Premenstrual syndrome

Premenstrual syndrome (PMS) refers to the different kinds of symptoms experienced

by some women during the luteal and menstrual phase of the estrus cycle. It affects
upwards of 75% of all women of menstruating age in varying degrees. The most common
physical symptoms of PMS are abdominal distension, breast swelling and tenderness,
headaches, changes in appetite, food cravings, fatigue, dizziness, weight gain, fluid
retention, joint pain, pelvic congestion, poor immunity, constipation or diarrhea, herpes
outbreak, and acne. Psychological symptoms might include insomnia, poor memory,
grief, irritability, anger, anxiety, poor concentration, and confusion. Such symptoms,
when recognized by the physicians of the middle ages, gave rise to all kinds of interesting
ideas, such as the concept of a “wondering womb” that searched the body looking for a
baby, and in its journey caused the myriad symptoms that we now define as PMS. The
modern medical approach to this condition is little better however, and the prevailing
notion is that PMS is nothing but a kind of female nervous tension best treated by
sedation. (Trickey 1998 35-37; Berkow 1992, 1791)

Although the causes of PMS are varied, in her book Women, Hormones and the
Menstrual Cycle, author Ruth Trickey illustrates some common themes, all of which are
related to neuroendocrine control:

•Estrogen- Elevated levels of estrogen relative to progesterone 5 – 10 days prior menses

is thought to cause feelings of irritability and aggression by elevating norepinepherine in
the brain.
•Progesterone- A relative deficiency of progesterone 5 – 10 days prior menstruation
allows for the elevation of aldosterone, enhancing sodium retention and the resulting
edema. The progesterogenic effects of the luteal phase are also inhibited by elevated
norepinepherine from emotional stress and elevated estrogen.
•Aldosterone- Aldosterone is a cause of premenstrual fluid retention, and is enhanced
with stress, low progesterone, high estrogen, and a deficiency of magnesium.
•Prolactin- Women with PMS are thought to have an excessive sensitivity to, or mildly
elevated levels of, prolactin. Prolactin is normally secreted in high levels during
lactation, and prolactin is implicated in the increased breast sensitivity and swelling of
some forms of PMS.
•Endorphins- Endorphins are natural opiates that elevate mood, and when decreased, can
give rise to symptoms of depression. Additionally, endorphins appear to regulate the
secretion of the gonadotropins.
•Dopamine- Dopamine in a prolactin antagonist, and is decreased under the influence of
estrogen and a deficiency of magnesium and vitamin B6. Dopamine also appears to
regulate mood, and a deficiency is implicated in anxiety, irritability, and emotional
lability. (Trickey 1998, 109-118)

Other factors in PMS include a prostaglandin imbalance and the overgrowth of Candida
albicans, the latter of which is linked to a relative estrogen excess. A deficiency of
vitamin B6 is often implicated in PMS, and treatment with this nutrient may provide relief
from depression and anxiety. The breast swelling and tenderness associated with

©2004 by Todd Caldecott

elevated prolactin levels may be relieved by supplementation of vitamin B6 through the
enhanced synthesis of dopamine. Vitamin B6 is also a cofactor in the production of the
series 1 prostaglandins and can normalize cellular magnesium levels. Magnesium too is a
factor in dopamine synthesis, and a deficiency can lead to depression, anxiety, and cyclic
breast pain. (Trickey 1998, 109-118)

There are five different subcategories of PMS, first devised by G.E. Abraham, and each
of these subtypes have a unique set of symptoms and metabolic abnormalities associated
with them. The following chart describes these subtypes and the mechanisms that could
cause them. It is important to note that a woman with PMS may experience more than
one subtype.

Subgroup Symptoms Mechanisms

PMS A Anxiety Estrogen excess
A = anxiety Nervousness Progesterone deficiency
Mood Swings Liver congestion
Nervous tension
PMS C Craving for sweets Hypoglycemia
C = craving Increased appetite Magnesium deficiency
Palpitations Prostaglandin imbalance
Fatigue Often occurs in association with PMS A
Dizziness
Headaches
PMS H Breast tenderness Elevated aldosterone
H= hydration Bloating Estrogen excess
Weight gain Progesterone deficiency
Edema Elevated prolactin
PMS D Depression Estrogen deficiency
D= depression Poor memory
Grief
Confusion
Insomnia
PMS P Lower back pain Estrogen excess
P= pain Abdominal pain Prostaglandin imbalance
Joint pain
Headaches
(Trickey 1998, 118-121)

Treatment of PMS A
The primary treatment of PMS A is to enhance progesterone levels, best accomplished
with Chasteberry (Vitex agnus castus), 40 gtt. of a 1:3 extract taken every morning for at
least 6 months. Vitamin B6, at a dose between 100-600 mg daily, taken with 50-100 mg
of a full spectrum B-complex, is best used 10-14 days prior menses. Magnesium is an
important supplement as well, taken at a dosage between 200-800 mg throughout the
cycle can be helpful. Botanicals that reduce anxiety and pain, as well as promote a
feeling of well-being are an important aspect of treatment, and include relaxing nervines
such as Valerian (Valeriana officinalis), Skullcap (Scutellaria lateriflora), Passionflower
(Passiflora incarnata), Vervain (Verbena officinalis), and anodynes such as Kava (Piper
methysticum) and Pasqueflower (Anenome occidentalis). Adaptogens are particularly
indicated in anxiety with exhaustion, including Ashvagandha (Withania somnifera),

