PMS: IT'S CAUSE, SYMPTOMS AND TREATMENT OPTIONS
by Dr. Randy W. Martin, Ph.D., O.M.D., L.Ac.
Doctor of Oriental Medicine
What is PMS?
PMS is one of the most common health problems facing women in our culture today. About one-third to one-half of the American adult female population from 15 to 50 experience some sort of PMS. This translates to a lot of missed days at school and work, severe stress on relationships, and needless suffering.
The symptoms of PMS begin ten to fourteen days prior to the start of menstruation and end in the first few days after its onset. There are actually more than 150 symptoms associated with PMS. Listed below are some of the most typical:
Irritability Anxiety Moodiness
Anger Headaches Skin
Vertigo Weight gain Bloating
Joint pain Back pain Cramps
Constipation Diarrhea Sugar craving
Sore throat Vision problems Chocolate craving
It is very common for women to have a combination of these symptoms, and not unusual for there to be alternating symptoms on a month-to-month basis. Some months may even be symptom-free.
What is the cause of PMS?
PMS is caused by psychological and physiological imbalances. Psychologically, the primary cause is stress. Physiologically, the primary cause is an imbalance of estrogen and progesterone. Secondary causes include poor diet, heredity, and lack of exercise.
Factors which have been shown to correlate with a higher risk for PMS include the following:
• Being “thirty something”
• Major emotional stress
• Poor eating habits
• Side effects from birth control pills
• Significant weight fluctuations
• Lack of exercise
• Being Unmarried
• Pregnancy complicated by toxemia
The causes and treatments of PMS are commonly grouped into six different classifications. Each classification is typified by the kinds of symptoms most commonly experienced, and each has unique causes and cures.
Type 1 experiences anxiety, irritability, and mood swings before her period. These problems stop as soon as the menstrual flow begins. Eighty percent of women with PMS are noted to have Type 1 symptoms, although it is common to have more than one type at the same time. Type 1 is caused by a relative abundance of estrogen relative to progesterone levels. The cause can be either an imbalance in the endocrine loop that regulates estrogen production in the body, or a toxic liver that is not breaking down and disposing of excess estrogen.
In Type 1 PMS, treatment is aimed at regulating estrogen production at the level of the endocrine glands and improving the function of the liver. Specific treatment methods include the following:
Sixty percent of women with PMS are considered to have Type 2 PMS. Symptoms include an increase in cravings for carbohydrates, sweets, alcohol, pastries, bread, chocolate, etc. Eating these foods creates even more cravings, which in turn cause mood swings, fatigue, headaches, and dizziness. This is a vicious downward cycle. Patients who have suffered from compulsive eating disorders are familiar with this symptomology.
The cause of Type 2 PMS is hypoglycemia or low blood sugar. This is due to a complex chemical reaction in the pancreas, the endocrine gland that secretes insulin. Insulin regulates and balances blood sugar levels. For a woman who suffers from Type 2 PMS, the body is much more sensitive to insulin just before her period than it is normally. The more sensitive the body is to insulin, the lower the blood sugar falls; the lower the blood sugar falls, the more cravings for foods to temporarily increase energy to the brain and muscles occur.
The liver is also partially at fault in Type 2 PMS. When the liver is working well, it helps keep blood sugar at normal levels. When the liver is toxic from overindulgence in refined carbohydrates and sweets, the liver is not capable of doing its job well.
To some extent, Type 2 PMS may also involve the adrenal and thyroid glands, since the complexity of endocrine gland feedback loops in the body is rather extensive and extremely complex.
Treatment of Type 2 is aimed at balancing blood sugar by changing the diet and balancing the thyroid, adrenals, and pancreas. This may include:
--licorice tea for blood sugar
--glandular thyroid, adrenal or pancreas extracts
--pantothenic acid (a B vitamin)
--glycine and other amino acids to help support the adrenal glands
--digestive enzymes to assure assimilation
--acupuncture to help regulate blood sugar and strengthen the digestive process
Type 3 PMS, or hyperhydration, is experienced by 40 percent of women with PMS. Symptoms of Type 3 include bloating, swollen and tender breasts, weight gain, migraine headaches, and vision problems. The cause is an excess output of a particular hormone (ACTH) from the pituitary gland. This hormone indirectly causes the body to retain too much sodium and retain fluids.
