Premenstrual Syndrome (PMS)  

PMS is a cluster of physical and emotional symptoms associated with the menstrual cycle.

Most women experience some degree of PMS at some point in their menstrual history, although symptoms vary significantly from woman to woman. Reproductive hormones and neurotransmitters are thought to play a central role in PMS. 

Five to ten days prior to menses, estrogen levels rise and progesterone levels decline. These changes are accompanied by an increase in something known as follicle stimulating hormone (FSH) six to nine days prior to menstruation. Then, around two to eight days before menstruation aldosterone levels peak. Prolactin levels are elevated in most PMS patients. So you can see that a lot of changes are occurring in a short period of time. 

There are many theories around what causes these major changes to occur and why they are more dramatic in some women and less dramatic in others. One theory is that the way that the body uses vitamins and minerals may be a factor. Another hypothesis is that there is some deviation in the viscosity or thickness of the blood along with a change in the amount of water within the red blood cells during the menstrual cycle. 

PMS can be divided into four subtypes: 

PMS-A (Anxiety) 

• Anxiety
• Irritability
• Nervous tension 

PMS-C (Cravings)  

• Increase in appetite
• Craving for simple carbohydrates
• Fluctuations in blood sugar
• Eating a lot of sugars results in fatigue, headaches, palpitations, dizziness, or fainting 

PMS-D (Depression)  

• Depression
• Tearfulness
• Confusion
• Insomnia 

PMS-H (Hyperhydration) 

• Water retention
• Abdominal bloating
• Breast tenderness
• Weight gain 

For most women, PMS produces symptoms that are annoying but manageable. For some, PMS is debilitating, leaving the woman unable to carryout daily activities. Moderate to severe PMS can be divided into four subtypes.

• PMS-A (Anxiety) is the most common type of PMS. Symptoms include anxiety, irritability, and nervous tension. Elevated estrogen and low progesterone levels are associated with this type.

 

• PMS-C (Cravings) is characterized by an increase in appetite, craving for simple carbohydrates (breads, sugars, grains, snack foods), and fluctuations in blood sugar. Giving in to this craving results in fatigue, headaches, racing heart beats, dizziness, or fainting.

 

• PMS-D (Depression) is the least common but most serious type of PMS. Symptoms include depression, tearfulness, confusion, insomnia, and withdrawal from daily and social activities. Low levels of estrogen, high progesterone, and elevated adrenal androgens are all found in this subtype. In 1994, the Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) (DSM-IVR) included “premenstrual dysphoric disorder” among its catalog of disorders.

 

• PMS-H (Hyperhydration) is associated with symptoms of water retention, abdominal bloating, breast tenderness, and weight gain. High levels of aldosterone may be a factor, which is thought to increase in the presence of stress, high levels of estrogen, and low levels of magnesium and dopamine 

What are Menstrual Cramps?  

Menstrual cramps, or dysmenorrhea (as physicians call it), are one of the most common healthcare problems that women suffer during their reproductive years. It has been estimated that as many as 30 to 50 percent of all women suffer from pain during their menstrual period, with the incidence being highest in younger women, from teenagers to women in their thirties.                                                                             

In fact, at least 10 percent of younger women have symptoms so severe that they are unable to handle their normal range of activities. Many women have to miss days of work and important social functions because any movement or activity is too painful. For the first day or two of menstruation, only bed rest or curling up on the floor in the fetal position is tolerable until the symptoms finally pass. This often happened to me during my teens and twenties. 

Besides the lower abdominal pain, cramp sufferers can also experience backache, pinching and pain sensations in their inner thighs, bloating, nausea, vomiting, diarrhea, constipation, faintness, dizziness, fatigue, and headaches. For those women who must curtail their activities because of cramps, these problems translate into billions of dollars of lost wages and productivity on the job, as well as a significant decrease in the quality of life for several days each month. 

In fact, the gynecology textbook that I used during my medical training estimated that menstrual cramps caused the loss of 140 million work hours annually. It is no wonder that women with moderate to severe cramps regard their monthly period with apprehension and even dread. 

Despite the many symptoms and the millions of sufferers, menstrual cramps have been traditionally considered by the medical community to be a “minor” female ailment. Doctors treated women as if the problem were “all in their heads.” The problem was either ignored or else treated with powerful painkilling drugs and tranquilizers. Often these drugs had significant side effects and did nothing to alleviate or help prevent the problem on a long term basis. Luckily, the medical community’s interest in menstrual cramps has increased during the past two decades. Researchers understand much more about what causes menstrual cramps on a physiological basis. This has led to newer, much more effective drug treatments, as well as nutritional and other lifestyle related therapies. 

