Elson M. Haas MDPremenstrual syndrome (PMS) is a recently described problem. Although the history of symptoms that occur around the menstrual cycle is ancient, it is likely that modern-day women, with increased demands and stresses, changes in nutrition, and new careers that take them away from their natural cycle and their connection to the home, garden, and nature, are particularly susceptible to such symptoms. Women might think about these symptoms as a call of the womb and the moon to be more attuned to their female cycle. It may not be easy, but I believe it is possible for women to stay connected to their female cycles and still be active and productive in the outer world. This may require more care in regard to nutrition and a supplement program that counteracts stress while supporting the female organs and hormone functions. Stress (and being out of touch with emotions or not following their true emotions) is definitely a big factor in women’s premenstrual symptoms.
The current medical theories about PMS or, as it is sometimes termed, premenstrual tension (PMT), relate it to an estrogen-progesterone imbalance, particularly reactions to the increased estradiol levels. During the second half of the cycle, after ovulation, progesterone levels normally rise, while estrogen levels also rise slightly. These changes can influence water retention, causing some fullness of the uterus and other body tissues; this seems to be exaggerated premenstrually with the relatively deficient level of progesterone. Many of the symptoms, such as bloating, breast swelling and tenderness, fatigue, headaches, emotional irritability, depression, back pain, and pelvic pain, are probably a result of the water retention and subsequent emotional tension. Other hormonal and physiological factors, or effects on the immune system, may contribute to the problem as well. Less common symptoms include dizziness, fainting, cystitis, hives, acne, sore throat, joint pains and swelling, and constipation.
Low progesterone levels seem to be the main factor in PMS symptoms. Why progesterone levels may be low has not yet been determined, but many women seem to respond to treatment with progesterone in the second half of their cycle, from just after ovulation to the usual time of menstruation. A common treatment is to use vaginal or rectal suppositories containing progesterone (or even topical progesterone) once or twice daily. The newer treatment is oral, micronized progesterone that is not destroyed by the gastrointestinal tract or broken down by the liver. Usually, however, progesterone therapy is not needed, because most women will respond to a nutritional and herbal approach to treating PMS. Many nutrients are needed, but probably the two most important ones are vitamin B6 (pyridoxine) and magnesium. B6 helps to clear water through a diuretic effect on the kidneys. Usually 50–100 mg. once or twice daily will be effective. A complete B vitamin supplement is also necessary to prevent these higher amounts of B6 from causing imbalances of other B vitamins. It has been theorized and shown in some studies that magnesium deficiency within the cells is also correlated with some of the PMS symptoms. Supplementing magnesium at amounts equal to up to one and a half times the calcium level, that is, about 800–1,200 mg., is helpful in reducing some PMS symptoms. Zinc is also an important mineral here.
Other possible menstrual irregularities, as discussed by Susan Lark, M.D., in the PMS Self Help Book (Celestial Arts, Berkeley, CA, 1984), have symptoms that may be related to low estrogen levels. Women with this problem often experience more of their symptoms after their period than before it. This low-estrogen state is far less common than the progesterone deficiency. Occasionally, tests to measure hormonal levels can be done at specific times of the month. However, these are expensive and not always easy to interpret (the range of normal is wide) unless done repeatedly. Generally though, as long as there are relatively regular menstrual periods, these ovarian and pituitary hormone levels will be within normal values. Other tests that may be abnormal include thyroid hormone levels, thyroid antibodies, or antiovarian antibodies, which may represent some autoimmune problems.
Another common symptom, not only of PMS but of most women’s premenstrual time, is a craving for sweets. This desire is often enhanced in those with PMS, which brings up another important point. Women with PMS often have other correlating conditions that may contribute to symptoms. These include hypoglycemia (low blood sugar), candidiasis (an overgrowth of and hypersensitivity to the common yeast Candida albicans), food and/or environmental allergies, moderate to severe stress, and vitamin and mineral deficiencies. Whether these problems contribute to or are a result of the premenstrual and hormonal problems is not clear, but it is important to evaluate women for these conditions when they either have significant PMS symptoms or do not respond well to treatment. PMS is definitely aggravated by low blood sugar generated by stress and an intake of refined flour and sugar products.
