supplement ingredients with the greatest evidence base for the management of menstrual disturbance include: black cohosh, soy and red clover isoflavones, L-theanine, evening primrose oil, dong quai, chasteberry, ginkgo biloba…and others with anecdotal benefit.
Water Retention Excessive salt and water retention is common in PMS, but it may be a result rather than a cause of PMS itself. Natural diuretics and herbal teas may be valuable (e.g. chamomile, dandelion root, green tea, etc.).
Body ToxinsThe concept of premenstrual intoxication was first reported 50 years ago, but scientific evidence that detoxification of the body with herbs or colon cleansing is universally effective has not been presented. Many women describe benefits of intermittent attempts to detoxify the body. One preferred route of detoxification is colon cleansing. Synergistic gentle colon cleansing formulae are most advisable with enhanced intake of fluids and dietary fiber.
Specific Nutrient DeficienciesDeficiency of vitamin B-complex has been linked to mood changes and depression in women with PMS or those taking progesterone hormone supplement. Excessive sugar intake and deficiency of omega-3 fatty acids have been variably implicated as a cause of PMS. For example, cramps may be caused by excess prostaglandin F2 alpha and alterations in prostaglandin production occurs with deficiencies or imbalances in the dietary intake of essential fatty acids. I recommend enteric coated fish oil capsules for all women with PMS, but I stress the advantages of delayed release, targeted delivery of fish oil in special gel capsules to improve absorption of the active omega 3 fatty acids EPA and DHA.
Hypoglycemia/Syndrome X Episodes of low blood sugar may occur in women with PMS and specific studies have shown that hypoglycemia may tend to occur more often in the premenstrual phase of the cycle. Alterations in the metabolism of glucose by the body due to insulin resistance and compensatory excess secretions of insulin are key factors in the metabolic Syndrome X, which is strongly associated with polycystic ovary syndrome (PCOS) and PMS. Lifestyle change and nutritional factors for Syndrome X are valuable.
Serotonin Balance Serotonin is an important factor in central nervous system and other body functions. Deficiencies in serotonin have been described in women with PMS. This has led to dietary recommendations to boost serotonin levels in the body and the use of supplements that are precursors of serotonin, such as 5-HTP. Serotonin levels in the brain are increased by some antidepressant drugs, e.g., Prozac.
Sleep Deprivation Restoration of the biorhythm of sleep is the most underestimated of all interventions in women with menstrual problems. Appropriate lifestyle changes and combination supplements can restore healthy sleep patterns. Without sleep PMS and menopause gallop in their progression.
NeuroticismPMS is real. While emotional disturbances are common in PMS, it is not acceptable to adopt the attitude that PMS is “all in a woman’s head.” Patients who visit physicians who have this opinion should vote with their feet.
Table 1. Potential causes of PMS with general comments about management options.
SYNDROME X AND PMS
The variable combination of hypertension, high blood cholesterol and an overweight status are fueled by insulin resistance. These problems form in the constellation of the metabolic Syndrome X. I emphasize that there is still widespread lack of knowledge about the importance of Syndrome X in women’s health, especially in relationship to menstrual function. The occurrence of cystic ovaries in young women has been quite clearly linked to Syndrome X. This condition is called polycystic ovary syndrome or Stein-Leventhal Syndrome. In popular medical literature, PCOS has been referred to as Syndrome X of the ovaries (or even Syndrome O). The typical female with PCOS is premenopausal, 18 to 28 years old, with variable degrees of obesity, excess body hair, irregular menstruation, period pains, acne and infertility. Lifestyle change and nutritional factors can be used to combat the Metabolic Syndrome X.
CONCLUSION
While topical progesterone cream has been proposed as a mainstay in the management of PMS, the application of this approach may require medical supervision and topical hormonal creams are not dietary supplements. Clearly, the general management approach to PMS involves its clear recognition together with good holistic management approaches, including but not limited to, psychosocial interventions, positive lifestyle changes and a first line approach with tailored nutritional medicine.