that PMS was a problem associated with ‘nerves’ or failure to cope and the only treatment recommended was sedation!

Although there is still no blood test to identify PMS we have come a long way in understanding the ‘physicality’ of the problem and it is clear that this is a problem that can probably be cured and at least be greatly helped by the right approach.

The herb that should probably be considered the starting point for PMS-A is Vitex -- more about that below along with some important dietary recommendations.

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Premenstrual syndrome-C (PMS-C)

This type of premenstrual syndrome (PMS-C) is characterised by such symptoms as headache, cravings for sweets, increased appetite, heart pounding, fatigue, dizziness or fainting. The ‘C’ after PMS stands for ‘carbohydrate craving’.

Glucose tolerance tests performed on PMS-C patients during the 5-10 days before their period showed a flattening of the early part of the curve that indicated they were secreting excessive amounts of insulin in response to sugar consumption. The same tests performed on the same groups of women at different times of the month gave normal glucose tolerance results.

This increased binding capacity for insulin appears to be caused by oestrogen levels that are too high in relation to progesterone. In turn this can be caused or contributed to by a faulty liver clearance of oestrogen. The ratio of oestrogen to progesterone is a critical factor in PMS-C; fortunately it is something we are able to favourably alter.

It is fairly rare to see PMS-C by itself. Most often it will be found along with some degree of PMS-A. The treatment for PMS-C is very similar to that which is used for PMS-A but there is an obvious emphasis on regulating carbohydrate metabolism. If a woman is prone to carrying excess weight around her middle, and/or is prone to mildly elevated blood pressure and cholesterol levels then she should carefully check to see whether she has the metabolic syndrome (a detailed article about it here) as correcting this will transform PMS along with many other associated problems.

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Premenstrual syndrome-D (PMS-D)

This type of premenstrual syndrome (PMS-D) is characterised by depression, forgetfulness, crying, confusion and insomnia. A woman may not have all these symptoms at once but if this seems to be the dominant pattern to your PMS then it will have an important bearing on the choice of treatment that will best help.

The ‘D’ after PMS stands for depression. PMS-D in its pure form is actually the rarest form of PMS and needs to be approached in a special way. Research has shown that women who suffer from PMS-D have low levels of certain key neurotransmitters in their central nervous systems.

The effects of depression on general life are much too deep and far-reaching to realistically tackle alone. A modern understanding of the ‘physicality’ of depression make it absolutely vital that people understand it is an illness that really has little to nothing to do with their ‘strength of character’.

Well-documented research has shown that certain natural medicines have a very high rate of success in treating depression -- read the article here for a detailed overview.

The symptoms of PMS-D are closely connected to disturbed or altered oestrogen metabolism. This makes it quite different to other forms of PMS where in general the oestrogen levels are simply too high. To improve oestrogen metabolism in PMS-D, as well as the dietary suggestions below it may be extremely helpful to use the great American Indian herb Black Cohosh (more info about it below)

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Premenstrual syndrome-H (PMS-H)

This type of premenstrual syndrome (PMS-H) is characterised by weight gain (often more than a kilo), swelling of the face, hands and ankles, breast tenderness and congestion and abdominal bloating or discomfort.

The ‘H’ stands for ‘hyper-hydration’. Elevated levels of the hormone aldosterone cause the retention of fluids in PMS-H. It appears that what causes aldosterone to rise excessively is a hormone imbalance between oestrogen and progesterone where oestrogen is too high and progesterone is too low in the premenstrual phase.

Stress also causes aldosterone to rise but it can be difficult to tell cause from effect as of course PMS itself can create a unique pattern of stress. Liver function plays an important part in PMS-H, not only does it regulate aldosterone but it also removes excess oestrogen from circulation.

Generally the best treatments for PMS-H are still similar to those used for other types of PMS. The main priority is still to return the cycle of hormonal changes into balance. However it is also quite possible that you need to help your body's fluid balance improve by helping improve your kidney function, something that the herb Juniper can be exceptionally helpful with along with some of the other herbs as mentioned below.