©2004 by Todd Caldecott

Shatavari (Asparagus racemosa), Dang gui (Angelica sinensis), Peony root (Paeonia
lactiflora), and Siberian Ginseng (Eleuthrococcus senticosus). Hepatics can be useful to
enhance the excretion of conjugated estrogens, and include Buplerum (Buplerum
chinensis), Barberry (Berberis vulgaris), and Dandelion root (Taraxacum officinalis).
Phytoestrogenic herbs that compete with estrogen-binding are useful, such as Red Clover
(Trifolium pratense), as well as phytoestrogen-containing foods such as fermented and
sprouted legumes. Fiber intake should be enhanced, and saturated fat and refined
carbohydrate intake should be curtailed. In particularly recalcitrant cases, natural
progesterone creams can be used to enhance serum progesterone levels, 1/4 tsp applied
over the extremities once daily before bedtime.

Treatment of PMS C
The primary treatment of PMC C is to regulate blood sugar levels, best accomplished by
enhancing protein intake, especially in the morning, and decreasing refined carbohydrate
intake throughout the day. Smaller, more frequent meals can help, as will the elimination
of methylxanthine-containing beverages such as coffee and tea that promote labile blood
sugar levels. Supplementation with magnesium is useful (800-1000 mg daily), as is
chromium (250 mcg t.i.d., with meals). To correct the prostaglandin imbalance that can
accompany this condition, supplementing with Black Currant seed oil, Borage seed oil or
cold water fish oil is very useful, 5 g daily taken mid cycle until menstruation, or
throughout the cycle on a daily basis Additionally, vitamin B6 (100-300 mg daily, taken
with a B-complex), vitamin E (200 600 IU daily), and zinc citrate (50 mg daily) can
facilitate the production of PGE1.

Treatment of PMS H
The treatment of PMS H is essentially the same as it is for PMS A, with the addition of
treatments to correct aldosterone levels and the sodium-potassium balance. To this end
botanicals that are rich in potassium such as Dandelion leaf (Taraxacum officinalis),
Catnip (Nepeta cataria), and Skullcap (Scutellaria lateriflora) are helpful when taken as
an infusion, as are potassium-rich foods such as kelp, raisins, avocados, apricots, potato
skins, cantaloupe, and broccoli. Although the treatment for PMS-H is similar to that of
PMS A, the use of Licorice root (Glycyrrhiza glabra) as a phytoestrogen is
contraindicated because of its aldosterone-like activity.

Treatment of PMS D
As PMS D relates to a relative estrogen deficiency, therapies that enhance estrogen
production or facilitate the cellular activities of estrogen are all helpful. It appears that
lead, found in some fuels, paints, and other household products can accumulate in the
body and interfere with the activity of estrogen receptors, and thus agents that decrease
lead absorption and retention such as magnesium, iron, copper, and zinc. A diet high in
fiber can promote the excessive excretion of estrogen and thus fiber intake should be
reduced. Foods high in phytoestrogens should be emphasized in the diet, as well as
botanicals such as Red Clover (Trifolium pratense), Wild Yam (Dioscorea villosa), False
Unicorn root (Chamaelirium luteum), and True Unicorn root (Aletris farinosa). And, just
as for PMS A, botanicals that reduce anxiety and pain, as well as promote a feeling of
well-being are an important aspect of treatment. For severe pain, follow the

©2004 by Todd Caldecott

recommendations under PMS P. Serotinergic foods such as those high in tryptophan (e.g.
turkey and hard cheeses) can also be taken to enhance serotonin levels, or with severe
depression the biological precursor to serotonin, 5-HTP (100-300 mg daily).

Treatment of PMS P
PMS P relates to an increased sensitivity to pain, perceived to be an imbalance of the
proinflammatory and pain-promoting prostaglandins, facilitated by elevated estrogen and
the excessive consumption of saturated animal fat. Once again magnesium appears to be
an effective agent to reduce pain sensitivity, as is vitamin B6 and zinc, all taken at
dosages previously mentioned. The therapeutic usage of GLA and EPA are both
important here, 5-10 g daily. The additional usage of herbs that have a phytoestrogenic
property are helpful, as is increasing dietary fiber. Herbs that inhibit the inflammatory
cascade include Feverfew (Tanacetum parthenium), Turmeric (Curcuma longa), Devil’s
Claw (Harpagophytum procumbens), and Baical Skullcap (Scutellaria baicalensis).
Botanicals that have potent analgesic and anodyne properties are Kava (Piper
methysticum), Wild Lettuce root (Lactuca virosa), Jamaican Dogwood (Piscidia
erythrina), White Willow bark (Salix alba), California Poppy (Eschscholzia californica),
and Pasqueflower (Anenome occidentalis).

©2004 by Todd Caldecott