From a dietary point of view, it is important to avoid the food stressors, irritants, and stimulants that, if they do not contribute to the PMS problem in the first place, definitely make it worse. These include sugars and refined foods, caffeine, alcohol, and chemicals. A diet that helps in reducing symptoms is a balanced, wholesome, and high-nutrient one, with lots of whole grains, leafy greens and other vegetables, good protein foods, and some fruits, but a minimum of fruit juice. A hypoglycemic diet of regular meals and protein-oriented snacks is often helpful. If there are yeast or allergy problems, a diet to help with those conditions (see previous programs) would be beneficial. If these problems are not present, extra brewer’s yeast, with its high levels of B vitamins and minerals, can be a supportive food. Eating a variety of foods and a modified rotation diet (as is discussed in the Allergy program in this chapter) are also helpful in getting the wide range of important nutrients and maximizing food sensitivities. Some women also experience a reduction of symptoms through colon detoxification and a cleansing-type diet high in juices, soups, and salads. Intake of fiber as psyllium or bran started a week before symptoms usually begin will improve colon elimination, and an enema or colonic irrigation at the time symptoms begin might be helpful.
Premenstrual syndrome is more common in women in their 30s and 40s than in those in their 20s and teenage years. Dr. Lark points out a number of other factors associated with an increased likelihood of PMS problems—these include women who are or have been married, do not exercise, have had children, experience side effects from birth control pills, have had a pregnancy complicated by toxemia, have a significant amount of emotional stress in their lives, or those whose nutritional habits lead to certain deficiencies or excesses. Dietary factors that worsen PMS include foods high in refined sugars and fats, processed or chemical foods, caffeine drinks (coffee, tea, colas), alcohol (especially wine and beer with the higher carbohydrate level), chocolate products, eggs, cheese, red meats, and high-salt foods. A natural food diet, of course, will help alleviate the symptoms of PMS.
British physician Katherine Dalton, M.D., was one of the first to describe PMS and offer some therapeutic help. Guy Abraham, an obstetrician-gynecologist, has further classified PMS problems, a system that Dr. Lark also discusses in her book. The four main types are:
- Type A (“anxiety”)—a mixture of emotional symptoms: anxiety, irritability, and mood swings.
- Type C (“carbohydrates” and “cravings”)—sugar cravings, fatigue, and headaches.
- Type H (“hyperhydration”), also known as Type W (“water retention”)—bloating, weight gain, and breast swelling and tenderness.
- Type D(“depression”)—depression, confusion, and memory loss.
Other groups of symptoms include acne—oily skin and hair and acne—and dysmenorrhea (painful periods)—cramps, low back pain, nausea, and vomiting; recently classified as Type P for pain.
Dr. Susan Lark’s PMS Self Help Book provides specific treatment plans for the different types of symptoms. The recommendations for the different types, including diet and suggestions, are all very similar. In her programs, all include some form of stress reduction, exercise, supplementation, herbal therapy, acupressure massage, and yoga postures.
For acne problems with PMS, extra vitamin A (20,000–40,000 IUs, mainly as beta-carotene) and zinc (20–40 mg.) are usually helpful. Choline and inositol, nutrients found in lecithin, may help nourish the skin; 500 mg. of each daily are recommended.
Dysmenorrhea and other pain problems respond well to higher amounts of magnesium, about 500 mg. more than calcium, as this has a nerve tranquilizing and muscle relaxing effect. Vitamin E (400–800 IUs) and vitamin B6 (100–300 mg. daily) may also be helpful in reducing pain. Extra B vitamins and a general vitamin and mineral program are usually also necessary.
