How many women with PMS does it take to change a light bulb?”
The punch line to that old joke is, “That’s not funny.” And for 80% of all menstruating women – the number of women in the United States who experience premenstrual syndrome – it is no laughing matter. Though if you do have PMS, you probably get the joke!
More than 150 symptoms have been attributed to PMS! The symptoms are so common that the medical community considered discarding the term “PMS” and accepting the symptoms as normal! This attitude trivializes the daily significance of PMS for the millions of women women who suffer from it. For at least 5% of all menstruating women, the symptoms of PMS are so severe that they are incapacitated on a monthly basis. For many women, even moderate PMS can interfere with work and can disrupt everything from parenting to social relationships.
What Causes PMS?
PMS is usually due to a combination of factors that lead to hormonal imbalances, imbalances in the stress hormones, and the neurotransmitters (chemicals that control mood).
- Nutrient deficiencies (especially B6, vitamin E, vitamin A, calcium, and magnesium)
- Blood sugar dysregulation
- Environmental factors, especially excess estrogen from plastics and other chemical exposures
- Stress (relationship, marital/sexual difficulties; workplace stress, money, etc.)
Thyroid problems can also cause PMS, so have your doctor check your thyroid hormones to make sure these are in proper order. And while you're at it, get your iodine and vitamin D levels checked – when low these can contribute to depression and other related symptoms.
Sometimes improving one factor alone can improve symptoms, but most often a combination approach of improved diet, improved lifestyle habits (for example, adequate rest, increased exercise, and changed beliefs about menstruation), and herbal and nutritional supplements are needed.
Natural Approaches to PMS
Natural approaches to PMS can transform your life! Here are my favorites!
Going with YOUR Flow: Work With Your Natural Energy
This may be the most important advice I can give to you. Recognizing the premenstrual time as one of naturally heightened awareness and emotions can actually help you to relax and get through a lot more easily. Rather than fight how you feel, go with it. Ways to do this include journaling your PMS feelings; setting aside time during the week before your period to pamper yourself with a hot bath, a cup of herbal tea, and a good novel; splurging for a massage; taking a yoga or dance class; or having a night out with your girlfriends. Pay close attention to the insights and feelings that arise during this time and record those in your journal. They may give you insight into some of your deeper feelings and point to things you might want to change in your life. Take the time to nurture yourself each month – eat better, rest more, move your body through exercise, and listen to your heart, mind, and spirit.
Diet and Nutrition
Here's where a plant-based diet can make a huge difference, so go Mediterranean-style if PMS is getting to you. A daily dose of dark leafy greens such as kale, collards, and broccoli and good quality fats are your ticket to the happier hormone party! The high fiber content of vegetables can help the body to effectively eliminate excessive hormones from the intestine, particularly estrogen, while adequate intake of legumes can support the production of hormones when there is a deficiency. Keep dairy products to a minimum to avoid any excess hormones coming into your system. Include cold-water fish (such as salmon and other low-mercury fish) a couple of times a week or take a high quality fish oil supplement.Dietary fats should come from olive oil, avocados, coconut oil, hemp oil, and other good quality oils.
Women with PMS consume significantly more sugar, dairy products, salt and refined carbohydrates than those who do not experience it. Caffeine intake has also been linked to premenstrual discomforts, especially breast tenderness. Cutting out sugar, all white-flour products and caffeinated items such as coffee, black tea, and sodas may be hard to do but can go a long way to relieve symptoms. Interestingly, dark chocolate (62% or greater) is the exception to the caffeine rule – it can help improve mood and prevent or relieve depression.
Adequate protein and fat at each meal will keep your blood sugar at a nice neutral hum – exactly where you want it to be to avoid the ups and downs of PMS and the roller coaster ride of imbalanced blood sugar – a gnarly combination!
In addition to a healthy diet, several supplements are beneficial in reducing PMS, particularly for improvement of mood, reduction of bloating, and reduction of breast tenderness. These include:
- Calcium citrate (up to 1,200 mg per day)
- Magnesium citrate or glycinate (400 mg per day)
- Vitamin B6 (50 mg per day as part of a B-complex supplement)
- Vitamin E ( 400 IU per day)
- DIM (Diindolylmethane) standardized to 25 mg of 25% diindolylmethane, from Brassicacae vegetables
- Sulforophane (from Broccoli sprout concentrate) 800 mcg
- Flax seed, 2 TBS fresh ground daily
Evening primrose oil is commonly recommended by herbalists, in a dosage range of 1,500 to 3,000 mg daily, as part of a treatment protocol for PMS. Unfortunately, most clinical trials have failed to show consistent benefit. Nonetheless, increased fatty acid intake has been associated with improved mood when there is depression, and evening primrose is not harmful, making it a practical addition to a treatment plan until further research proves or disproves its benefits.
