Pre-Menstrual Tension

A condition characterized by nervousness, irritability, emotional
instability, depression and possibly headaches, edema and mastalgia; it
occurs during the 7 to 10 days before menstruation and disappears a few
hours after onset of menstrual flow.

In other words the name describes a broad range of symptoms that
occur cyclically which are severe enough to disturb a woman’s life patterns
or cause her to seek help from a health practitioner. Most women experience
some body change cyclically during the menstruating years corresponding
to the pattern of cycling hormones. The subtle shift in mental and emotional
focus as well as body response is observed and ritualized in many cultures.
Women often express a positive attitude toward the conscious observance
of these patterns within their own bodies, however when the hormonal and
chemical changes result in debilitating symptoms they may disrupt functioning
in virtually all body systems.

The symptom picture may include:

Behavioral Symptoms: personality alteration in the form of nervousness,
irritability, agitation, unreasonable temper, fatigue, depression. Violent
crimes and suicide are often committed in the premenstruum. Symptoms that
suggest clinical depression such as anxiety, palpitations, tightening in
the chest, hyperventilation are common.

  • Neurological Symptoms: headache, vertigo, syncope, paresthesias
    of the hands or feet, aggravation of seizure disorders have all been recorded.

  • Respiratory Symptoms: asthma may be intensified.

  • Gastro-intestinal Symptoms: constipation, and increase or decrease
    in appetite, carbohydrate craving particularly sugar and chocolate.

  • Miscellaneous: edema, weight gain, backache, enuresis, oliguria,
    capillary fragility, exacerbations of dermatologic disease, breast changes,
    and eye complaints

Four categories of PMT have been identified corresponding to the major symptoms
patterns :

  • PMT-A (80%): predominantly anxiety, associated with excess estrogen,
    and CNS stimulation resulting in anxiety. Excess estrogen can be caused
    by deficiency in progesterone (high estrogen/progesterone ratio), or by
    inability of the body to break down estrogen (poor liver function, or Vitamin
    B deficiency resulting in same).

  • PMT-H (60%): predominantly hyperhydration (bloating, edema),
    increased ACTH, water/salt saving by kidneys.

  • PMT-C (40%): carbohydrate craving, due to increased responsiveness
    to insulin.

  • PMT-D (5%): depression, due to excess progesterone, CNS depression
    PMS is diagnosed on the basis of when symptoms are present. There is (by
    definition) a period of time when symptoms are absent, usually just after
    the onset or end of menses. PMS occurs during the proliferative or luteal
    phase of the menstrual cycle when levels of estrogen and progesterone are
    relatively high. Estrogen is a central nervous system stimulant. Progesterone
    is a CNS depressant. What is important in the relationship of estrogen to
    progesterone during the luteal phase.

A number of etiological factors have been identified for primary PMT:

  • Estrogen excess.

  • Progesterone deficiency.

  • Fluid retention: it is believed that many of the symptoms of
    PMS relate to a shift in the fluid in the water compartments, intra and
    extracellular and intravascular with increased retention of water and water
    moving into the extracellular spaces. Mediated by increased ACTH and aldosterone.

  • Hypoglycemia: the cells are more receptive to insulin in the
    premenstruum, causing relative hypoglycemia resulting in carbohydrate craving.

  • Decreased production of Prostaglandin E1: researched by David
    Horrobin; advocates the use of Gamma-linolenic acid, which is found naturally
    in human milk and oil of evening primrose. Other nutrients encouraging the
    conversion of fatty acids to Prostaglandin E1 are: Magnesium, B6, Zinc,
    Niacin, and Vitamin C.

  • Increased production of other prostaglandins.

  • Magnesium deficiency leading to decreased dopamine in the brain
    resulting in increase levels of CNS stimulators (norepinephrine and serotonin).

  • Increased prolactin levels causing decreased progesterone.

NOTE: post partum depression is very similar to PMS both in symptoms, and
in the hormonal picture of progesterone deficiency.

Actions indicated for the processes behind this disease :

Nervine herbs will usually remove the symptoms, but rarely
clear the recurrent pattern.

Anti-spasmodic herbs will ease any dysmenorrhoea that accompanies
the PMT.

Diuretic remedies would be indicated if water retention is part of
the picture.

Hormonal Normalizers would be indicated if the diagnosis suggests
a pivotal contribution by hormonal imbalance.