Anxiety symptoms, such as mood swings and irritability, often respond to extra B vitamins, particularly thiamine (B1), 150–250 mg. per day, and pyridoxine (B6), 200–300 mg. per day, with about 50 mg. each of the rest of the B vitamins. Using inositol and extra magnesium, such as magnesium citrate (which causes fewer bowel symptoms, especially diarrhea, than other magnesium salts), about 400–600 mg. daily, will help. Progesterone therapy may be most helpful for Type A, or anxiety, problems. A doctor must be consulted for this therapy. Also, phenylethanolamine (PEA), a substance found in certain foods, such as bananas, chocolate, and hard cheeses, may increase symptoms of anxiety. These foods should be avoided in this type of PMS.
For depression, added tryptophan (if available), 1,000 mg. before bed, may be helpful. If this does not help, or if it causes side effects, such as headache, Stuart Berger, in his Immune Power Diet, recommends trying another amino-acid, L-phenylalanine, in the same dosage. Zinc, vitamin B6, and calcium/magnesium may also be beneficial in reducing premenstrual depression.
For women with the Type C, or sugar cravings, pattern, often associated with stress, fatigue, and headaches, confusion, or dizziness, a program that should help reduce these symptoms supplements the basic vitamin and mineral plan with additional B vitamins, particularly B6, 200–300 mg. per day, and B1, 150–250 mg. per day; chromium, 200–400 mcg.; vitamin E, 800 IUs; and vitamin C, around 6–8 grams per day. Eating frequent, small meals and avoiding sugar will also be helpful in reducing cravings.
For Type H with water or bloating problems, which can be the most troublesome, causing weight gain, breast tenderness, and general emotional upset, the basic B vitamins, including high amounts of B6 and supplemental B1, magnesium, potassium, vitamin E, and evening primrose oil (with GLA, gamma-linolenic acid, as the active ingredient), 1–2 capsules taken three times daily, may be very helpful. (I have seen evening primrose oil be helpful for many women with various PMS symptoms.) Also, with water retention problems, food allergy, particularly to wheat, may be a contributing factor. A trial of a couple of months of avoiding wheat products can aid in providing relief of symptoms. Sometimes the response can be dramatic. Regular exercise is also important in reducing this type of PMS.
Many herbs are helpful in treating PMS. Angelica, or dong quai, is a commonly used herb that acts as an energizer and female tonic when it is taken regularly as capsules (2 capsules twice a day) or as a tea. Ginger root acts as a circulation aid and mild stimulant and is helpful in getting some of that retained water moving. Other diuretic herbs include parsley and juniper berry. Licorice root is a good balancer and seems to provide an “up” feeling when drunk with some ginger as a tea. Their flavors tend to combine well. Valerian root or catnip tea will provide some relaxation when there is general anxiety or irritability. Sarsaparilla is a tonifying (strengthening) herb that supports the hormonal functions and may actually contain some hormones itself. There are also many herbal formulas for treating PMS and for strengthening the female functions. One that I have found helpful to my patients is FE-G (Female General Tonic), made by Professional Botanicals. It contains black haw, licorice, false unicorn root (estrogen-containing plant), ginseng root, ginger, and life root. I recommend 2 capsules two or three times daily, usually for three to six months if it appears helpful. In the first month or two herbs tend to work more slowly and must be taken over a longer period of time than stronger pharmaceuticals. There are many similar formulas available now for PMS and other female problems.
| Type | Main Symptoms | Key Treatment Plans |
| PMT-A | Anxiety | Magnesium 400–600 mg. per day. Progesterone therapy. Low PEA diet-avoid chocolate, bananas, and hard cheeses. | PMT-D | Depression | Zinc 30–60 mg. per day. Vitamin B6 100–300 mg. per day. Magnesium 400–600 mg. per day. Triptophan 1,000–1,500 mg. before bed or 500 mg. two or three times daily. |
| PMT-H or W | Water retention | Avoid foods allergens, particularly wheat. Potassium 1–2 grams per day, plus potassium foods. B complex vitamins with extra B6 50–200 mg. per day. Regular exercise. |
| PMT-P | Plain | Vitamin E 400–800 IUs per day. Magnesium 400–600 mg. per day. |
| PMT-C | Cravings | Low-sugar diet. Frequent small meals. Chromium 200–400 mcg. per day |
Some doctors also use glandular supplements in treating PMS. In Super Fitness Beyond Vitamins (New American Library, New York, 1987), Michael Rosenbaum, M.D., describes his success with the use of pituitary, particularly anterior pituitary, extract in treating stubborn PMS symptoms. Brain and pancreas glandular supplements may also be helpful, Dr. Rosenbaum points out.
