For the past 50 years or more, most treatment recommendations for women with premenstrual syndrome have been developed to reflect a theoretical cause. These might include, for example, hormones for a hormonal imbalance or supplements for a nutrient deficiency; essential fatty acids for problems with prostaglandins; or anti-depressants for abnormalities in central neurotransmitters. However, because none of these irregularities individually gives rise to the constellation of symptoms that make up premenstrual syndrome (PMS), and because many of the proposed causes have been found to be implausible, treatment recommendations in recent years have tended to focus more on symptoms rather than on an evidence based approach. In addition, the underlying causes seem to be different for a number of sub-groups of women with premenstrual syndrome and treatments may need to be adapted accordingly. For example, women in the peri-menopause seem to experience more mood changes, which may occur in relation to decreasing levels of oestrogens; women who have experienced post-natal depression seem to have a heightened tendency to premenstrual syndrome and premenstrual dysphoric disorder (PMDD), women with pre-existing depressive or other mood disorders may become worse around the premenstrual weeks. All of this points to a need for consulting practitioners to take the constellation of presenting symptoms and the possible underlying causes into account for each and every woman and then devise a treatment that will effectively improve that woman’s condition.

The Medical Treatment Of Premenstrual Syndrome

A natural approach

Despite the many theories proposed, many now believe that premenstrual syndrome occurs because of an aberrant response to normal changes in the levels of oestrogen and progesterone. Consequently, some sort of hormone modulation is often suggested to influence these hormonal fluctuations and improve symptoms. In many cases, hormone modulation is all that is necessary.

For other women, a more complex approach may be required, for example when sugar cravings, pain or moderate to severe anxiety or depression accompany the classic premenstrual syndrome symptoms. In these cases, hormone modulation can be combined with appropriate treatment for the particular complaint.

In all cases, correctly diagnosing the origin of the accompanying symptom is the key to successful treatment. Some symptoms — headaches, irritability, depression, for example — may have multiple associations. The menstrual symptom questionnaire has some symptoms appearing in more than one grouping for this reason and can be used as a diagnostic tool to categorise symptoms and improve insight into the type of treatments required for an individual.

Lifestyle and dietary changes are helpful and should be recommended as a first line of treatment for all women with premenstrual syndrome (PMS). Exercise, dietary restrictions or additions, and stress management techniques are outlined in the self-care section on site.

Hormone Modulation In PMS

Hormone modulation is a helpful first line of treatment for those women who have some troubling, but mild symptoms of premenstrual syndrome (PMS). Vitex agnus-castus and Paeonia lactiflora are two effective herbs to relieve symptoms. Rectification of latent hyperprolactinaemia has been suggested as one possible explanation for the positive effects seen with Vitex. Increased entero-hepatic recycling of oestrogens may also play a role. Many women respond to the dietary or lifestyle corrections found in the self-care section on site.

Hormone Modulation In PMS: Symptoms

• Mood swings

• Fatigue

• Breast fullness or heaviness

• Abdominal bloating

Hormone Modulation In PMS: Treatment

• Lifestyle changes as outlined in the self-care section.

Vitex agnus-castus extract, 1:2:40 drops every morning, starting on the first day of the cycle and continued for between three and six months. It is specifically indicated for progesterone deficiency and for latent hyperprolactinaemia.

Paeonia lactiflora is often prescribed with Bupleurum falcatum and Angelica sinensis for menstrual irregularity accompanied by premenstrual anxiety and irritability. Paeonia must be prescribed at appropriate dosages to be effective.

Also worth considering:

• Vitamin B6 100-200 mg, or vitamin B complex containing 50 mg of vitamin B6 for ten to fourteen days before the period.

• Bitters can be suggested to aid liver clearance of oestrogens.

