PMS

Question 1

PMS

Answer 1

PMS = symptoms affecting many women a week or two before their period. Symptoms can extend into the first few days of menses.

Question 2

PMS- Prevalence

Answer 2

Affects up to 80% of women. Peak occurrence in the 30s and 40s . Approx. 50% state that symptoms followed
childbirth worsening with each pregnancy.

Question 3

Premenstrual dysphoric disorder (PMDD)

Answer 3

A severe variant affecting 1-10% of women that includes at least one affective symptom e.g., anger, irritability during the second ½ of the menstrual cycle.

Question 4

PMS: Signs and symptoms

Answer 4

• Over 150 symptoms have been associated with PMS.
• Non-physical: Mood swings, irritability, low mood, anxiety, feeling out of control, poor concentration, change in libido and food cravings.
  Reduced cognitive and visuospatial ability, increase in accidents.
• Physical: Breast tenderness, bloating, headaches, backache, weight gain, acne, GIT upset.

Question 5

PMS subtypes

Answer 5

• PMS-A (anxiety): Possibly related to high oestrogen:
  progesterone. Symptoms: Irritability and anxiety.
• PMS-C (craving): Blood glucose imbalance, hypoglycaemia and
  ↓ magnesium. Symptoms: Increased appetite, sugar cravings.
• PMS-D (depression): Low oestrogen:progesterone ratio and neurotransmitter imbalances (e.g., low serotonin).
• PMS-H (hyperhydration): water retention secondary
  to aldosterone (excess salt intake, excess oestrogen, stress or magnesium deficiency). Symptoms: Weight gain, breast
  tenderness, abdominal bloating and swelling of hands and feet.

Question 6

PMS: Causes and risk factors

Answer 6

• Interactions between oestrogen, progesterone and neurotransmitters
• Reduced cortisol awakening response (CAR)
• Smoking
• Obesity BMI > 30
• Alcohol
• High intake of dairy and sugars with a low
  protein
• High omega 6:3 ratio

Question 7

Natural Approach to PMS

Answer 7

1. Avoid/minimise high GI / GL foods, caffeine, alcohol, cigarettes, table salt, dairy, red and processed meats.
2. Balance oestrogen:progesterone ratio
3. Balance blood glucose
4. Reduce inflammation
5. Optimise status of key nutrients
6. Balance neurotransmitters
7. Reduce fluid retention

Question 8

PMS Supplements

Answer 8

Vitamin B6
Magnesium
Calcium
Vitamin D
Zinc
EFAs
Vitex Agnus Castus
Gingko biloba

Question 9

Vitamin B6

Answer 9

• B6 is a cofactor for the production of GABA, serotonin and dopamine.
• Oestrogen progesterone imbalances can lead to a relative deficiency of B6.
  ↓ dopamine = ↑ prolactin which affects breast tissue and promotes water retention.
• B6 levels are typically low when taking the OCP.
• Vitamin B6 is required for corpus luteum development
  oestrogen metabolism in the liver. It supports healthy progesterone levels and modulates oestrogen.

Question 10

Magnesium

Answer 10

Important for GABA and serotonin synthesis and various other cell functions.

Question 11

Calcium

Answer 11

Cofactor for tryptophan -> serotonin conversion

Question 12

Vitamin D

Answer 12

Important role in female reproductive health via cyclic sex hormone fluctuations , or neurotransmitter function.

Question 13

Zinc

Answer 13

Zinc is important for the proper action of many sex hormones in particular, it controls prolactin.

Question 14

EFAs

Answer 14

Women with PMS have been shown to exhibit EFA and prostaglandin abnormalities (e.g., low GLA).

Question 15

Vitex Agnus
castus

Answer 15

• Hyperprolactinemia can result in long or irregular cycles and is often linked to low progesterone levels.
• Binds to dopamine receptors to reduce secretion of prolactin.
• Reduces mood changes, irritability, headache and breast tenderness.

Question 16

Gingko biloba

Answer 16

• Effective against congestive symptoms, including breast pain / tenderness and vascular congestion.
• Can decrease the overall severity of symptoms.