PMS was classified in the early ’80s into four types by medical researcher Guy Abraham, MD. Although most women suffer from a mix of these types, it may be helpful, in terms of the most appropriate treatment strategies, to sort out symptoms as follows:
“A” is for anxiety, irritability and nervous tension. This is the most common category, affecting up to 80% of menstruating women. The symptoms are thought to be due to relatively high estrogen and lower progesterone in the second half of the menstrual cycle (after ovulation). B vitamins will help the liver “clear” the excess estrogens.
“B” is for bloating, breast tenderness, swelling of the hands and feet, and weight gain. (Dr. Abraham labeled this category “H” for hyperhidrosis). This is the second most common collection of PMS symptoms, effecting 60% or more of patients. Problems with the kidney hormones which control diuresis and salt retention are thought to be the culprit here.
“C” is for cravings, for example for chocolate! About 25% of PMS patients report carbohydrate cravings followed by hypoglycemic symptoms including headcahes, fainting, fatigue, dizziness, palpitations and trembling. Various nutrient deficiencies including magnesium, zinc, Vitamin C, B vitamins and chromium may play a role here.
“D” is for depression, withdrawal, forgetfulness, weepiness, insomnia and even suicidal ideation. These symptoms are thought to be due to high progesterone and low estrogen, may be associated with high lead levels, and again, B vitamin and Magnesium deficiencies.
Premenstrual syndrome (PMS) is a complex interplay of hormonal, nutrient and psychosocial factors that have been troubling women, and their clinicians, since ancient times. Because the incidence of PMS has increased in recent decades with greater environmental stressors, including hormones, pesticides and plastics in the food chain, and because of the media attention PMS has enjoyed, women are finally getting good help. PMS symptoms typically occur during the “luteal” phase of the menstrual cycle, from ovulation to the onset of menses. “Luteal” is from the Greek for “yellow.” Healthy ovaries are bright yellow — saturated with the pro-vitamin A beta-carotene. The “corpus luteum” (or yellow body) is the ripe egg which bursts through the ovary wall at ovulation. A variety of causes can and do contribute to disruption of the ideal pulsations of hormones, including estrogen, progesterone and prolactin, during the monthly cycle. The ideal fluctuation of female hormones is a peak mid-cycel of both estrogen and progesterone, with another, smaller, progesterone peak and steep drop-off at the end of the month, which causes “shedding” of the endometrial lining. These idealized fluctuations can be disrupted by emotions, diet, pollutants or other stressors such that some women with PMS experience excess progesterone or excess estrogen (more commone). Treatment of PMS symptoms is best accomplished through consultation with a physician or nurse practitioner who is experienced with hormone balancing, therapeutic nutrition and is oriented towards women’s healthcare. However, here are several suggestions that can help to get you started.
To begin, lifestyle factors that will help include less stress, regular moderate exercise, good sleep habits, regular bowel function, and good nutrition. Have you heard this litany before? Good! Because it really works. To break down that list a bit, let’s start with nutrition. The less dairy products, refined sugar (including alcohol) and caffeine a woman ingests during the month, the fewer premenstrual symptoms she is likely to experience. Caffeine consumption (including chocolate) is correlated, in particular, to increased breast tenderness. Sugar and dairy products impair the absorption of magnesium, the natural muscle relaxant. Another good tip is to reduce sources of estrogen in your foods, namely commercial red meat, and even worse, chicken. For a comprehensive look at the meat and poultry industries in the U.S. please refer to the book or video by John Robbins called “Diet for a New America.” You will never want to eat mass produced red meat or chicken again. Free range chicken is fine; these birds are not fattened up with hormones. Also watch out for salty munchies before your period is due. Excess sodium leads to water retention, and concomitant bloating.
As implied above, basic nutrients with a long track record of being helpful in treating PMS are B6 to promote serotonin synthesis and magnesium to promote muscle relaxation and good elimination. Lack of B-vitamins, generally speaking, makes it more difficult for the liver to both eliminate excess estrogens and to balance blood sugar. B-vitamin deficiency also makes us more susceptible to stress. More recently, studies have focused in on one particular B vitamin that is particularly helpful with PMS; the active form of vitamin B6, pyridoxal-5-phosphate, also known as PLP, 50 mg daily. PLP will not cause peripheral neuropathy or GI upset, which can sometimes occur with “plain” B6 in high doses. PLP is crucial in the formation of dopamine, serotonin and GABA. These neurotramitters are “calming” brain chemicals. Some researchers believe that PLP decreases blood estrogen, and increases progesterone, reducing irritability. PLP also works as a diuretic, thus reducing bloating.