System Support :

In addition to the reproduction system, the nervous system usually needs
aid. In some intransigent cases attention must be given to endocrine function.

Specific Remedies :

Different remedies may act as specifics for specific women, so generalizations
are problematic. From my clinical experience I would suggest Scutellaria
in the short term is as close to a specific for relief of symptoms
as possible. Longer term `specific’ herbs would be the hormonally focused
ones such as Vitex agnus-castis.

One possible prescription :

Scutellaria spp. 2 parts

Valeriana officinalis 1 part

Taraxacum officinalis fol. 1 part 5ml of tincture taken as needed
to alleviate symptoms

Vitex agnus-castis 2 parts

Cimicifuga racemosa 1 part 5ml of tincture taken once a day throughout

The dosage of the symptomatic medication may be increased until the desired
relief is experienced. The dosage regime may be altered as necessary, varying
time of day and quantity of dose to suit individual needs. For example this
may be the whole dose first thing in the morning, or smaller amounts at
frequent intervals throughout the day. The womens’ experience is the guiding
principle here. Always treat the human being and not the theory about
the `disease’!

This supplies the following actions :

Nervine (Scutellaria spp., Valeriana officinalis,
Cimicifuga racemosa

Anti-spasmodic (Scutellaria spp., Valeriana officinalis, Cimicifuga

Diuretic (Taraxacum officinalis fol.)

Uterine Tonic (Cimicifuga racemosa, Vitex agnus-castis)

Hormonal normalizer (Vitex agnus-castis)

If water retention predominates symptomatically, then more focus should
be given to diuretics. Palpitations would suggest Leonurus cardiaca
as a relevant herb. As an example of how this basic approach can be modified
to address specific symptoms consider the following.

One possible prescription : PMT associated with transitory skin problems

Scutellaria spp. 2 parts

Anemone pulsatilla 1 part

Galium aparine 1 part

Taraxacum officinalis fol. 1 part 5ml of tincture taken as needed
to alleviate symptoms

Vitex agnus-castis 2 parts

Cimicifuga racemosa 1 part 5ml of tincture taken once a day throughout

This supplies the following actions :

Nervine (Scutellaria spp., Anemone pulsatilla, Cimicifuga

Anti-spasmodic (Scutellaria spp., Anemone pulsatilla, Cimicifuga

Diuretic (Taraxacum officinalis fol., Galium aparine)

Alterative (Galium aparine, Anemone pulsatilla)

Uterine Tonic (Cimicifuga racemosa, Vitex agnus-castis)

Hormonal normalizer (Vitex agnus-castis)

Broader Context of Treatment :

The whole gamut of issues that the holistic practitioner can address must
be focussed upon. The herbal treatment can be exceptionally effective, but
will benefit from appropriate stress management techniques and possibly
dietary support. The following dietary guidelines have been suggested by
Dr. Karen Bilgrai Cohen D.C. in Clinical Management of Women In
the Childbearing years

  • Limit refined sugar as it increases excretion of B Vitamins, Magnesium,
    and Chromium, and contributes to increased insulin secretion resulting in

  • Limit salt to under 3 grams per day.

  • Limit red meat because of high sodium & high fat content, to 3 oz.
    per day. Some evidence shows that the hormones in red meat contribute to
    fibrocystic disease & menstrual cramps.

  • Limit alcohol to I oz. per day. Alcohol destroys B Vitamins, Magnesium
    and Chromium, and may be a potent depressant in some people.

  • Limit Caffeine: it intensifies anxiety and contributes to fibrocystic

  • Limit dairy products. They are high in fat, interfere with magnesium
    absorption, & may constipate.

  • Limit fats to 30% of total calories. * Limit cold foods.

  • Limit protein to 1 gram per kilogram of body weight.

  • Avoid licorice: it stimulates the production of aldosterone.

  • Minimize spinach, beet greens and other oxalates as they interfere with
    mineral absorption.

  • Increase complex carbohydrates to 40% of diet, with whole grains, green
    leafy vegetables and legumes. They are high in fiber, B Vitamins and release
    sugar slowly.

  • Increase potassium rich foods, which are beneficial against water retention:
    sunflower seeds, dates, figs, peaches, bananas, tomatoes.

  • Increase intake of natural diuretics: artichokes, asparagus, parsley,

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Written by David L. Hoffmann BSc Hons MNIMH

Explore Wellness in 2021