Monday, August 11, 2008

The trouble with PMS…

At one stage or another, the majority of us will have experienced some form of PMS during our menstruating years. Cramps seemed to be the common symptom during high school days and whether this conveniently happened just before our P.E. class or not, it was usually severe enough to dread the oncoming months of pain our period would bring. Later on down the track, emotional turmoil may have ensued and the fluid retention and weight gain some experienced could rival the Michelin man. Most women put up with PMS as’ just a part of life’ but there is quite a lot that can be done to reduce the severity of this all too common condition.

PMS relates to a plethora of physical and psychological disturbances that occur during the first half of the cycle, known as the luteal phase. The timing of these disturbances is important in diagnosing PMS. They must be absent in the first week after menstruation and before ovulation, and the onset of the period must result in a reduction in the severity of symptoms[1]. If symptoms last outside of this pattern, other causes may need to be investigated.

The symptoms related to PMS are many and varied and can occur with varying degrees of severity. For some, PMS can go by with very little bother but for others, the severity of symptoms can be so severe that they have a negative impact on work and personal relationships. For ease of grouping and listing these symptoms, there are 5 separate categories that we can look at in terms of symptomatology. These categories are not fixed and overlapping often occurs.

PMS A (anxiety) PMS C (cravings)

anxiety dizziness or fainting
nervous tension headache
mood swings fatigue
irritability palpitations

PMS D (depression) PMS H (hyperhydration)

depression fluid retention
forgetfulness weight gain
crying swelling of extremities
confusion breast tenderness and swelling
insomnia abdominal bloatin

PMS P (pain)

aches & pains
lowered pain tolerance[2]

The exact cause of PMS is not completely understood but it is believed to be influenced by hormonal imbalances, neurotransmitter abnormalities, nutritional deficiencies and/or poor diet and lifestyle[3].

Hormonal influences:

Oestrogen/progesterone ratio imbalance: both hormones are required to regulate the cycle and when this balance is tipped, oestrogen can dominate the environment. This may bring about mental and emotional changes commonly seen in PMS such as feelings of irritability, aggressiveness and anxiety. Heavy and prolonged bleeding may also feature. An oestrogen dominant environment can predispose conditions such as endometriosis, fibroids and cysts, which can then go on to contribute to unnecessary weight gain.

Progesterone deficit: Progesterone levels themselves may be sufficient but there may be problems with signalling this hormone into the cell. This could be due to faulty cells or from an increase in stress hormones, which block receptors and make them unavailable to progesterone. Progesterone receptors are found throughout the body including the brain, respiratory tract, uterus, skin, eyes and breasts and these are all common areas affected by PMS[4].

Adrenal hormones: Not only can stress hormones interfere with receptor responsiveness, they can also interfere with the overall communication between other major hormonal systems. The adrenal gland secretes a hormone responsible for maintaining fluid balance. Stress can increase the production of this hormone which can contribute to fluid retention[5]. Long term stress can also deplete the body of important nutrients and can cause unwanted weight gain.

Neurotransmitters

Both oestrogen and progesterone interact with the neurotransmitters serotonin, noradrenalin and dopamine. Fluctuations in any of these neurotransmitters can contribute to feelings of anxiety, difficulty concentrating, depression, irritability and mood swings. Blood sugar levels can also be affected resulting in increased appetite and sugar cravings.

Dietary imbalances

May be caused by the following factors

  • high carbohydrate to protein ratio
  • high dairy intake
  • caffeine
  • alcohol
  • high sugar intake
  • high animal and saturated fat intake
  • prolonged stres

With so many possible contributing factors, where on earth does one start with the whole treatment process? This is where a number of different approaches may be of benefit to cover as many relevant factors as possible. Each treatment plan needs to reflect the needs of the individual and target the main presenting symptoms. This can be done in a number of ways.

  • Herbs: there are a wide range of herbs to address the many PMS related symptoms such as fluid retention, sugar cravings, irritability, fluid retention, cramping and heavy bleeding
  • B Group Vitamins: nourishes the nervous system and assists with liver clearance of oestrogens, dampening the oestrogen rich environment in PMS, fibroids, cysts and endometriosis
  • Magnesium: nourishes the nervous system, may assist with correct fluid balance, regulates blood sugar levels to reduce cravings and excessive hunger, relaxes muscles that may be affecting cramps and headaches
  • Bitter foods: to aid liver clearance of oestrogens. Include foods such as endive, chicory, silverbeet, radicchio, outer leaves of cos lettuce, dandelion root, and grapefruit
  • Exercise: crucial for oxygen transport which may relieve cramps, will assist with liver clearance of hormones, fantastic way to lower stress levels and increase endorphins to help stabilise moods & emotions
  • Stress reduction: yoga, meditation, massage and counselling are all useful tools to help relieve the pressures of daily life
  • Dietary modification:

# increase protein, especially fish rather than dairy and red meat
# decrease poor quality carbohydrates
# reduce or avoid caffeine and alcohol
# reduce sugar intake and avoid excess fruit and juices
# avoid salt: watch for hidden salt in processed foods
# increase vegetable intake
# eat small, frequent meals to balance blood sugar levels
# increase fibre to assist with bowel clearance

It seems likely that the interaction between ovarian hormones, stress hormones, neurotransmitters, nutrient deficiencies, poor diet and lack of exercise are all factors that need to be considered when focusing on the potential causes, and treatment, of PMS. The important thing may not be to rely solely on treating just one area of imbalance as more often than not, an imbalance in one area will soon spread to another. Taking a holistic approach to treating PMS may well be the only way to achieve long term results. Your MassAttack program will assist in identifying these imbalances and will initiate a treatment plan that will help you remember PMS as a thing of the past.

Emma Scasni is a qualified naturopath at MassAttack Health Clinic and has a keen interest in women’s health. Emma is passionate about all aspects of natural health and is happy to offer support and advice to new and existing MassAttack members. MassAttack specializes in natural treatment programs for women with hormonal imbalances such as PCOS, Fibroids, Endometriosis & thyroid imbalance. Narelle Stegehuis, CEO of MassAttack, is the recipient of the Australian Naturopathic Excellence Award 2006 and can be contacted at narelle@massattack.com.au


[1] Ruth Trickey, (2003) “Women, Hormones & the Menstrual Cycle”, Allen & Unwin NSW, pg 115-116
[2] Suzie O’Donohue, Gynaecology: Approaches to Treatment with Natural Therapies, SSNT, 2003 pg 42
[3] Ruth Trickey, (2003) “Women, Hormones & the Menstrual Cycle”, Allen & Unwin NSW, pg 116
[4] Ruth Trickey, (2003) “Women, Hormones & the Menstrual Cycle”, Allen & Unwin NSW, pg 118
[5] Ibid