Salt: If you predominant symptoms reflect PMS-H then you probably need to reduce or even avoid added salt in your diet. Many women with PMS-H have been identified as being ‘salt-sensitive’. During the premenstrual phase they can react strongly to salt with a diminished ability of the kidneys to maintain proper fluid volume within the body. This can cause high blood pressure as well as the retention of fluids, -hyper-hydration. 


Juniperus communis (Juniper berry)

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Premenstrual syndrome-P (PMS-P)

This type of premenstrual syndrome (PMS-P) is mainly characterised by an increased sensitivity to pain that is believed to be associated with an imbalance of cellular hormones called prostaglandins. The ‘P’ after PMS stands for pain. The main symptoms of PMS-P include aches and pains, a reduced pain threshold and dysmenorrhoea (a painful period).

Research has shown that the principal causes behind PMS-P are an imbalance of the oestrogen to progesterone ratio, with oestrogen levels becoming too elevated and progesterone levels becoming too low.

There are several herbs that I see as the cornerstone for a successful treatment of PMS-P, Feverfew in particular has been shown to markedly reduce the prostaglandins that are associated to the increased sensitivity to pain. Also the herbs Black Cohosh and Vitex have also been extensively proven in numerous studies to benefit the oestrogen-progesterone ratios; they have wide ranging ‘adaptogenic’ (balancing) effects on the hormonal cycle generally; more about them as well as some important dietary suggestions below.


Tanacetum parthenium (Feverfew)

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Herbs for the Premenstrual Syndrome

You should definitely let Nature take the first step when it comes to the premenstrual syndrome. So long as you get the right herb at the right dose there is an excellent chance things will get very much better if it is given enough time to work.

Vitex agnus castus

I most often use this great hormonal balancer as the cornerstone of my treatment for PMS-A, PMS-C, PMS-H and possibly PMS-P. Vitex has been extensively proven in numerous studies to benefit the oestrogen-progesterone ratio and has wide ranging ‘adaptogenic’ (balancing) effects on the hormonal cycle generally.

This is a herb that needs to be taken with much care and respect and if you will consider using it then I recommend you read my thoughts in detail on this enigmatic herb in its monograph here.


Vitex agnus-castus (Chaste tree)

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Black Cohosh

The cornerstone of my medicinal treatment with my female patients with PMS-D and possibly PMS-P is very likely to revolve around using the potent herb Black Cohosh. I and others have found that this herb has a powerful and specific effect for the depression of PMS-D -- sometimes it has literally felt like a life-saver!

Black Cohosh has been the subject of numerous research papers that show it is indeed a substance that can remedy disturbed oestrogen metabolism. A recent German study with 135 women suffering from severe PMS showed it greatly reduced symptoms of depression, anxiety, tension and mood swings. You can read about it in much more detail here.


Cimicifuga racemosa (Black Cohosh)

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Feverfew

Feverfew, although most commonly thought of as a migraine herb, can particularly be of benefit with PMS-P as it can greatly reduce the certain types of prostaglandins that are associated with the pain and cramping of this syndrome. More information here.


Tanacetum parthenium (Feverfew)

Liver Cleansing

As mentioned earlier, high quality research shows that many symptoms of PMS are caused by imbalances of oestrogen and progesterone and one of the key factors that seem to determine both whether a woman will get PMS for longer than a day or so as well as how severe it gets is the health of the liver. It is now understood that the liver plays a tremendously important role in how much oestrogen in particular continues to get recycled around the bloodstream.

If you have any signs of impaired liver function such as --
a) some yellowing in the whites of your eyes
b) a thicker than usual creamy or yellow coating on the back of your tongue
c) a low morning appetite and general irritability (at any time)
d) a poor tolerance to fatty foods or alcohol

then you should certainly consider that your liver health may be the key to getting your hormones back into balance. Read my article on detoxification here to get an overview of this important subject. Again I urge you to work with an experienced practitioner if at all possible but if not then the potent and economic Juniper & Celandine cleanse will go a long way to improve matters - it is written up in practical detail here.