Treatment of Type 3 is aimed at eliminating sodium from the diet and strengthening the kidneys and pituitary gland and may include:
--herbal diuretics such as buchu, dandelion, corn silk, burdock
--extra vitamin B6 in the special form of pyridoxal-5 phosphate
--acupuncture to strengthen the kidneys
In Type 4 PMS the primary symptom is depression. Additional symptoms are confusion, insomnia, memory loss, and suicidal thoughts in severe cases,. It is caused by ovaries which do not produce enough estrogen. Type 4 PMS is seen by itself in only five percent of women with PMS; but as a companion to Type 1, it is seen in 20 percent of women. It has the potential to be the most serious form of PMS.
Type 4 PMS will not respond to the traditional progesterone treatment many Western trained medical doctors use. Holistic treatment stimulates the secretion of female reproductive hormones produced by the ovaries, in particular estrogen. Therapy may also involve treating the thyroid and pituitary glands.
--Dong Quai and St. John's Wart are both very effective at treating this type of PMS.
--Additional treatments involve regulating thyroid and pituitary gland function, through glandular extracts and herbs like Red Raspberry tea
--Acupuncture to regulate progesterone and overall hormones
The fifth grouping of PMS symptoms includes blackheads, cystic acne, oily skin or other skin problems. These symptoms are usually caused by lower levels of estrogen or by an increase in male hormones called androgens, which affect skin pH.
Skin problems are treated by eating a more alkaline diet, eliminating sugar, and taking teas and herbs to cleanse the blood. It is also important to balance the hormones, cleanse the liver, and improve overall digestion and assimilation. In terms of Oriental medicine, we aim to correct the balance of yin and yang through acupuncture and Chinese herbs. Some basic and effective North American skin cleansing herbs are ginger root, burdock and cayenne.
The sixth type of PMS is not technically PMS because it usually begins after the onset of menstruation, but for simplicity of treatment and classification it is ordinarily discussed along with PMS. Symptoms include cramping, diarrhea, shooting pains, nausea, vomiting, and low back and/or leg pains. These symptoms can last anywhere from one to four days and are due to an excess of a chemical called Prostaglandin F, which is produced in the uterus. Prostaglandin F causes painful uterine muscle contractions.
Treatment is usually aimed at increasing Prostaglandin E, an antagonist to Prostaglandin F. This can often be accomplished by taking either evening primrose oil or black current seed oil. Increasing intake of calcium and magnesium also helps to relieve cramps. Make sure that you take twice the magnesium to the amount of calcium you are taking when for the purpose of relieving menstrual cramping.
What are some of the general treatments for PMS?
Recent research has also shown St. John's Wart to be very effective in treatment of the emotional aspects of PMS. St. John's Wart works to cut down on depression, anxiety and irritability, so it's effects are on both Type 1 and Type 4 PMS. It works by raising the circulating levels of naturally occuring Serotonin and GABA in the body. Serotonin and GABA help to give you a relaxed feeling and enable you to handle stress more effectively. Tryptophan does the same thing; and GABA, and 5HTP act similarly.
Diet is the first and foremost factor within your control. Foods known to increase symptoms of PMS include caffeine, milk, hard cheese, salt, chocolate, sugar, alcohol, beef, pork, lamb, and pickled foods.
Foods helpful in reducing the symptoms of PMS include whole grains such as brown rice, oatmeal, and millet; Pritikin-type breads with no added oils, salt or sugar; all vegetables but especially beets, carrots, collard greens, mustard greens, and beet tops; fish; and all kinds of beans—which are your best sources of protein as well.
Twenty to 30 minutes of daily exercise also plays a large role in balancing hormone levels. A simple exercise program such as walking 30 minutes a day usually has a beneficial effect. Outdoor exercise has been shown to be more beneficial than indoor exercise.
Acupuncture will usually significantly reduce symptoms of PMS within two months as well.