Categories: Diseases & Treatment Plans

Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS)

Info
Description
A group of signs and symptoms experienced during the luteal phase of the menstrual cycle which are typically relieved within the first few days of menstruation. PMS symptoms subside by the end of the full flow of menses.
PMDD (Premenstrual Disphoric Disorder)
  • A more severe form of PMS
PMS can be broken down into subtypes/categories:
  • PMS-A (Anxiety)
    • Anxiety, Insomnia, Irritability, Emotional changes, Palpitations, Stress induced sweating.
  • PMS-C (Craving)
    • Sugar cravings, Increased appetite, Headache, Hypoglycaemia, Palpitations, Increased sweating
  • PMS-D (Depression)
    • Depression, Despair, Crying, Fatigue, Insomnia, Low libido, Apathy
  • PMS-H (Hyperhydration)
    • Oedema of hands and feet, Weight gain, Bloating, Breast tenderness/swelling
Signs & Symptoms
  • Mood changes
    • Irritability
    • Anxiety
    • Depression
    • Loss of control
    • Inability to cope
  • Bloating
  • Breast symptoms (pain/tenderness, swelling)
  • Pain/cramping
  • Fluid retention or weight changes
  • Headaches or migraines
  • Cravings or appetite changes
  • Hot flushes
  • Acne or skin changes
  • Libido changes
  • Worsening of current medical conditions:
    • Epilepsy
    • Migraine
    • Asthma
Causes & Contributors
  • Hormonal imbalance
    • Oestrogen excess
    • Low progesterone during luteal phase
    • Prostaglandin excess or deficiency
    • Endogenous hormone allergy
    • Hyperprolactinaemia
  • Abnormal neurotransmitter response to ovarian signalling
  • Disordered aldosterone function leading to sodium and water retention
  • HPA dysfunction
    • leading to altered adrenal hormone secretion
  • Nutrient deficiency
  • Hypoglycaemia/Carbohydrate intolerance
  • Environmental factors
    • stress
  • Family history
  • Fluid and electrolyte balance
    • High sodium to potassium ratio
Pathophysiology/Aetiology
  • PMS-A (Anxiety)
    • Involves an excess of oestrogen and a deficiency of progesterone with a possible relation to poor clearance of oestrogens.
    • Support oestrogen clearance and reduce cortisol secretion.
  • PMS-C (Craving)
    • Possibly enhanced insulin-binding effects
    • Improve insulin sensitivity and regulate progesterone and dopamine
  • PMS-D (Depression)
    • Oestrogen leading to increased neurotransmitter degradation
    • Support and regulate oestrogen and progesterone ratio
  • PMS-H (Hyperhydration)
    • Possible increased aldosterone in late luteal phase due to excess oestrogen.
    • May be related to increased cortisol from poor HPA function.
    • Support oestrogen clearance
Commonly AffectedMenstruating women 15-35 years
Complications
  • Progression to PMDD
  • Further hormonal complications (eg. infertility)
Treatment
Best Therapeutic Treatment
  • Hormonal Panel
    • To find which hormones play a role
Dietary Advice

Additionally:

  • Eat These:
    • Low GI foods
    • Vegetables (Try not to overcook. Steam or stir fry preferred)
      • Fibre (helps bind to excess oestrogen)
    • Brassica family (Try not to overcook. Steam or stir fry preferred)
      • Broccoli, cabbage, cauliflower, brussel sprouts
      • Helps eliminate excess oestrogens
    • Organic meats
      • Less oestrogens added to feed etc.
    • Fish
      • Omega 3
    • Eggs
  • Avoid These:
    • High GI foods
      • Refined grains, sugar, cakes
      • Spikes in insulin lower levels of SHBG which binds to excess oestrogen
    • Caffeine
      • Coffee, tea (black, green, oolong), chocolate
      • Shown to worsen menstrual symptoms
    • Exogenous oestrogens
      • Dairy
      • Soy
      • Plastics (water bottles, food storage)
      • Meat (particularly beef)
      • Phthalates (synthetic scents, cling wrap)
Nutritional
Herbal Treatment
  • Chaste tree 1:2 10ml
  • St Johns Wort 1:2 20ml
  • Schisandra 1:2 25ml
  • Withania 1:1 25ml
  • Skullcap 1:2 30ml
  • 8ml in water twice a day. Every day of cycle
OR
  • Chaste tree 1:2 5-40ml a week (Only for two weeks prior to period)
    • 10ml/week (1.5ml a day)
    • 20ml total in 20ml bottle, will last 2 weeks and 1 menstrual cycle
    • Take two weeks prior to period. Stop at start of period
OR
  • Chaste tree tablets
    • 0.25-3g/day
Lifestyle
  • Exercise
    • Improves metal health and mood
    • Decreases fluid retention
  • Reduce stress
    • Stress exacerbates symptoms
    • Meditation
    • Yoga
    • Walking
    • Something to clear the mind (If stress is a contributor)
  • Ensure good quality sleep
  • Increase water intake
Herbal
  • Vitex agnus-castus
    • Clinical evidence with great results over 3 cycles
    • Increase progesterone
    • Decrease prolactin
  • Hypericum perforatum (St John’s Wort)
    • Effective for depression
    • Contraindicated in OCP
  • Taraxacum officinale
    • Diuretic for fluid retention
  • Withania somnifera
    • Improve stress response
  • Paeonia lactiflora
    • Anti-inflammatory, analgesic, antispasmodic
  • Schisandra
    • Phase 1 and 2 Liver detoxification for clearance of sex hormones
Example Herbal formula:
Chaste tree 1:2 10ml
St Johns Wort 1:2 20ml
Schisandra 1:2 25ml
Withania 1:1 25ml
Skullcap 1:2 30ml
8ml in water twice a day. Every day of cycle
OR
Chaste tree 1:2 5-40ml a week (Only for two weeks prior to period)
  • 10ml/week (1.5ml a day)
  • 20ml total in 20ml bottle, will last 2 weeks and 1 menstrual cycle
  • Take two weeks prior to period. Stop at start of period
OR
Chaste tree tablets
  • 0.25-3g/day
If fluid retention is present, dandelion leaf 1:1 at 8ml, once a day can be added to the second half of the cycle
Nutritional
  • Vitamin B6 (50-100mg/day)
  • B-vitamins
    • For energy and stress support
    • Decreased levels with OCP use
    • Vitamin B1
      • Clinical evidence for PMS
    • Vitamin B2
      • Required for B6 activation
      • Neurotransmitter function
      • Decreases with OCP use
    • Vitamin B3
      • Hormone synthesis
      • Neurotransmitter production
    • Vitamin B5
      • Supports adrenal function and stress support
    • Vitamin B6
      • Clinical evidence for PMS improvement
      • Modulates GABA and Serotonin
      • Magnesium transportation
      • Especially good for high oestrogen/progesterone from OCP use
    • Vitamins B9 & B12
      • Neurotransmitter formation
  • Magnesium
    • Assists in fluid retention
    • Beneficial for anxiety
  • Calcium
    • Clinical evidence
  • Omega 3 (1080mg/day EPA, 720mg/day DHA)
    • Reduces pain and symptoms
  • Evening Primrose Oil (GLA)
    • Lacks evidence
    • Suggested mechanism is that PMS patients are deficient in linoleic acid, which is needed for prostaglandin formation.
  • Trytptophan or 5-HTP
    • Serotonin precursor