The Normal Menstrual Cycle 

It is important to look at the normal menstrual cycle and see how it functions. This background will make it easier for you to understand why painful menstruation occurs. 

First, understand why we menstruate. Menstruation refers to the shedding of the uterine lining, or endometrium. Each month the uterus prepares a thick, blood-rich cushion to nourish and house a fertilized egg. If pregnancy doesn’t occur and the egg doesn’t implant in the uterus, then the body doesn’t need this extra buildup of the uterine lining. The uterus cleanses itself by releasing the extra blood and tissue so that a fresh buildup can occur all over again the following month, in preparation for a possible pregnancy. 

The mechanism that regulates the buildup and shedding of the uterine lining is controlled by fluctuations in your hormonal levels. It begins each month when follicle stimulating hormones (FSH) and luteinizing hormones (LH) are released from the pituitary, a gland located at the base of the brain. Once FSH and LH are released into the bloodstream, their destination is the ovaries. The ovaries hold all the eggs a woman will ever have, in an inactive form called follicles. 

During each cycle, the FSH and LH from the pituitary gland cause one follicle to ripen, and normally one egg is released for possible fertilization. As part of this pro-cess, the follicles begin to produce the hormones estrogen and progesterone. Estrogen reaches its peak during the first half of the cycle as the newly released egg is maturing. Progesterone output occurs after midcycle when ovulation has occurred. Ovulation refers to the production of a mature egg cell. 

Besides preparing the egg for fertilization, estrogen and progesterone stimulate the lining of the uterus. During the first two weeks following menstruation, estrogen causes the uterine lining to gradually rebuild itself. The inner mucous layer of glands of the endometrium begin to grow long, and the lining thickens through an increase in the number of blood vessels as well as the production of a mesh of fibers that interconnect throughout the lining. By midcycle, the lining of the uterus has increased three times in thickness and has a greatly increased blood supply. 

After midcycle, usually around day 14, ovulation occurs; the egg is picked up by the fallopian tube and continues on to the uterus. The follicle that has produced the egg for that month (graafian follicle) is further stimulated after midcycle by LH and changes into a yellow body, or corpus luteum. It is the corpus luteum that secretes progesterone. Progesterone has further effects on the uterine lining. It causes a coiling of the blood vessels of the lining, which becomes swollen and tortuous and secretes a thick mucous.

If the egg is fertilized, it will implant on the uterine wall and the corpus luteum will continue to secrete progesterone. If no fertilization occurs, the corpus luteum begins to deteriorate and the progesterone levels decrease. The lining of the uterus starts to break down and menstruation begins. 

Types of Menstrual Cramps 

There are two types of menstrual cramps: primary dysmenorrhea, in which the pain itself is the main problem; and secondary dysmenorrhea, in which the pain is a consequence of another underlying health problem. 

Primary spasmodic dysmenorrhea is the type most commonly found in young women in their early teens to late twenties. It is more common in women who have never borne children. In fact, childbearing seems to mark the end of the primary spasmodic type of cramps in many women. It is characterized by sharp, viselike pains that are caused by a constriction and tightening of the uterine muscle. Some women also feel these sharp pains in the inner thighs and low abdominal muscles, and some additionally experience feelings of hot and cold, faintness to the point of passing out, nausea, vomiting, and bowel changes varying from constipation to diarrhea. The immediate cause of the cramping is that the uterine muscle and the blood vessels that supply the uterus are tight and contracted. Blood circulation and oxygenation to this area are diminished, so the metabolism of the uterus and pelvic muscles is decreased. Waste products of metabolism, such as carbon dioxide and lactic acid, build up, intensifying the pain and discomfort. 

Treatment Options 

Conventional 

Conventional management of PMS symptoms includes drugs which work with either the hormones, water retention, pain, or mood. In some instances a combination of therapies is recommended. These therapies might include oral contraceptives, diuretics, NSAID’s, and anti-depressants. 

Natural Treatment

There are a great many vitamins, minerals, herbal supplements and other natural remedies that have been shown to effectively treat this condition safely and effectively. Which therapies are chosen will be based on the root cause and not just the symptom. Your practitioner will carefully evaluate your situation and put together an effective protocol with natural remedies rather than dangerous medications that merely treat the symptom.

Over­all, it’s more impor­tant to focus on the root cause and what are the under­ly­ing mechanisms that are caus­ing the condition rather than just treat­ing it symp­to­mati­cally. 

Each person is encour­aged to seek out a qual­i­fied nutri­tion­ist or other qualified healthcare practitioner in order to assess exactly which nutri­ents, herbs, home­o­pathics and nat­ural reme­dies; in which com­bi­na­tion; in what pro­por­tion are right for the par­tic­u­lar indi­vid­ual and are intended at treat­ing the root cause rather than just a symptom.