The importance of adequate rest and moderate exercise cannot be overstated for improving PMS symptoms. Fatigue from lack of regular sleep will exacerbate nearly all physical and emotional discomfort. Moderate exercise, even just walking or light cardiovascular exercise for as little as fifteen minutes three to four times per week can drastically improve mood and reduce fatigue. A boogie down dance party with a good sweat is even more fun! When we exercise, we are more likely to feel empowered in our lives and are more likely to take care of ourselves in ways that reduce PMS and improve overall quality of reproductive health.
Herbs are powerful allies for us in many aspects of our reproductive cycles. PMS is no exception. Herbs can be used to improve mood, support hormonal regulation, and reduce many of the PMS symptoms. Companies such as Gaia Herbs, Herb Pharm, Eclectic Institute, Kan Herbs, and Planetary Formulas will carry products that contain some or all of these in various excellent combinations. Take as directed on the packaging.
Include herbs that help to regulate the hormones when treating PMS. Vitex (chaste berry) is probably the most commonly used, helping to heal ovarian dysfunction and corpus luteal insufficiency, which cause insufficient progesterone levels. Its prolactin-inhibiting effects may also, in part, explain its beneficial effects in treating PMS. Dosage is 2 to 5 ml of tincture one to two times daily, with one dose typically taken in the morning and the other midday. Black cohosh and peony are also frequently used in formulas for PMS. Black cohosh can be used for treating menstrual headaches, breast tenderness, anxiety, and depression. Its effects may be due in part to its mild enhancement of serotonin reuptake. Peony has been shown to enhance ovarian function, improving levels of both estrogen and progesterone and reducing symptoms of PMS. A standard dose of black cohosh is one to two 40-mg capsules twice daily, or 2 to 4 ml of tincture one to three times daily.
Stress Relieving Nervines
These are herbs that support the nervous system improving mood, reducing headache, stress, and anxiety, and promoting overall relaxation. Passionflower, motherwort, St. John’s wort, milky oats, and kava kava are some of my all time faves. These herbs may be used alone or in combination and with the exception of kava (which should be used for short durations only) they may be used throughout the month over an extended period of time, or just prior to and through the premenstrual time. Kava should be used only under the supervision of a qualified practitioner as it has been associated with liver disease, and no more than 1 ml twice daily for the week before the menses, and then discontinue. Feverfew, though not a nervine and more of an anti-inflammatory, may be especially appropriate when a woman also experiences premenstrual headache, as it has been shown to reduce migraines, especially when used preventively.
A number of herbs provide general support to the body, improving energy, sugar metabolism, mental functioning, mood, and general health. Among these are the adaptogenic herbs Asian ginseng and American ginseng, eleuthero, schisandra, and ashwaganda. These can be taken alone or in combination, and for best results should be taken for a minimum of two to three months before significant results are seen. Typical dosage ranges are 1 to 2 capsules twice daily or 2 to 4 ml of tincture twice daily.
Herbs have long been used to support and stimulate the function of the liver, which is the central clearing house for your excess and used up hormones. Dandelion root is a classic. Others include milk thistle, artichoke, and tumeric. Some liver herbs improve digestion, relieve mild constipation, and help clear up acne.
In Chinese medicine, it is believed that PMS is a result of one or more of several factors, most commonly “liver qi stagnation.” Liver qi stagnation is caused by long-term repressed emotions including anger and frustration, as well as imbalances in lifestyle, particularly a lack of adequate sleep and going to bed too late at night (after 11 p.m.). Excessive consumption of caffeine, alcohol, red meat, nuts, dairy products, and fried, fatty foods can cause or aggravate this condition. Creative activity can help to unblock stagnant liver qi. The premier herbal formula for regulating this problem is a bupleurum and dong quai formula known as Rambling Powder (this formula is also used for building the blood). It is available through many herbalists, acupuncturists, and herbal medicine companies.
The Magic of Women's Cycles
The menstrual cycle has long been a source of magic and mystery. Some cultures consider menstruating women to have strange and magical powers. The Polynesian word “taboo,” which in English has come to mean something that is forbidden, actually means both “sacred” and “menstruating” in its native language. Among many Native American tribes, menstruating women were considered more powerful even than medicine men.
It is thought that how we view our bodies and menstrual cycles may influence how we experience menstruation. If a woman views menstruation negatively, with dread, or shamefully, all of which are deeply entrenched attitudes about menstruation, she may be more likely to experience menstrual difficulties than a woman who has a positive outlook on her body’s natural functions.
Ok, while I'm not saying that having your period is fun, there is no end to how our experience of our lives affects our biology. Many women today are embracing the menstrual cycle as a time of heightened emotional sensitivity, creativity, intuitiveness and personal power. The term “moon time” is sometimes used by women in place of the word “period” as a more poetic affirmation of this. Indeed, the words “menarche,” “menses,” and “menstruation” have their origin in the word “moon,” reflecting the cyclical nature of a woman’s body in harmony with the monthly cycles of the moon. There is even a “Red Tent” Movement going on across this country, where women gather and share stories, ceremony, and helpful ideas and comfort.
While PMS is certainly not just “in your head,” positive reframing may be an important part of helping women to overcome menstrual difficulties.
Wishing you happier, healthier hormonal cycles!
With love always,