Premenstrual Syndrome With Mood Changes

Premenstrual Syndrome With Food Cravings

Sugar cravings and/or excess intake of refined carbohydrates, causing a sugar-induced sensitivity to insulin, may be both a cause and effect of premenstrual sugar cravings. The hypoglycaemic chart on site can be filled in during the premenstrual week and just after the period to establish the presence and/or severity of symptoms. Abnormal glucose tolerance may be worsened by a magnesium deficiency, an imbalance in prostaglandins or prolonged stress. Changes in serotonin levels are also associated with sugar and carbohydrate cravings.

Migraines or headaches are commonly seen in conjunction with sugar cravings and careful differentiation of the underlying phenomena is required. Oestrogen fluctuations, sinusitis, food allergies, neck and back problems, and weather changes can all trigger migraines and may need to be considered as causes instead of poor glucose tolerance.

Premenstrual Syndrome With Food Cravings: Symptoms

• Craving for sweets and refined carbohydrates

• Increased appetite

• Fatigue

• Headaches or migraines

• Irritability, especially when hungry

Premenstrual Syndrome With Food Cravings: Symptoms: Treatment

Treatment for hormone modulation combined with:

• Magnesium: 200-800 mg daily of elemental magnesium in the form of magnesium phosphate, aspartate, orotate or chelate.

• Restricted sugar, refined carbohydrate and salt intake combined with small, frequent meals, and adequate protein and complex carbohydrates as outlined in the hypoglycaemic diet on site.

• Dietary and herbal bitters to regulate glucose tolerance.

• Nutrients that improve glucose tolerance such as zinc 20-50 mg per day, chromium 50-400 mcgm daily and manganese 10-20 mg daily may also be indicated.

Premenstrual Syndrome With Fluid Retention

Fluid retention is thought to be brought about by an increase in circulating aldosterone levels. Aldosterone may be elevated in response to the lower progesterone secretion, elevated oestrogens, magnesium deficiency, serotonin or dopamine irregularities, or stress. Prolactin may be implicated when breast symptoms predominate.

Premenstrual Syndrome With Fluid Retention: Symptoms

• Breast fullness

• Weight gain

• Abdominal bloating

• Swollen extremities

Premenstrual Syndrome With Fluid Retention: Treatment

Treatment for hormone modulation combined with:

• Magnesium: 200-800 mg daily of elemental magnesium in the form of magnesium phosphate, aspartate, orotate or chelate.

Taraxacum officinale leaf as a tea is a mild diuretic and reduces fluid retention. This herb should be taken in the morning.

Vitex agnus-castus is specifically indicated as a herbal hormone modulator for premenstrual breast pain or swelling.

Premenstrual Syndrome With Pain

An increased sensitivity to pain is believed to be associated with prostaglandins imbalance. One explanation is that an excessive dietary intake of animal fats provides the precursors for the series 2 prostaglandins. Alternatively, rising oestrogen levels in the luteal phase can favour the production of these pro-inflammatory prostaglandins. Cyclical breast pain is discussed in more detail later in this chapter.

Premenstrual Syndrome With Pain: Symptoms

• Breast pain

• Dysmenorrhoea

• Reduced pain threshold

• Aches and pains

Premenstrual Syndrome With Pain: Treatment

• Magnesium reduces sensitivity to pain in doses of 200-800 mg.

• Essential fatty acid supplements, such as evening primrose oil or star flower oil. Daily doses of 3 g of evening primrose oil containing 216 mg of linoleic acid and 27 mg of gamma linoleic acid. The supplements can be taken all month or from mid-cycle until menstruation to rectify the deficiency of PGE l. Vitamin B6 and zinc are necessary co-factors in the production of the series 1 prostaglandins.

• Restricted animal fats, but increased intake of raw vegetable and seed oils to selectively decrease the dietary precursors of series 2 prostaglandins and increase the series 1 prostaglandins.

Vitamin E, between 100-600 IU per day, can also positively influence prostaglandin ratios. Doses of vitamin E 400-800 IU per day are necessary to treat breast tenderness.

Tanacetum partbenium is a prostaglandin inhibitor and is useful for dysmenorrhoea and migraine headaches.

Premenstrual Syndrome With Depletion

Estrace

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