Many complaints can become more severe or occur more frequently during the luteal phase of the cycle. This is known as menstrual distress syndrome, or alternatively as (pre-)menstrual magnification. The most common disorders are migraines, depression, infections, irritable bowel syndrome and hypoglycaemic symptoms. Less common are various types of epilepsy, allergies, asthma and chronic fatigue or other fatigue syndromes.
Depression and anxiety
Women with depressive disorders or anxiety states often report a worsening of symptoms during the premenstrual phase of the cycle, and some women will make an initial contact with a practitioner believing these symptoms to be premenstrual syndrome (PMS). As might be expected, a prospective questionnaire over several cycles will indicate the presence of mood changes all month and should make differentiation between premenstrual syndrome and depression or anxiety relatively easy. Women with premenstrual magnification of psychiatric conditions may require some hormone modulation, but their primary treatment should centre on the management of the affective disorder.
Increased infection rate
Many women suffer from an increased rate of infections during the luteal phase of the cycle. Problems might include genital or facial herpes; sinusitis; increased rate of colds and upper respiratory tract infections; recurrent non-specific flu-like symptoms such as chills and fever, swollen glands, sore throat (especially amongst women with chronic fatigue syndrome); urinary tract infections and vaginal thrush.
In some cases hormone modulation alone is sufficient to correct this situation and herbalists often prescribe Vitex agnus-castus until improvement occurs, usually within the first three cycles. Some women will require additional herbs or supplements to improve immune response, and these might include Echinacea purpurea or E. angustifolia; zinc and vitamin C; or Hypericum perforatum as a specific treatment for herpes simplex virus. Fungal infections may also require dietary modification such as restricted sugar and alcohol intake.
Irritable bowel syndrome (IBS)
IBS can aggravate during the luteal phase of the cycle and cause pelvic pain that can be confused with gynaecological problems such as endo-metriosis. Hormone manipulation may be required, but most often symptoms will abate with the regular use of the seed breakfast as outlined on site.
Hypoglycaemic symptoms often mimic premenstrual syndrome (PMS), but many women have symptoms all month that worsen premenstrually, indicating that they have an ongoing problem with poor glucose tolerance. These women should try the hypoglycaemic diet outlined on site before adopting strategies to modulate hormone levels.
Bitter foods, cabbage family vegetables and a high fibre intake can help to modulate rising oestrogen levels in the luteal phase of the cycle. Another dietary intervention to control premenstrual syndrome symptoms is to increase the intake of complex carbohydrates and to eat more frequently — a ‘grazing’ or hypoglycaemic diet. This helps to reduce the food cravings many women experience premenstrually. The positive effects may be related to normalisation of glucose tolerance as well as to indirect influences on progesterone or serotonin. One theory is that progesterone cannot be transported into cells which do not contain sugar, and that progesterone levels drop because breakdown speeds up after a large meal. Another is that the levels of serotonin are stabilised by eating foods rich in the amino acid tryptophan.
When fluid retention, bloating, breast soreness or heaviness and weight gain are prominent symptoms, salt intake should be restricted and dietary potassium in the form of vegetables, grapefruit juice and bananas increased. Most processed cheese is high in sodium and should also be restricted.
Women who experience breast soreness, muscle or joint pains or period pain respond well to reducing animal fats, processed vegetable oils, coconut and peanuts; and increasing the intake of foods containing essential fatty acids and vitamin E.
Coffee, alcohol, sugar and chocolate aggravate feelings of depression, irritability and anxiety, as well as worsening many breast symptoms. Restriction or complete avoidance is warranted during the premenstrual phase. Limiting these foods might also improve insomnia.
Many of the symptoms of premenstrual syndrome have been attributed to magnesium deficiency. Where this is the case, it may be beneficial to eat more magnesium-containing foods and restrict dairy products in the diet. On the other hand, a good calcium intake has also been shown to be beneficial. A calcium information chart is included on site. Both calcium and magnesium are essential for bone health for all women and an adequate intake of both should be maintained throughout life.
Sleep disturbance accompanying premenstrual syndrome can be managed by adopting a regular pattern of getting to sleep and getting up. This helps to rectify poor sleep latency — the tendency to get to sleep and then wake a few hours later. Alcohol, sugar and caffeine also aggravate this problem. Eating a protein-rich meal at night, such as fish and vegetables, rather than rice or pasta, can also be beneficial.
Phyto-oestrogens are indicated for premenstrual syndrome associated with the perimenopause and improve symptoms thought to be associated with a rapid decline of oestrogens just before the period such as headaches, migraines and depression.
Exercise, stress management and other techniques
Women with premenstrual syndrome who use long, slow, distance exercise or yoga seem to be able to handle the physical changes much more capably than women who do not incorporate these lifestyle activities in their daily life. Exercise minimised negative mood premenstrually, and a better effect was noticed amongst those women who were categorised as high exercisers compared with those who exercised less often. Another study found that aerobic exercise reduced fluid retention.
Suitable stress management techniques such as meditation, and counselling are also useful. Women with premenstrual syndrome improved with progressive muscle relaxation in conjunction with guided imagery. An interesting study of the use of foot, ear and hand reflexology showed that women who received pressure to actual reflex points responded significantly better than women who were given treatment of incorrect reflex points. Acupuncture and massage are also very effective techniques to relieve the severity of premenstrual syndrome (PMS).