Natural Strategies for Premenstrual Syndrome
by Carissa Fioritto
Premenstrual syndrome is an extremely common set of symptoms that the majority of women have experienced. Every woman has a set of unique signs to know that her menses will begin soon, like clockwork. Unfortunately, women suffer PMS symptoms for years before seeking support, as PMS is accepted as a cultural norm—when in actuality it is a sign of imbalance.
The menstrual cycle is a delicate balance of hormones waxing and waning every 28 to 33 days. Day 1 is considered the first day of menses, or a period. During day 1 through approximately day 14, estrogen levels climb to support the thickening of the uterine lining. Sometime between day 14 and 16, a woman will ovulate, release an egg, causing two hormones to spike, then drop: follicle stimulating hormone (FSH) and luteinizing hormone (LH). After these hormones spike, the body signals for a rise in the hormone progesterone. If during ovulation the egg is not fertilized, the body will shed its lining, and the cycle will begin again.
Symptoms of PMS vary from woman to woman. These symptoms can include mood changes (swings, irritability, depression, anxiety), cramps, breast tenderness, gastrointestinal changes, bloating, sleep disturbances, cravings or skin breakouts. Symptoms can appear from 10 days before the onset of menses and often resolve once the cycle starts. As most women have experienced, these symptoms can range widely from mildly annoying to debilitating enough to have to miss work or school for a few days.
While there are many factors causing these symptoms, often an imbalance in estrogen and progesterone are to blame. Symptoms of breast tenderness can be a sign of low progesterone. Menstrual cramping and mood changes can be a sign of elevated estrogen. Another contributing factor to hormone imbalance is elevated testosterone. Women who experience high testosterone levels may experience more acne breakouts, irregular menstrual cycles and hair growth along the chin. Another factor to keep in mind when treating PMS is inflammation. It is key to monitor the blood for markers of inflammation and take measures to reduce inflammation while balancing hormones.
While hormone imbalance and inflammation are the most common causes of PMS, there are others to consider such as fluid retention, vitamin deficiencies, insulin dysregulation and neurotransmitter imbalances.
While PMS is usually diagnosed based on symptoms alone, bloodwork can also be done to help get to the root cause of the symptoms. Hormones that can be evaluated are estrogen, progesterone, FSH, LH, testosterone and prolactin. Depending on the symptoms, more tests may be run. In addition to bloodwork, a doctor may do a physical to examine for things like endometriosis, ovarian cysts and fibroids. Once other pathologies are ruled out, one can incorporate many naturopathic treatments to help ease symptoms, regulate the cycle and reduce inflammation.
It is important to track your cycle and plan ahead. There are many apps available on your phone to help you track symptoms and cycle length. It is important to schedule some vitamin R (rest/relaxation) on the days you know you will be most symptomatic. This may be making sure you have an early bedtime, doing a favorite activity like reading or watching a TV show or having a relaxing bath.
While it is important to improve nutrition all cycle, the biggest benefit may be felt in the 7 to 10 days before you start. Avoiding alcohol and other inflammatory foods, like refined carbohydrates (breads, sugar, white flour) and dairy, is important to decrease cramping and discomfort. If you retain water before your cycle, you will benefit from limiting processed or salty foods. It is beneficial to increase your intake of vegetables, especially those in the brassica/cruciferous family. They contain a compound called indole-3-carbinol that helps the liver process estrogen and clear it from the body. Foods in this family include Brussels sprouts, kale, broccoli, arugula and cabbage. Aim for five servings of vegetables a day with at least one being in the cruciferous family.
There are some supplements that can be taken to help manage symptoms.
• B vitamins, specifically B6, can be helpful with mood changes and energy levels. B6 is specific to serotonin production, and a deficiency of serotonin can cause low mood.
• Magnesium and calcium can be taken for menstrual cramps as they relax smooth muscle. Studies have shown that women with magnesium deficiency experience more PMS symptoms than those with adequate levels.
• Essential fatty acids, like flax oil and evening primrose oil, can be beneficial to reduce inflammation in the body. Flax oil contains alpha linoleic acid, which produces anti-inflammatory prostaglandins in the body. Flax is also a phytoestrogen, which means it helps the body make estrogen but also clear estrogen from the body. Evening primrose oil contains gamma-linolenic acid, which helps create prostaglandins as well as promote progesterone production. For best benefit one can rotate the time of the month you use these oils, using flax during the first half of the cycle and evening primrose the second half.
• Supplements to help promote more estrogen detoxification include calcium-d-glucarate and diindolylmethane (DIM). These are helpful for symptoms of high estrogen. They bind estrogen and help process it so the body can excrete it.
• Vitamin C, an antioxidant, is excellent to consider if acne is a concern. It can help clear up inflammation and achieve glowing skin.
• Taraxacum, or dandelion leaf, is a diuretic that can help balance the fluid in the body. Drinking one to three cups of dandelion leaf tea can help ease bloating or breast tenderness. It can also help keep the skin clear.
• IV nutrient therapy may be something to consider short-term to help build up key nutrients the body may be deficient in. IV therapy is a quick and effective way to give the body the nutrients it needs. An infusion can have many of the nutrients listed above, like B complex, magnesium, calcium and vitamin C. The results can be rapid if a particular cycle is extremely symptomatic.
If PMS is disrupting your life, consider seeing a naturopathic doctor to help resolve symptoms and promote overall health and well-being.
Dr. Carissa Fioritto, ND, is a licensed Naturopathic Physician practicing at Collaborative Natural Health Partners, LLC. She is an in-network provider with most major health insurance providers and is accepting new patients. Please call 860-533-0179 to schedule an appointment. See ad, back cover.