    • Some PMS patients have been found to be tryptophan deficient, leading to aggression and worsening of symptoms
  • Calcium D-glucarate
  • Indole-3-carbinol
  • DIM (Diindolylmethane)
Dietary
Eat These:
  • Low GI foods
    • Spikes in insulin lower levels of SHBG which binds to excess oestrogen
  • Vegetables (Try not to overcook. Steam or stir fry preferred)
    • Fibre (helps bind to excess oestrogen)
  • Brassica family (Try not to overcook. Steam or stir fry preferred)
    • Broccoli, cabbage, cauliflower, brussel sprouts
    • Helps eliminate excess oestrogens
  • Organic meats
    • Less oestrogens added to feed etc
Avoid These:
  • High GI foods
    • Refined grains, sugar, cakes
    • Spikes in insulin lower levels of SHBG which binds to excess oestrogen
  • Caffeine
    • Coffee, tea (black, green, oolong), chocolate
    • Shown to worsen symptoms
  • Exogenous oestrogens
    • Dairy
    • Soy
    • Plastics (water bottles, food storage)
    • Meat (particularly beef)
    • Phthalates (synthetic scents, cling wrap)
Increase water intake
*Give food swap ideas if necessary
Lifestyle
  • Exercise
    • Improves metal health and mood
    • Decreases fluid retention
  • Reduce stress
    • Exacerbates symptoms
    • Meditation
    • Yoga
    • Walking
    • Something to clear the mind (If stress is a contributor)
  • Ensure good quality sleep
Pharmaceutical
  • OCP
    • Ethinyloestradiol + dropirenone
  • NSAIDs
  • SSRIs
    • Fluoxetine
    • Sertraline
    • Highly effective in PMS
    • Intermittent use (2 weeks prior to next period)
      • Less adverse effects and more acceptable
      • Not as effective as continual use
  • Diuretics
    • Spironolcatone
      • Effective at relieving breast tenderness, bloating and oedema
  • GnRH Agonists
Combination Products
  • B-complex
  • P-Lift (metagenics)
    • Vitex
    • Withania
    • Ginger
    • Iodine
    • Lutein (carotenoids)
    • Selenium
    • B6
    • Vitamin E
    • Zinc
Other
  • Warm wheat bag, hot water bottle or bath
More
Differential Diagnosis
Diagnostic Criteria
PMS
  • Clinical presentation: (at least one of each)
    • Affective symptoms: depression, anger, irritability, anxiety, confusion
    • Somatic: breast tenderness,  bloating, headache, swelling of extremities.
  • Timing of symptoms (pre-menstruation)
  • Symptoms relieved from days 4-13 of menstrual cycle
PMDD (more sever form of PMS)
  • DSM-IV diagnostic criteria
Testing/Examinations
  • Menstrual charting
  • Hormone profile
    • Serum or saliva
  • LFT
    • To assess any issues with detoxification pathways
  • Functional Hepatic Detoxification Profile (FHDP)
    • To assess if hormonal clearance is impaired
  • Thyroid profile
    • Rule out thyroid involvement
Additional Notes
  • There is a high response rate (up to 40%) for placebo in PMS that may continue for 3 months or more.
Images/Infographics

Bone, K. (2007). The Ultimate Herbal Compendium. Phytotherapy Press
Braun, L., & Cohen, M. (2015). Herbs and Natural Supplements, Volume 2. Elsevier Health Sciences.
Hechtman, L. (2018). Clinical Naturopathic Medicine. Elsevier Health Sciences.
Henshaw, C. (2007). PMS: Diagnosis, aetiology, assessment and management: Revisiting… Premenstrual syndrome. Advances in Psychiatric Treatment, 13(2), 139-146. doi:10.1192/apt.bp.106.003392
Kwan, I., & Onwude, J. L. (2015). Premenstrual syndrome. BMJ clinical evidence, 2015, 0806.
Noviyanti, N. I., Gusriani, Ruqaiyah, Mappaware, N. A., & Ahmad, M. (2021). The effect of estrogen hormone on premenstrual syndrome (PMS) occurrences in teenage girls at Pesantren Darul Arqam Makassar. Gaceta sanitaria, 35 Suppl 2, S571–S575. https://doi.org/10.1016/j.gaceta.2021.10.103
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4 years ago

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