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Health Protocols

Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS)

Millions of women, at some point in their lives, experience troublesome physical, emotional, and cognitive symptoms during the two weeks leading up to menstruation (Bhatia 2002; MGH 2013). When these symptoms interfere with day-to-day life, this is called premenstrual syndrome or PMS (Marjoribanks 2013; O'Brien 2011; Rapkin 2012; Alvero 2014). It is estimated that 8–20% of reproductive-aged women experience moderate-to-severe PMS (Rapkin 2009).

Premenstrual dysphoric disorder or PMDD is a premenstrual condition closely related to PMS that affects an estimated 3–8% of women (Rees 2014; Marjoribanks 2013; Steiner 2006). PMDD is usually characterized by severe psychological symptoms such as depression, anxiety, or persistent anger. PMDD is much more severe than PMS and can impact a woman’s life as much as major depressive disorder (Pearlstein 2008; Rapkin 2009; Epperson 2012).

Both PMS and PMDD occur in cycles. During the luteal phase of the menstrual cycle, which lasts from ovulation to the onset of menstruation, levels of the hormones estrogen and progesterone in a woman’s body change (Justice 1999; Ounis-Skali 2006). These hormonal fluctuations coincide with the onset of PMS symptoms. It is thought that changing hormone levels affect brain chemicals called neurotransmitters and neuropeptides, which help regulate mood (Freeman 2002). Direct actions of hormones, coupled with their effects on neurotransmitters, are believed to contribute to PMS and PMDD. The symptoms of PMS and PMDD usually go away when, or soon after, menstruation begins and return again during the next luteal phase (Rapkin 2012; Rees 2014; Rapkin 2014).

Dietary and lifestyle changes may be sufficient to resolve symptoms in mild cases of PMS. These include exercising; eating a healthy diet rich in vegetables, whole grains, and fruits; avoiding excess salt, sugar, alcohol, and caffeine; getting adequate sleep; managing stress; and not smoking. Over-the-counter pain relievers can help address physical symptoms such as cramps, pain, and headaches, but are not without side effects, especially if used long-term (OWH 2012; Alvero 2014). Cognitive behavioral therapy and other behavioral and self-help modalities may also reduce PMS and PMDD symptoms (Pearlstein 2008; Willacy 2012).

For women whose symptoms are not relieved by dietary and lifestyle modifications alone, several drugs are available to treat PMS and PMDD, though many women find several of them to be only partially effective or experience unwanted side effects (Kleinstauber 2012; Rapkin 2009; Marjoribanks 2013). These medications include oral contraceptives and gonadotropin-releasing hormone agonists, which block ovulation; and serotonin reuptake inhibitors and anxiolytics, which modify brain neurochemical metabolism (Mayo Clinic 2012).  

Women who suffer from PMS or PMDD are not limited to conventional treatments, however. Many integrative interventions, including calcium and vitamin D, chasteberry extract, magnesium, St. John’s wort, and vitamin B6 have been shown to reduce symptoms of PMS in clinical studies (Bertone-Johnson 2005; Canning 2010; Yonkers 2008; Alvero 2014; OWH 2012). Moreover, given the hormonal basis of PMS and PMDD symptoms, women who experience either of these conditions should undergo a blood test to evaluate their sex hormone levels. Hormonal imbalance, which can be revealed by blood testing, may be an important underlying factor in PMS and PMDD for some women. Once a hormonal imbalance has been identified, some women may benefit from using bioidentical hormone replacement therapy to restore balance among their hormones (Dennerstein 1985; Fugh-Berman 2007; Holtorf 2009; Hudson 2013).

In this protocol you will learn about the possible causes of PMS and PMDD, and how to differentiate these two conditions. You will also learn how PMS and PMDD are typically treated and common side effects of conventional treatments. Emerging treatment modalities will be examined and a number of integrative interventions that may help relieve symptoms of PMS and PMDD will be described.