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

Premenstrual dysphoric disorder (PMDD)

Answer 2

a severe variant affecting 1–10% of women
that includes at least one affective symptom
e.g., anger, irritability during the second 1⁄2 of the menstrual cycle
Conditions with overlapping symptoms are often exasperated during PMS e.g., hypothyroidism, CFS, depression and anxiety

Question 3

PMS: Signs and symptoms

Answer 3

• 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 4

PMS subtypes

Answer 4

PMS subtypes — a woman may suffer from some or all of these:
* 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 5

PMS: Causes and risk factors

Answer 5

• Interactions between oestrogen, progesterone and neurotransmitters:
  – Progesterone metabolites bind to GABA receptors and render them resistant to activation. These metabolites are often low in PMS, e.g., due to hormonal contraceptives etc.
  – Deficient serotonergic functioning. Progesterone and oestrogen can modify serotonin availability in synapses. Also consider nutritional deficiencies such as tryptophan, gut dysbiosis etc.
• Reduced cortisol awakening response (CAR) — consider high adrenal function / chronic stress and a salivary cortisol test.
• Smoking — nicotine affects neurocircuitry
  increasing susceptibility to environmental stressors. Further declines HPA axis functioning.
• Obesity — BMI > 30 is strongly associated with ↑ PMS risk.
• Alcohol — has a negative association with anxiety,
  mood changes and headaches during PMS.
• High intake of dairy and sugars with a low protein intake can aggravate PMS symptoms.
• High omega 6:3 ratio can increase inflammatory prostaglandins and induce aromatisation

Question 6

PMS: Naturopathic approach

Answer 6

CNM Naturopathic Diet with a ‘Hormone Balancing Approach’, and focus on oestrogen:progesterone balance:
* Optimise hormone detoxification (phase 1 and 2), elimination and metabolism (i.e., methylation, GIT health etc.) and hydration.
* Minimise xenoestrogen exposure (earlier).
* Address chronic stress. Adrenal support.
* Restore nutritional deficiencies (e.g., the B vitamins, zinc and magnesium).
* Balance blood glucose levels.
* Reduce inflammation. Also consider thyroid support if applicable.
1. Avoid / minimise:
* High GI / GL foods, caffeine, alcohol, cigarettes, table salt, dairy, red and processed meats.
2. Balance oestrogen:progesterone ratio:
* Support oestrogen detoxification / elimination (e.g., B vitamins, magnesium, high fibre, cruciferous vegetables, broccoli sprouts).
* Increase phytoestrogens including red clover tea (2 cups / day).
* Low saturated fat diet reduces oestrogen circulation.
* Remove endocrine disruptors, optimise weight, address stress.
* Herbal medicines, e.g., Vitex Agnus castus
3. Balance blood glucose:
* Low GI / GL, plant-based foods, complex carbohydrates.
* Alpha-lipoic acid, cinnamon, chromium, magnesium, B-vitamins.
4. Reduce inflammation:
* Increase omega-3, GLA (EPO, borage oil). Eliminate inflammatory
products (dairy, sugar, hydrogenated oils etc.).
* Increase antioxidants (e.g., vitamins A, C, E).
* Good quality protein (focus on plant proteins).
5. Optimise status of key nutrients:
* B vitamins (esp. B6), magnesium, zinc, vitamin D, EFAs, calcium
6. Balance neurotransmitters:
* L-Tryptophan (serotonin precursor) or 5-HTP.
* Other key nutrients: Tyrosine, B6, B12, folate,
zinc, magnesium, L-theanine (green tea).
* St John’s wort, saffron — serotonergic effects.
* Remove alcohol and caffeine; optimise sleep and exercise.
7. Reduce fluid retention (if applicable):
* Reduce sodium and increase potassium-rich foods.
* Vitamin B6 to help regulate aldosterone.
* Seed cycling (pumpkin and flax / sunflower and sesame).
* Diuretics — celery, dandelion, parsley, nettle. Nat. sulph. tissue salt

Question 7

PMS: Nutritional support

Answer 7

Question 8

PMS: key nutrients

Answer 8

Question 9

PMS: herbal medicines

Answer 9

• Rosemary — antioxidant effects, neutralising quinones.
  It downregulates CYP3A4 and induces CYP1A1 —
  reducing 16-OH-E and increasing the more beneficial 2-OH-E.
• Ashwagandha — adaptogen, nervine, thyroid support.
  A warming Ayurvedic tea to ↑ blood flow to reproductive organs:
• 2 tbsp Assam or Darjeeling tea, 12 slices fresh ginger, 11⁄2 tsp black peppercorns, 12 cardamom pods, 2 cinnamon sticks,
  5 cloves, 500 ml plant-based milk, maple syrup to taste.
• Put 1 litre water, tea and spices together in pot and gently simmer for 10–20 minutes. Add plant milk and maple syrup.
  Other herbal teas for PMS:
• Ginger root — improves blood circulation, reduces congestion / cramping; reduces bloating.
• Nervine teas (esp. for PMS-A) — chamomile (also eases bloating) and passionflower.
• Green tea — L-theanine to calm the nervous system.
• Peppermint — antispasmodic, eases bloating.
• St John’s wort (MAO inhibitor, GABA antagonist) — enhances mood.
  Additional considerations:
• Optimise sleep; regular aerobic exercise (modulates oestrogen).
• Acupuncture and homeopathy can also be very helpful.