Chelidonium majus (Celandine)

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Food as Medicine

A large scale study by Dr Guy Abraham  in the Journal of Reproductive Medicine showed that women who suffer from PMS compared to symptom free women consume 62% more refined carbohydrates, 275% more refined sugar, 79% more dairy products, 78% more sodium (salt), 53% less iron, 77% less manganese and 52% less zinc. A large part of the reason for this is likely to be tied up with what are termed ‘negative coping skills’. The following steps should be somewhat helpful for all types of PMS

Avoid hypoglycaemia

When blood sugar levels are low the ability of progesterone to be transported into the cells is also impaired. At the other end of the scale, a high sugar intake has been shown to both increase oestrogen levels as well as impair the metabolism of oestrogen and pretty much all PMS symptoms occur more frequently and severely in women whose blood sugar levels swing up and down. As well as making sure you don't go too long without food one of the best ways to prevent hypoglycaemia is to have a good amount of protein in the morning, especially eggs but also nuts, seeds or dairy products.

Eat foods that are rich in phyto-oestrogens

These are foods contain natural oestrogen like substances that compete with your own oestrogen hormone when it is too high in the body. There have now been numerous well-designed studies showing how a diet rich in phyto-oestrogens can benefit many aspects of reproductive health. Cultures that traditionally eat large amounts of these foods (especially soy products) have markedly lower rates of PMS. This table shows the foods rich in various phyto-oestrogens.

Isoflavones

Coumestans

Resorcyclic
Lactones

Lignans

Steroidal
Saponins

  Others

Soya bean*
Chick pea
Cherry
Alfalfa*
Parsley
Licorice
Wholegrains
Mung beans

Alfalfa*
Soya sprouts*
Green bean
Kidney bean
Split peas
Mung beans
Olives

Oats
Barley
Rye
Sesame seed
Wheat
Peas
Corn
Rice

Linseed*
Rye
Buckwheat
Millet
Sesame seed
Sunflower seed
Legumes and beans
Whole grains

Licorice*
Potato

Fennel
Carrot
Aniseed
Cabbage
Rhubarb
Beetroot
Yeast
Plum
Garlic


* contains especially high levels of phyto-oestrogens

Increase Magnesium rich foods

Many of the symptoms of PMS have been at least partially attributed to magnesium deficiency. When oestrogen levels are high excess calcium can be retained in the body leading to a relative ratio imbalance between calcium and magnesium. In some people this may appear marked enough to warrant magnesium supplementation and even the avoidance or reduction of dairy foods during the premenstrual phase. For most people it is sufficient to eat plenty of magnesium rich foods.

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Eat a high fibre diet

Eating plenty of fibre (which basically means eating lots of fruit and vegetables, raw or cooked) is certainly widely recommended for general health and many other kinds of common health problems.

In terms of PMS, the benefit of a high fibre, low fat diet has well-documented support. Women eating a high fibre diet have been shown to excrete up to 2 to 3 times more oestrogen and have 50% lower levels of free oestrogen in their blood than those on a typically low fibre diet.

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Mental Health Care for the Premenstrual Syndrome

I've been talking about a very physical approach using herbs and diet to treat PMS which is I think the right place to start because it emphasises to all concerned that this is a physical problem that requires physical solutions. That said it is clear that for many women the effects of their hormonal changes on their mood and relationships can be quite devastating.

As well as the steps as described above I very much encourage you to take care of your mental health and see it is a just as important to bring into balance as your body. If you are person who suffers especially from anxiety then the article here has a number of practical and very effective strategies to help.

If your mood gets low or you would even say you get depressed then certainly read here to see an approach that I have found tremendously helpful for many.

Lastly if you simply need some help relaxing then I encourage you to visit this page here to try out some of the exercises or the music to help you on your way. Good luck!

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Constitutional Health Note

Finally, you might benefit from learning about your constitution to know what kind of foods, herbs, exercises etc. will work especially well for your health in general as well as what might potentially help you with the great balancing act of the cycle of life. I would say that it seems that the hotter constitutions are the most prone to PMS in general but that is just a generalisation based on observation and any woman can potentially suffer from it. In any case there is a brief introduction to this great subject here and a more detailed section on working out which constitution you are here.

Please understand that I cannot personally advise you without seeing you in my clinic.
This living 'book' is my labour of love so, wherever you are, I wish you peace & good health!

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© 2011 R.J.Whelan Ltd