The other critical PMS nutrient is magnesium, 400-800 mg daily, best at night. Magnesium is not only a highly effective smooth muscle relaxant and gentle laxative, it is also required for the formation of the brain chemicals dopamine, GABA and serotonin. Deficiences of each of these neurotransmitters have been implicated in some symptoms of PMS, particularly depression. Magnesium deficiency, more common in women with increased levels of stress, is known to cause water retention and depression. Magnesium also helps to control blood sugar fluctuations, and plays an essential role in fat metabolism. Which brings us to the good fat/bad fat part of this essay.
One leading theory of PMS is that it is inflammation without infection. The signs are swelling, tenderness and irritability. One of the easiest ways to aid the body’s natural anti-inflammatory capability is to ingest Omega-3 fatty acids, which shunt a class of hormones, the prostaglandins, away from inflammatory precursors such as arachidonic acid. A delicious source of Omega-3 fatty acids is Flax Oil. Other excellent choices are Borage oil or Evening Primrose oil, 1-2 grams daily, uncooked. Please avoid fried foods and regular use of hydrogenated oils, even if you don’t have PMS.
Specially formulated teas or herbal tinctures can be enormously effective in helping to create smooth transitions in hormonal fluctuations, particularly if used consistently. Some of the most popular PMS herbs include Red Raspberry leaf (tones the uterus), Siberian Ginseng (Eleutherococcus senticosus, an energy and immune system booster), Squaw Vine, Chaste-Tree, Dandelion, Dang Quai (Angelica sinensis, known as the “woman’s Ginseng”), and the nervines Skullcap and Valerian. Commerical Red Raspberry (Rubus idaeus) tends to be heavily fumigated so look for organic. Chaste-Tree (Vitex agnus-castus) should only be used with the help of a skilled herbalist. The Chinese medical tradition consider the uterus an organ that “dislikes Cold” and therefore warming herbs, such as Cinnamon and Ginger, and warming foods such as garlic and onions, are thought to provide relief. Garlic and onions, from a Western biochemical perspective, are high in sulfur compounds, which render fat soluble molecules, such as hormones, more water soluble, so they can be excreted more easily by the kidneys. If your PMS is predominantly anxiety and irritability, this may be due to excess estrogens and decreased progesterone. The estrogen-balancing plant Medicago sativa (Alfalfa; that’s right — sprouts!) may help, whereas Discorea villosa (Wild Mexican Yam) will help balance and increase progesterone. Progesterone deficiency symptoms are depression, forgetfulness, insomnia, weepiness and withdrawal.
If I had to choose three “top” herbs for PMS they would be Dandelion, Angelica, and one of the nervines, probably Skullcap. Here’s why.
The common Dandelion weed (Taraxacum officinale) is a high medicine. It is a powerful diuretic, thus reduces bloating. Unlike most commercial diuretics, which cause unhealthy potassium loss, Dandelion is rich in potassium. This means it is a safe diuretic even in heart problems affiliated with water retention, such as congestive heart failure. One French nickname for this magic herb is “pis-en-lit” meaning wet-your-bed. French moms know not to put dandelion greens in their childrens’ dinner salads! The English word dandelion comes from another French name for this revered herb: “dents-de-lion,” which means lion’s teeth because of the serrated edge to the mildly bitter leaves. Dandelion is also a potent but gentle liver cleanser (side-effect-free)because it helps conjugate (bind to a carrier protein) the excess estrogens, allowing them to be more rapidly excreted. Thus, Dandelion is great for most PMS symptoms, especially “A” (anxiety) and “B” (bloating). Put 2-3 teaspoons of the ground root and leaf mix ito one cup of water, bring to the boil and gently simmer for 10-15 minutes. This should be sipped 2 to 3 times daily in the 10 days before your expect your period. For Dandelion in capsule or tincture form, double suggested doses on the label in the ten days before expected menses. Young dandelion leaves are also delicious in a raw salad.
