Premenstrual syndrome (PMS) is a common name for a wide variety of recurring psychological and physical symptoms experienced by some women in the week or two before menstruation. Symptoms include sudden episodes of tearfulness, irritability, or depression; fatigue; water retention; headaches; and joint or muscle pain. Twenty to 50 percent of all women are believed to experience at least one symptom of PMS regularly; only five percent of these women are estimated to have symptoms severe enough to interfere with normal activity. PMS can begin with puberty but is most common in women over age 25. The cause is still unknown, but one theory proposes that low progesterone levels in the second half of the menstrual cycle may be responsible.

Conventional medical treatment of PMS sometimes involves prescription of diuretics for water retention and if symptoms are severe, tranquilizers and antidepressants (one study found that Prozac reduced PMS symptoms). Some conventional medical practitioners prescribe progesterone for PMS symptoms. From a complementary and alternative medicine standpoint, certain herbs and nutrients are often used in the treatment of PMS. Following is a discussion of those herbs and nutrients.

Vitex
Research has shown that the herb Vitex (Vitex anguscastus; aka, Chasteberry) is able to increase progesterone levels.¹ Studies have shown that using Vitex once in the morning over a period of several months helps normalize hormone balance to alleviate the symptoms of PMS.² Vitex has been shown to be as effective as 200 mg vitamin B6 in a double-blind study of women with PMS.³ In another placebo-controlled clinical study, women with PMS were given Vitex or a placebo. By the end of the study, women taking the Vitex had a significantly greater reduction in overall PMS symptoms (including irritability, headache, breast tenderness, etc.) than the placebo group.⁴ Another recent, multi-center trial on the efficacy of a Vitex extract investigated 50 patients with PMS. The conclusion was that the extract successfully treated PMS, with the main effect seemingly related to symptomatic relief rather than to the duration of the syndrome.1 Since Vitex is a slow acting herb, an extract providing 40 mg extract (standardized for 0.5% agnuside) should be taken for at least three menstrual cycles to determine if it will work for you.

Vitamin B6
Many PMS sufferers have reported beneficial results with vitamin B6. Furthermore, many^5,6,7,8,9 but not all¹⁰ studies have shown that taking 50–400 mg of vitamin B6 per day for several months can relieve symptoms of PMS. The mechanism of action for vitamin B6 with PMS may have to do with this nutrients ability to increase the conversion of the fatty acid GLA to prostaglandin E1; a chemical which may reduce the effects of PMS.¹¹ Vitamin B6 is one of the most useful of the B-vitamins for reducing PMS symptoms. It particularly reduces fluid retention, breast swelling, and tenderness, bloating and edema in general, as well as anxiety, irritability, insomnia, sugar craving and symptoms caused by refined sugar. About 100 mg of vitamin B6 daily is a good dose.

Magnesium
Women with PMS are often deficient in magnesium.^12,13 Supplementing with magnesium may help reduce symptoms.^14,15 Furthermore, like vitamin B6, magnesium has the ability to increase the conversion of GLA (see following paragraph on GLA) to prostaglandin E1C a biochemical, which may reduce the effects of PMS.¹⁶ In some research, 400 mg of magnesium daily was used.¹⁷

Dong quai
Dong Quai, a traditional Chinese medicinal herb that is often referred to as the "female ginseng", helps promote normal hormone balance and is particularly useful for women experiencing premenstrual cramping and pain.¹⁸ An appropriate dose seems to be about 600 mg of Dong Quai extract daily.

Black Cohosh
Black Cohosh appears to help modulate female hormone levels, which may have an effect on the balance of menstrual hormones. Although extensive research supports the use of this herb in the treatment of menopause, it also has been used extensively in the treatment of PMS. In fact, Germany’s Commission E (an internationally authoritative source of credible information on the use of herbs for various disorders) has approved Black Cohosh for use in women with PMS.¹⁹ About 40–80 mg/day of Black Cohosh extract standardized for 2.5% triterpene glycosides is recommended.

Ginkgo biloba
Although generally associated with improving short-term memory, Ginkgo biloba extract has also been shown to be beneficial in the treatment of congestive symptoms of PMS (e.g., painful or tender breasts, edema/water retention). In a French study,²⁰ Ginkgo extract demonstrated statistical significance in reducing breast pain and tenderness. There were also improvements in edema, anxiety, depression and headaches but there were not statistically significant. However, in another study²¹ of patients with cyclic edema, Ginkgo extract was found to have anti-edema activity. The recommended daily dose of Ginkgo biloba leaf 50:1 extract is 160 mg, standardized for 24% flavone glycosides, 6% terpene lactones.

