"Why Am I So Angry?"- Understanding Premenstrual Syndrome (PMS)
When it comes to PMS and other menstrual disorders, women are often frustrated with the lack of understanding and proper care they receive from conventional sources. “One week before my period, I’m so irritable I could rip my husband’s head off” is a frequent statement. Oral contraceptives seem to be the one-stop treatment of choice for many of these complaints and although artificial stabilization of hormones can bring relief for the issues of PMS, it does not help to find the cause of the problem.
Natural medicine has much to offer for PMS sufferers as it targets the root of the problem. In my practice in Brisbane, I help women unravel the cause of their particular PMS symptom picture
Let’s take a look at what’s going on.
PMS is defined as the well known myriad of symptoms which start 1-2 weeks before the period. These include
- Breast pain
- mood changes such as anger or depression
- digestive complaints such as bloating, constipation, or diarrhea
- weight gain and water retention
- sugar cravings
- fatigue often 1-2 weeks before the period.
All symptoms MUST resolve with the onset of the period to be classified as PMS or something else is going on.
From the first day of the period to ovulation (typically around day 14), oestrogen rises slowly and declines after the egg is released from the ovary. In a normal menstrual cycle, progesterone is the main hormone after ovulation-it helps to offset some of the strong effects of oestrogen.
A common finding in PMS sufferers is an elevated oestrogen/progesterone ratio in which oestrogen is abnormally elevated compared to the level of progesterone. This can be due to an inefficient liver clearance of oestrogen or mild progesterone deficiency.
Another reason why progesterone is low in the 2nd half of the cycle is stress. Stress raises a hormone called cortisol. When stress is continuous, progesterone is taken from the menstrual cycle to convert to cortisol. This is a protective mechanism –as the body thinks it is running from a tiger it considers cortisol more important than the reproductive hormone progesterone.
Irritability and Depression
Not only can high oestrogen cause all of the symptoms of PMS, but an elevated oestrogen/progesterone ratio has also been shown to impair proper neurotransmitter synthesis such as the “feel-good” serotonin. This may be due to oestrogen depleting B6 levels which is a necessary vitamin to produce proper serotonin levels.
B6 levels are frequently low in depressed patients, especially those taking oestrogens such as the birth control pill or menopausal medication such as Premarin.
Anger is also often experienced by women with PMS. Energetically, anger can be a frequent sign of liver congestion and oestrogen overload.
The total amount of oestrogen in your body is determined by
- how much you make yourself (technically, all oestrogen starts as testosterone and is converted in the ovaries or fat tissues-known as endogenous oestrogen)
- how much comes from the outside (from hormones in animal products, chemicals in cosmetics etc-known as exogenous oestrogen)
- and how well you detoxify both
Too high oestrogen is known as oestrogen dominance, a condition associated with PMS, breast cancer, uterine fibroids, and endometriosis.
Other hormonal influences
In addition to the above mentioned effects, excess oestrogen has also been implicated in a rise in aldosterone secretion from 2-8 days prior to menses, causing fluid retention, a common complaint in PMS. Endogenous and exogenous oestrogen can also increase prolactin secretion by the pituitary gland. Elevated prolactin has been linked to progesterone deficiency, breast pain, fibrocystic breast disease, and hypothyroidism.
Hypothyroidism affects a large percentage of women with PMS, and should therefore not be underestimated. If symptoms persist, a simple blood test can identify blatant thyroid dysfunction.
Natural Approaches to PMS
It is always important to know what type of PMS you are experiencing before embarking on a treatment plan. The suggestions below are just examples of a wide variety of professional treatments.
Diet: In my practice, diet and lifestyle recommendations are always the foundation on which I build my treatment plan. I often start the treatment with a cleansing diet for 2-4 weeks, after which I focus on specific diet changes. Depending on the symptom picture, a typical dietary recommendation for a patient with PMS may be to reduce all animal products to decrease exogenous oestrogens as well as saturated fats. To put this into context: vegetarian women excrete two to three times more oestrogens in their faeces and have 50% lower free oestrogens than their omnivore counterparts. Overall reduction of fat, sugar, and salt all has been shown to significantly improve PMS symptoms in some women.
Liver Detox: the liver is a very important organ of detoxification. Oestrogens are detoxified through the 2 main detox pathways of the liver. Abstaining from alcohol, caffeine, chemicals and processed foods can lower the total detox burden of the liver. Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage) contain Indole-3-carbinol-a potent compound that aids in the liver detoxification of oestrogen. This is also available in pill form from a qualified naturopath.
The Gut: Another important aspect of PMS treatment is to establish proper bowel flora. To detoxify oestrogens, the liver binds it to glucuronic acid which prevents the reabsorption of oestrogens from the bowel. Certain undesirable gut bacteria produce the enzyme beta-glucuronidase which cleaves this bond and allows these oestrogens to re-enter the circulation, adding to the total oestrogen pool. Increasing fibre and adding probiotics to the treatment protocol can be very beneficial.
Exercise and stress reduction have been clearly documented in the literature for reducing symptoms of premenstrual syndrome.
Specific Herbs and Nutrients
A professional naturopath has many herbal remedies and nutrients to design an individualized treatment plan.
By far the most commonly used herb in PMS is Vitex agnus-castus (Chaste tree berry). It is so effective in regulating menses and lowering prolactin it has been written up in Europe’s prestigious “German Commission E” –a scientific database on herbal substances
B6 and Magnesium are important for proper serotonin production especially in cases of oestrogen dominance. It also seems to help with sugar cravings before the period.