“Why am I so angry?” – Understand premenstrual syndrome (PMS)
When it comes to PMS and other menstrual disorders, women are often frustrated by the lack of understanding and adequate care they receive from conventional sources. “A week before my period, I’m so cranky I could rip my husband’s head off,” is a common statement. Oral contraceptives appear to be the comprehensive treatment of choice for many of these conditions, and while artificial hormone stabilization can alleviate PMS problems, it does not help find the cause of the problem.
Natural medicine has a lot to offer those who suffer from PMS, since it attacks the root of the problem. In my practice in Brisbane, I help women unravel the cause of their particular pattern of PMS symptoms.
Let’s take a look at what’s going on.
PMS is defined as the multitude of well-known symptoms that begin 1-2 weeks before the period. These include
- brisket bread
- mood changes such as anger or depression
- Headaches
- acne
- digestive discomfort such as bloating, constipation, or diarrhea
- weight gain and water retention
- sugar cravings
- fatigue often 1-2 weeks before period.
All symptoms MUST resolve by the start of the period to be classified as PMS or something else is going on.
Hormonal Balance
From the first day of your period until ovulation (usually around day 14), estrogen slowly increases and decreases after the egg is released from the ovary. In a normal menstrual cycle, progesterone is the main hormone after ovulation; helps offset some of the strong effects of estrogen.
A common finding in patients with PMS is an elevated estrogen/progesterone ratio in which estrogen is abnormally elevated compared to the level of progesterone. This may be due to inefficient hepatic clearance of estrogen or mild progesterone deficiency.
Another reason progesterone is low in the second half of the cycle is stress. Stress increases a hormone called cortisol. When stress is ongoing, progesterone is taken from the menstrual cycle to be converted into cortisol. This is a protective mechanism: since the body thinks it is running from a tiger, it considers cortisol to be more important than the reproductive hormone progesterone.
irritability and depression
Not only can high estrogen cause all the symptoms of PMS, but an elevated estrogen/progesterone ratio has also been shown to impair the proper synthesis of neurotransmitters, such as “feel-good” serotonin. This may be because estrogen depletes levels of B6, which is a vitamin needed to produce adequate levels of serotonin.
B6 levels are frequently low in depressed patients, especially those taking estrogens such as the birth control pill or menopausal medications such as Premarin.
Women with PMS also often experience anger. Energetically, anger can be a common sign of liver congestion and estrogen overload.
estrogen dominance
The total amount of estrogen in your body is determined by
- how much it produces (technically, all estrogen starts out as testosterone and is converted in the ovaries or fat tissues, known as endogenous estrogen)
- how much comes from outside (from hormones in animal products, chemicals in cosmetics, etc., known as exogenous estrogen)
- and how well you detox both
Estrogen that is too high is known as estrogen dominance, a condition associated with PMS, breast cancer, uterine fibroids, and endometriosis.
Other hormonal influences
In addition to the effects mentioned above, excess estrogen has also been linked to an increase in aldosterone secretion 2 to 8 days before menstruation, leading to fluid retention, a common complaint in PMS. Endogenous and exogenous estrogens can also increase prolactin secretion by the pituitary gland. Elevated prolactin has been linked to progesterone deficiency, breast pain, fibrocystic breast disease, and hypothyroidism.
Hypothyroidism affects a large percentage of women with PMS and therefore should not be underestimated. If symptoms persist, a simple blood test can identify flagrant thyroid dysfunction.
Natural Approaches for PMS
It is always important to know what type of PMS you are experiencing before embarking on a treatment plan. The suggestions below are just examples of a wide variety of professional treatments.
Diet: In my practice, diet and lifestyle recommendations are always the foundation on which I build my treatment plan. I often start treatment with a cleansing diet for 2-4 weeks, after which I focus on specific dietary changes. Depending on the symptom picture, a typical dietary recommendation for a PMS patient may be to reduce all animal products to decrease exogenous estrogens and saturated fat. To put this in context: Vegetarian women excrete two to three times more estrogen in their feces and have 50% less free estrogen than their omnivorous counterparts. Overall reduction in fat, sugar, and salt has been shown to significantly improve PMS symptoms in some women.
Liver detoxification: The liver is a very important organ of detoxification. Estrogens are detoxified through the 2 main pathways of liver detoxification. Abstaining from alcohol, caffeine, chemicals, and processed foods can reduce the overall detox load on the liver. Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage) contain Indole-3-carbinol, a potent compound that aids in the liver’s detoxification of estrogen. This is also available in pill form from a qualified naturopath.
The gut: Another important aspect of the treatment of premenstrual syndrome is to establish an adequate intestinal flora. To detoxify estrogen, the liver binds it to glucuronic acid which prevents the reabsorption of estrogen in the intestine. Unwanted gut bacteria produce the enzyme beta-glucuronidase which cleaves this bond and allows these estrogens to re-enter the circulation, adding to the total estrogen pool. Increasing fiber and adding probiotics to the treatment protocol can be very beneficial.
Exercise and stress reduction. have been clearly documented in the literature to reduce PMS symptoms.
Specific herbs and nutrients
A professional naturopath has many herbal remedies and nutrients to design an individualized treatment plan.
By far the most commonly used herb in PMS is Vitex agnus-castus (chaste tree berry). It is so effective in regulating menstruation and lowering prolactin that it has been written into Europe’s prestigious “German Commission E”, a scientific database on herbal substances.
B6 and magnesium are important for proper serotonin production, especially in cases of estrogen dominance. It also seems to help with sugar cravings before your period.