Diet and/or other considerations
Dietary considerations for PMS involve the avoidance of refined sugar, excessive alcohol, and caffeine while consuming a high-fiber, low-fat diet. Women who consume high-sugar foods appear to have an increased risk of PMS.²² Although an occasional drink is not a problem, keep in mind that alcohol can affect hormone metabolism, and alcoholic women are more likely to suffer PMS than are non-alcoholic women.²³ Also, research has shown an increase in the prevalence and severity of PMS in women consuming caffeine-containing beverages.^24,25 Moreover, the more caffeine women consumed, the more likely they were to suffer from PMS.²⁶ In addition, several studies suggest that diets low in fat or high in fiber may help to reduce symptoms of PMS.²⁷

References:

1. Blumenthal M, Hall T, Goldberg A, Kunz T, Dinda K, Brinckmann J, et al, eds. The ABC Clinical Guide to Herbs. Austin, TX: American Botanical Council; 2003.
2. Dittmar FW, et al, Therapiwoche Gynäkol (1992) 5:60B68.
3. Lauritzen C, et al, Phytomedicine(1997) 4:183B89.
4. Schellenberg R. Treatment of the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ(2001) 332:134–7.
5. Barr W, Practitioner (1984) 228:425B27.
6. Gunn ADG, Int J Vitam Nutr Res (1985) Suppl 27:213B24 [review].
7. Kleijnen J, Riet GT, Knipshcild P, Br J Obstet Gynaecol (1990) 97:847B52 [review].
8. Williams MJ, Harris RI, Deand BC, J Int Med Res (1985) 13:174B79.
9. Brush MG, Perry M, Lancet (1985) i:1399 [letter].
10. Hagen I, Nesheim B I, Tuntland T, Acta Obstet Gynecol Scand (1985) 64:667B70.
11. Horrobin DF, et al, J Nutr Med(1991) 2:259B64.
12. Abraham GE, Lubran MM, Am J Clin Nutr (1981) 34:2364B66.
13. Sherwood RA, et al, Ann Clin Biochem (1986) 23:667B70.
14. Nicholas A. Traitement du syndrome pre menstruel et de la dysmenorrhee par l=ion magnesium. In First International Symposium on Magnesium Deficit in Human Pathology (1973) ed. J Durlach. Springer Verlag, Paris, pp. 261B63.
15. Facchinetti F, et al, Obstet Gynecol (1991) 78:177B81.
16. Horrobin DF, et al, J Nutr Med (1991) 2:259B64.
17. Werbach MR, Int J Alternative Complementary Med (1994) Feb:29 [review].
18. Qi bing M, Jing yi T, Bo C, Chin Med J (1991) 104:776B81.
19. Blumenthal M, et al (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines(1998) American Botanical Council and Boston: Integrative Medicine Communications, Austin, pp. 90.
20. Tamborini A, Taurelle R. Rev fr Gynéol Obstét (1993) 88:447.
21. Lagrue G, et al. Presse Méd (1986) 15:1550.
22. Rossignol AM, Bonnlander H, J Reprod Med (1991) 36:131B36.
23. Halliday A, et al, Obstet Gynecol(1986) 68;322B26.
24. Rossignol AM, Zhang J, Chen Y, Xiang Z, Am J Public Health (1989) 79:67B6.
25. Rossignol AM, Am J Public Health (1985) 75(11):1335B37.
26. Rossignol AM, Bonnlander H, Am J Public Health (1990) 80:1106B10.
27. Werbach MR, Nutritional Influences on Illness, 2d ed. (1993) Third Line Press, Tarzana, California, pp. 540B41.

Millions of women each year seek relief for hormonal issues, including hot flashes, night sweats, hormonal migraines, PMS, ovarian cysts, fibroids, endometriosis, fibrocystic breasts, weight gain, foggy thinking, and heavy bleeding. These symptoms are lumped together into the hormonal imbalance pigeonhole. In the case of menopause, HRT or Bioidentical Hormone Replacement Therapy is the conventional cure. For menstruating women, oral contraceptives are most often prescribed.

When resolving hormonal problems, women are led to believe all that is required is tweaking their hormonal levels or, in the case of oral contraceptives, a complete shutting down of ovarian function. However, hormonal imbalances, rather than merely aberrations of a wayward reproductive system, are, in fact, symptoms of deeper root cause issues. For long term hormonal balance and optimal health, understanding and addressing these deep problems is a critical piece of the hormone puzzle!

The Adrenals and Hormones
The adrenals are involved in manufacturing numerous hormones; blood sugar regulation; the regulation of the body's minerals; modulating the immune system; producing and maintaining the body's energy levels in conjunction with the thyroid; and producing stress-monitoring hormones. The adrenals, considered to be the body's shock absorbers, are the core of the endocrine stress response system. Two of the most important hormones produced by the adrenals, adrenaline and cortisol, are responsible for the fight-or-flight response. Adrenaline deals primarily with short-term stress while cortisol is produced as a result of both acute and long-term stress.

Prolonged stress, whether as a result of emotional, environmental or physical causes, is disastrous for the adrenals. Initially, it results in chronically elevated cortisol levels, resulting in weight gain (especially around the midsection), blood sugar imbalances, thinning skin, muscle wasting, memory loss, high blood pressure, dizziness, hot flashes, night sweats, excessive facial hair, and other masculinizing tendencies.

Overworked adrenals eventually crash, leading to adrenal exhaustion, where the body is unable to maintain adequate adrenal hormone production. Symptoms of overtaxed adrenals include extreme fatigue (Chronic Fatigue Syndrome), irritability, inability to concentrate, frustration, insomnia, addictions to either sweet or salty foods, allergies, nervousness, depression, anxiety, PMS, sensitivity to cold, diabetes and headaches. Chronic low blood pressure can be a key symptom of seriously exhausted adrenal glands.

