One group of premenstrual syndrome symptoms seem to be related to lower levels of oestrogen, as is common in the peri-menopause, when a woman is underweight, exercising excessively, or has diminished ovarian hormone reserves for other reasons. This group of women most commonly report premenstrual symptoms of depressive mood change in association with other low-oestrogen symptoms such as hot flushes, migraines, fatigue, memory loss and poor word-finding.

Herbs for hormone modulation are those that regulate the fluctuations in oestrogens and promote ovulation and therefore progesterone production where possible. Dietary phyto-oestrogens reduce symptoms associated with oestrogen decline when consumed regularly.

Another group of depleted women are those experiencing extreme stress leading to ‘burn out’ or adrenal exhaustion. These women might develop concurrent mood changes from either category A or B in Table 8.2 ‘Menstrual symptoms questionnaire’, depending on whether they are in the ‘resistance’ or ‘exhaustion’ phase of the stress cycle. There is considerable overlap in symptoms with those seen when oestrogen is low — for example, both groups can experience hot flushes, physical fatigue and poor cognition. The history and other accompanying symptoms will determine the direction of the treatment.

Hormonal modulation for women who develop premenstrual syndrome in conjunction with adrenal exhaustion should combine the adrenal adaptogens and tonics with nervine tonics and anxiolytic herbs to counteract the adverse effects of stress on the nervous system. Lifestyle changes as outlined in the self-care section should also be adopted.

Premenstrual Syndrome With Depletion: Symptoms

Low oestrogen

• Category B mood changes

• Fatigue

• Poor word-finding, memory loss

• Hot flushes and night sweats

• Headaches or migraines

Adrenal exhaustion

• Category A & B mood changes

• Fatigue

• Mental fatigue, poor concentration

• Hot flushes and night sweats

Premenstrual Syndrome With Depletion: Treatment

Low Oestrogen

Hormone modulation with:

• Phyto-oestrogens from dietary sources are an essential part of the treatment plan. Linseeds are indicated because they are believed to improve ovulation rates and therefore have the capacity to normalise both oestrogen and progesterone levels. Eating soya products seems to improve memory and can also reduce hot flushes.

• The herbs which contain steroidal saponins such as Asparagus racemosa and Dioscorea villosa; or herbs with triterpenoid saponins, of which the most important is Cimicifuga racemosa. These herbs improve symptoms associated with low oestrogen levels.

Glycyrrhiza glabra can also be useful, but is contraindicated when fluid retention accompanies symptoms.

• The Chinese herbs Angelica sinensis combined with Paeonia lactiflora are of benefit for peri-menopausal women or when oestrogen levels are low for other reasons.

Cimicifuga racemosa and Lavandula officinalis are indicated when premenstrual headaches are caused by a rapid drop in oestrogen levels.

Adrenal exhaustion

Hormonal modulation with:

• Adrenal adaptogens and tonics, including Eleutherococcus senticosus, Panax ginseng, Codonopsis pilulosa, Scbizandra chinensis or Panax quinquefolia.

Mood changes

Hormone modulation with:

• Nervine tonics and/or anxiolytics are often recommended for the fatigue and insomnia that frequently accompanies hormone and mood changes. Examples include Lavandula officinalis, Witbania somnifera and Scutellaria laterifolia.

Hypericum perforatum is often suggested for depressive symptoms in conjunction with hormone-modulating herbs.

Estrace

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