There are also many nutritional supplement formulas available for premenstrual syndrome. The table below presents an all-encompassing nutrient program (most of these nutrients are best taken in two or three portions over the course of the day). This may be tailored for specific symptoms by application of the suggestions given earlier. Of course, many of the nutrients listed are consumed in the diet. Supplementation of sodium, potassium, chloride, fluoride, iodine, and phosphorus is usually not necessary, though additional potassium, about 1 to 2 grams, may be helpful in some cases. Even extra vitamins D and K may not be needed. The precursor of B6 (pyridoxine), pyridoxal-5-phosphate, may actually be more effective than B6 itself, because some people may not be able to easily convert the pyridoxine to its usable form. Both forms of vitamin B3 are used; niacin offers some circulatory stimulation and flushing while niacinamide supports the general neuromuscular relaxation of B3.
I have seen a high rate of success in the improvement and elimination of symptoms in women who change their diets and implement a regular supplement program. I have also heard other gynecologists, family doctors, and nurse practitioners claim that they see nearly an 80 percent success rate with a good program. Of course, learning to deal better with life stresses, relationships, and sexual issues will further increase the likelihood of success.
| Vitamin A | 5,000–10,000 IUs | Calcium | 800–1,000 mg. | ||
| Beta-carotene | 10,000–20,000 IUs | Chromium | 200–400 mcg. | ||
| Vitamin D | 200–600 IUs | Copper | 1–2 mg. | ||
| Vitamin E | 400–1,000 IUs | Iodine* | 150–300 mcg. | ||
| Vitamin K* | 150–300 mcg. | Iron | 15–20 mg. | ||
| Thiamine (B1) | 50–250 mg. | Magnesium | 750–1,500 mg. | ||
| Riboflavin (B2) | 50–100 mg. | Manganese | 2.5–15 mg. | ||
| Niacin (B3) | 25–100 mg. | Molybdenum | 150–500 mcg. | ||
| Niacinamide (B3) | 50–100 mg. | Phosphorus* | 800–1,000 mg. | ||
| Pantothenic acid (B5) | 50–500 mg. | Potassium* | .5–5.0 g. | ||
| Pyridoxine (B6) | 50–200 mg. | Selenium | 150–300 mcg. | ||
| Pyridoxal-5-phosphate | 50–150 mg. | Zinc | 15–30 mg. | ||
| Cobalamin (B12) | 50–200 mcg. | ||||
| Folic acid | 400–800 mcg. | Gamma-linolenic acid | 3–6 capsules | ||
| Biotin | 50–400 mcg. | Eicosapentaenoic acid (EPA plus DHA) | 1–2 capsules | ||
| Choline | 500–1,000 mg. | L-amino acid formula | 1,000 mg. | ||
| Inositol | 500–1,000 mg. | L-tryptophan+ (before bed) | 250–500 mg. | ||
| PABA | 50–100 mg. | L-phenylalanine (in 2 doses during the day) | 500–1,000 mg. | ||
| Vitamin C | 1–3 g. | | Bioflavonoids | 250–500 mg. | | |
*These nutrients will not usually be supplemented.
+Only, of course, if L-tryptophan is available.
**Digestive enzymes, herbs, and glandulars may also be helpful in reducing PMS problems.
Maryon Stewart
Jim Strohecker
Tom Ferguson MD