Since the adrenals produce about 35 percent of premenopausal female hormones and almost 50 percent of postmenopausal hormones, compromised adrenal function directly impacts hormonal balance.

Progesterone is the primary raw material for producing cortisol. When the glands are in overdrive, the body will divert progesterone to the adrenals to support cortisol production. With reduced progesterone, the body may experience estrogen dominance, i.e., PMS, hot flashes, night sweats, migraines, fibroids, heavy bleeding, breast tenderness, weight gain, etc. Excessive cortisol also blocks progesterone receptors, further contributing to low progesterone. These two imbalances are the primary reasons why adrenal exhaustion leads to estrogen dominance.

Restoring adrenal function is a pre-requisite for restoring and maintaining hormonal balance. Nutrients that have special importance to the adrenals are the B vitamins (especially B5), vitamin C, proteins, magnesium, manganese, zinc, potassium, plant enzymes, adaptagenic herbs, adrenal extracts and the amino acids tyrosine and phenylalanine. Rest is essential to rejuvenate the adrenals. Individuals who suspect adrenal exhaustion can determine whether the body is producing healthy levels of adrenal hormones through proper testing. Cortisol levels can be measured with a saliva test that collects at least four samples over 24 hours.

The Thyroid and Hormones
Overtaxed adrenals can lead to hypothyroidism, which has a direct effect on women's hormonal health. By age 50, one in every twelve women has a significant degree of hypothyroidism. By age 60, it is one woman out of every six.

The thyroid, which regulates metabolism, may tune down its hormonal activity in an attempt to reverse adrenal overdrive. Some symptoms of hypothyroidism include fatigue, weight gain, fibroids, endometriosis, ovarian cysts, heavy bleeding, fibrocystic breast disease, depression, PMS, migraines, lack of concentration, cold hands and feet, menopausal symptoms, miscarriage and infertility.

Birth control pills and estrogen increase thyroid-binding proteins in the bloodstream. This means that thyroid blood test results may be unreliable. Even though they may show normal thyroid hormone levels in the blood, there may be insufficient thyroid hormone in the tissues.

Hypothalamus-Pituitary-Adrenal axis activation due to stress causes decreased production of thyroid-stimulating hormone (TSH), and blocks inactive thyroxin conversion to the biologically active triiodothyronine (T3), which has the greatest effect on the body.

Effective natural approaches help in regulating the thyroid. Natural progesterone balances the thyroid-inhibiting effect of estrogen dominance, as does supplementation with thyroid glandular extracts, enzyme therapy, minerals (Iodoral, selenium and magnesium), vitamins and herbals.

The Candida-Hormone Connection
A serious digestive concern is the yeast-fungal infection known as candidiasis. Approximately 75 percent of women suffer from at least one yeast infection during their lives. This toxic yeast overgrowth is caused by eating large amounts of sugar and/or prolonged or repeated use of antibiotics, birth control pills, estrogen therapy, and cortisone.

Candida produces 79 different toxins known to wreak havoc with the immune system. A long list of potential symptoms associated with Candida overgrowth include depression, anxiety attacks, mood swings, lack of concentration, drowsiness, poor memory, headaches, insomnia, fatigue, bloating, constipation, bladder infections, menstrual cramps, vaginal itching, muscle and joint swelling, pain, hypothyroidism, and skin problems.

However, it is rarely understood that Candida also contributes to hormonal problems. A Candida waste product produces a false estrogen, which tricks the body into thinking it has produced adequate levels, signaling a reduction of its own estrogen. Similar messages can also be sent to the thyroid, reducing thyroxin production and initiating or worsening a hypothyroid problem.

Elevated estrogen levels also increase vaginal candidiasis incidence. Estrogen will literally feed Candida growth, which is why birth control pills and estrogen replacement therapy put women at a greater risk of developing Candida. The botanicals pau d'arco, oregano oil and olive leaf extract can be used along with a sugar-free and low carb diet to reduce the effect of this harmful yeast overgrowth. Probiotics are another key player to re-establish the beneficial bacterial in the colon.

Get Hormonally Balanced by Getting Healthy It is commonly believed that conditions of hormonal imbalance somehow just happen to us. For some reason, our culture has taught us that when diagnosed with a hormonal issue such as PMS, endometriosis, fibroids, hot flashes or night sweats, the answer lies in a pharmaceutical intervention such as some form of contraceptives or some variation of hormone supplementation with HRT or Bioidentical Hormone Replacement.

If we really want to regain hormonal harmony, it is vitally important that we understand that all hormonal problems are symptomatic of underlying dysfunctions occurring in our body. Learning to understand the message our body is trying to give us, will direct us to the real source of the problem so permanent healing can occur.

All hormonal imbalances are a message that our body is out of balance. A big piece for resolving hormonal issues requires understanding the significant role of ensuring the health of our adrenals, thyroid and colon. Getting healthy is the key to getting our hormones back on track!