‘That time of the month’, otherwise called PMS (Premenstrual Syndrome) and commonly known as PMT, can be an extremely unpleasant time not just for women but also for their partners and family.
PMS is a particularly prevalent condition, affecting 30-40% of menstruating women of childbearing age, especially those in their mid-thirties, and increasing with age. Quality of life can be severely disturbed, as symptoms can be extreme enough to disrupt personal relationships, social activities or job performance.
What is Premenstrual Syndrome?
Pre-Menstrual Syndrome is characterised by a collection of potentially distressing symptoms prior to the onset of a period and usually abates very soon afterwards. Women whose health and resistance are good are less likely to suffer from Pre-Menstrual Syndrome than those suffering from poor nutrition and lack of physical exercise.
A severe form of PMS: Premenstrual Dysphoric Disorder
A more debilitating and severe form of Pre-Menstrual Syndrome, known as premenstrual dysphoric disorder (PMDD), affects 5-10% of women. PMDD manifests as Pre-Menstrual Syndrome and is accompanied by severe depression that occurs during the last week of the menstrual cycle and which markedly interferes with daily living. Women who suffer from PMDD display real ‘Jekyll and Hyde’ behaviour.
How do I know if I have a hormone imbalance?
It is important for women and their naturopaths/doctors to differentiate between the three syndromes that can worsen pre-menstrually (the days prior to a period starting) – Pre-Menstrual Syndrome, the more severe PMDD, or pre-menstrual magnification of a pre-existing complaint such as depression or irritable bowel syndrome (IBS). Many other conditions such as diabetes, anaemia, an underactive thyroid gland or other hormone issues might mimic some of the features of pre-menstrual syndrome without actually worsening pre-menstrually and should also be excluded as a cause of the symptoms.
Hormone imbalances can be assessed through:
- Signs and symptoms
- Blood tests
- Salivary hormone tests
Causes of PMS
The causes of PMS are usually associated with a hormone imbalance, such as sagging progesterone levels, histamine intolerance or a low thyroid gland function. It is important to see if any of the imbalances listed below are causing the problem.
- Oestrogen excess
- Imbalance between estrone, estadiol and estriol
- Progesterone deficiency
- High prolactin levels (some symptoms such as breast tenderness, have been linked to an imbalance of prolactin, a hormone that stimulates the production of breast milk)
- Underactive thyroid gland (see below)
- Adrenal stress or fatigue
- Oestrogen: Progesterone ratio imbalance
- Histamine intolerance (which drives inflammation)
Oestrogen: Progesterone ratio imbalance
An increase in the ratio of oestrogen to progesterone is associated with a number of physical changes that contribute to PMS. These include:
- Impaired liver function
- Reduced production of serotonin (the feel good chemical in our brain)
- Decreased action of vitamin B6
- Increased aldosterone secretion
- Increased prolactin secretion
High prolactin can cause sodium and water retention and is affected by oestrogen, stress, hypoglycaemia, pregnancy and oral contraceptives.
Aldosterone is elevated two to eights days prior to the onset of menses with PMS and may be implicated in fluid imbalance at this time.
Thyroid function – one of the causes of PMS?
Oestrogen, in particular oestradiol, and T4 (a thyroid hormone important for hormone health) appear to have a synergistic relationship in female conditions. Without an adequate level of T4 the effectiveness of oestradiol is severely reduced, or even totally halted.
An underactive thyroid gland has implications in conditions such as PMS, infertility, heavy periods(menorrhagia), continuous bleeding, poor placental function, osteoporosis and anorexia nervosa.
It is important to consider an underactive thyroid as an underlying cause of PMS. Research has shown that for many women, administration of thyroid hormone alleviates PMS, indicating that even a slightly sluggish thyroid activity should be considered even when blood tests indicate that thyroid hormone levels are normal.
Symptoms such as dysfunctional uterine bleeding, fatigue, insomnia, reduced short-term memory, dyspraxia (difficulty translating thought to action) and moderate to severe depression have all been associated with a combination of insufficient oestradiol and T4 levels.
Thyroid Stimulating Hormone (TSH) levels have been observed to be normal in these patients, and T4 may be either deficient or at the low end of the normal range.
Elevated prolactin may be linked to low thyroid function. Chaste tree (Vitex agnus castus), vitamin B6 and zinc can help lower prolactin levels.
Other Causes of PMS
A number of other factors are known to influence PMS symptoms, including:
- Vitamin B6 and essential fatty acids deficiencies (good oils)
- Calcium and magnesium imbalances
- Blood sugar imbalance
- Food allergy.
PMS symptoms are wide-ranging and can begin as early as a girl’s first period until menopause.
Common PMS Symptoms & Signs
- Mood changes such as depression, irritability or fearfulness
- Reduced ability to cope
- Breast tenderness
- Fluid retention
- Food cravings & hypoglycemia
- Headaches and migraines
- Skin complaints such as acne
- Abdominal bloating
Moods And PMS
Mood swings can be one of the most distressing symptoms of women experiencing PMS. It ranges from moodiness, irritability, tearfulness to severe depression and suicidal thoughts.
It is now understood that the changing levels of reproductive hormones throughout the menstrual cycle can have direct or indirect effects on mood.
The mood changes associated with PMS may also be the result of progesterone metabolites interacting with receptors that normally suppress anxiety. This may be worsened by a deficiency in GABA.
St John’s Wort and 5 HTP may be useful components of the treatment plan for patients with PMS.
Supplementation with vitamin B6 may also help to alleviate hormonally-induced depressive symptoms, especially if you are taking the oral contraceptive pill.
Headaches, Menstrual Migraines & PMS
During the menstrual cycle, the altering levels of hormones can affect the prevalence and intensity of headaches.
Oestrogen and progesterone have potent effects on our brain neurochemistry. Headaches that occur during your period appear to be due to oestrogen withdrawal, with or without a combination of histamine intolerance.
However, it should be noted that increased oestrogen during pregnancy and decreased oestrogen during menopause may also affect headaches.
Furthermore, headaches associated with use of the oral contraceptive pill or hormone replacement therapy (HRT) may be partially related to periodic discontinuation of oral hormones and therefore changes to oestrogen levels.
HRT is often seen to exacerbate migraine. It is important to realise that hormone medication may generate new headaches or aggravate or ameliorate pre-existing headaches.
Where medication is a potential causative factor, it may be necessary to discuss alternative methods of contraception or hormone replacement. Stopping the pill or HRT may not bring immediate headache relief – there may be a delay of six to 12 months, or no improvement at all.
Hypoglycaemia And PMS
Low blood sugar levels are common prior to the start of menstruation and can contribute to the mood problems, food cravings and headaches.
Chromium and the herb gymnema can be effective in controlling hypoglycemia, especially when taken in conjunction with eating a balanced diet and protein eaten throughout the day.