Angelica sinensis, or “Dang Quai” , is known in traditional Chinese medicine as the female Ginseng (although Ginseng is good for women too). Its historical uses include menopausal symptoms (especially hot flashes), painful menstruation, lack of or excessive menstrual bleeding, to ensure health pregnancies and easy deliveries, and as a blood sugar balancer. Angelica has anti-inflammatory properties and is traditionally also used for “rheumatism” or swollen joints. It has “carminative” properties which means it is a digestive aide, reducing flatulence, bloating and sugar cravings. As a uterine tonic, first increasing contractions, then relaxing the uterus, it helps pave the way to a pain free flow. Angelica is especially helpfully for :MS type “C” (cravings) and will also help with pre-menstrual cramping. Take a teaspoonful of the cut root in a cup of water, bring to the boil and simmer for two minutes. Take off the heat and let stand for 15 minutes. Take one cup three time daily in the 10 days before anticipated menses, or use 1 teaspoon of commercially prepared tincture (alcohol extraction) three times daily during the same time period. If you can only find this herb in capsule form, double the suggested dose on the label during the 10 days before your period.
Skullcap (Scutellaria laterifolia) is probably my favorite nervine because of its deep but gentle action, and pleasant taste. “Nervine” means having an effect on the nervous system. Skullcap is great for reducing nervous tension (tight shoulders, stomach cramps, headaches) and is completely safe. It combines well with another excellent, but nasty tasting, nervine, Valerian. The nervous system percolates throughout the whole body, from the brain out to the tips of the fingers and toes, and also includes the digestive system. Skullcap is an effective mild laxative and is very helpful in relieving insomnia when taken at bedtime. Skullcap works great for PMS “D” (depression) and also for PMS type “A”. Use 1/2 to 1 tsp of the commercial tincture three times daily (or all at once at bedtime) or in tea form, if you can get the fresh, dried herb. The leafy part of the plant is used: pour a cup of boiling water onto 1 or 2 teaspoons of the dried herb and leave to infuse to 10 to 15 minutes. Drink the tea 3 times daily during the premenstrual period. You can also take encapsulated Skullcap, 1 with lunch, 1 with dinner and 2-3 at bedtime during the premenstrual period.
Using the above information, you can create your own PMS “brew” depending upon your individual symptoms. Dandelion, Angelica and Skullcap combine safely. A great tip from traditional Chinese medicine: when combining herbs, whether in tincture, tea or capsule form, add a “dash” of Licorice (unless you have high blood pressure) to potentiate the synergism between the herbs. Licorice is also an excellent adrenal tonic, and will sweeten an otherwise somewhat bitter mix.
There are lots of ways to get self-help and enhance personal power. Healthfood store supplements can be part of the picture; plant medicines are gentle and effective health aides; working gracefully and respectfully with your own body — dance! — will also help bring you into loving alignment. Women are blessed with a monthly, moon-based, cycle of introspection and cleansing followed by exuberant, outward-moving energy. Connecting to your cycle spiritually, recognizing and honoring the moon-time as a potent force in self-awareness, is perhaps the most crucial part of coming to peaceful terms with your pre-menstrual symptoms. Think of these symptoms as a call for inner reflection. If you don’t slow down and spend some creative, contemplative “down” time each month, your body will force you down. If at all possible, take the first day of your period all to yourself. If that’s not practical for you right now in your life, take a few hours. Don’t leave your needs until last. Make a space in your home — whether a whole room or a shelf for special ritual items (your altar) — that is yours alone. Spend time there, heeding the call to turn inward. Ritualize your moon-time and it will become something to look forward to each month. Enjoy!
- Hoffman, David. The New Holistic Herbal. Element Books, Inc. Rockport, MA 1986.
- Murray, Michael and Pizzorno, Joseph. Encyclopedia of Natural Medicine. Prima Press, Rocklin, CA 1998.
- Piesse JW. Nutritional factors in the premenstrual syndrome. Int Clin Nur Rev 4:58-81, 1984.
- Barnhart KT, Freeman EW and Sondheimer SJ. A clinician’s guide to the premenstrual syndrome. Med Clin North Am 79:1457-72, 1995.
- Abraham GE. Nutritional factors in the etiology of premenstrual tension syndromes. J Reprod Med 28:446-64, 1983.