PMS: Natural Therapies That HelpI've yet to meet a woman who enjoys being on her period or experiencing the lovely mood changes that often come with it. Many women simply deal with the irritability and bloating and get on with life (because we are women and that's what we do). But sometimes even the toughest of us need a little relief from our premenstrual problems.
First, a look at what premenstrual syndrome (PMS) is exactly. After ovulation, midway through your cycle, your hormones transition from higher levels of estrogen to higher levels of progesterone. This shift can trigger such symptoms as moodiness, irritability, anxiety, breast tenderness, and bloating.
These symptoms escalate in intensity, then magically disappear when menstruation begins and the hormones reboot. Many of my patients with severe PMS describe a sense of relief when they start their period as they begin to "feel like themselves again." (If you experience anger and irritability throughout the month, that is not hormonal PMS - it could be a sign of depression, so talk to your doctor)
If you experience mild to moderate PMS symptoms and are looking for some relief, there are some natural therapies that might help:
ExerciseAerobic exercise almost always makes you feel better, but especially in the weeks leading up to your period. The endorphins of exercise can help counteract the hormonal blues of PMS and the unpleasant bloating sensation that occurs after ovulation. Thirty minutes of aerobic exercise daily during the week before your cycle has shown to work as well as antidepressants for treating mild PMS symptoms. While exercise may be the very last activity you feel like doing when you have PMS, if you will make it a priority during that time, you will most likely feel better.
What is Premenstrual Syndrome?A week or two before your period starts, you may notice bloating, headaches, mood swings, or other physical and emotional changes. These monthly symptoms are known as premenstrual syndrome or PMS. About 85% of women experience some degree of PMS. A few have more severe symptoms that disrupt work or personal relationships, known as premenstrual dysphoric disorder (PMDD).
Symptoms of PMS
* CravingsMany women get specific cravings when PMS strikes, often for sweet or salty foods like chocolate cake. The reasons for this aren't really clear. Other women may lose their appetite or get an upset stomach. Bloating and constipation are also common.
* AcneAcne is one of the most common signs of PMS, and it doesn't just affect teenagers. Hormonal changes can cause glands in the skin to produce more sebum. This oily substance may clog the pores, triggering a breakout - a visible reminder that your period is on its way.
* PainPMS can trigger a wide range of aches and pains, including:
- Back pain
- Tender breasts
- Joint pain
* Mood SwingsFor many women, the worst part of PMS is its unpredictable impact on mood. Irritability, anger, crying spells, depression, and anxiety may come and go in the days leading up to your period. Some women even have trouble with memory and concentration during this time.
Who Gets PMS?Any woman who has a period can get PMS, but some women are more likely to have symptoms:
- PMS is more likely in the late 20s to mid-40s.
- Older teens tend to have more severe PMS than younger teens.
- PMS may be more severe in the 40s.
- Women who've had at least one pregnancy are more prone to PMS.
- Women with a history of depression or other mood disorder may have more PMS symptoms.
How PMS Affects Other ConditionsPMS can worsen the symptoms of certain chronic conditions, including:
- Asthma and allergies
- Depression and anxiety
- Seizure disorders
What Causes PMS?The exact cause of PMS is not clear, but we do know that levels of estrogen and progesterone drop during the week before your period. Many doctors believe this decline in hormone levels triggers the symptoms of PMS. Changes in brain chemicals or deficiencies in certain vitamins and minerals may also play a role. Too many salty foods, alcohol, or caffeine may make symptoms worse as well.
PMS or Something Else?The symptoms of PMS can be similar to or overlap with other conditions, including:
- Depression or anxiety
- Chronic fatigue syndrome
- Thyroid disease
- Irritable bowel disease
The key difference is that PMS symptoms come and go in a distinct pattern, month after month.
Diagnosing PMS: Symptom TrackerTo figure out whether you have PMS, record your symptoms on a tracking form like this one. You may have PMS if:
- Symptoms occur during the five days before your period.
- Once your period starts, symptoms end within four days.
- Symptoms return for at least three menstrual cycles.
When to See a DoctorIf you have any thoughts of harming yourself, call 911 or get emergency medical care. You should also see your doctor right away if your symptoms are causing problems with your job, personal relationships, or other daily activities. This may be a sign of a more severe form of PMS known as PMDD.
Premenstrual Dysphoric DisorderPremenstrual dysphoric disorder (PMDD) follows the same pattern as PMS, but the symptoms are more disruptive. Women with PMDD may experience panic attacks, crying spells, suicidal thoughts, insomnia, or other problems that interfere with daily life. Fortunately, many of the same strategies that relieve PMS can be effective against PMDD.
Risk factors for PMDD include a personal or family history of depression, mood disorders, or trauma.
* ExerciseExercise can help boost your mood and fight fatigue. To get the benefits, you need to exercise regularly - not just when PMS symptoms appear. Aim for 30 minutes of moderate physical activity on most days of the week. Vigorous exercise on fewer days can also be effective.
* Diet Rich in B VitaminsFoods rich in B vitamins may help fight PMS. In one study, researchers followed more than 2,000 women for 10 years. They found that women who ate foods high in thiamine (pork, Brazil nuts) and riboflavin (eggs, dairy products) were far less likely to develop PMS. Taking supplements didn't have the same effect.
* Complex CarbsComplex carbohydrates, such as whole-grain bread and cereals, are packed with fiber. Eating plenty of fiber can keep your blood sugar even, which may ease mood swings and food cravings. Enriched whole-grain products also have PMS-fighting B vitamins, thiamine, and riboflavin.
* Foods to AvoidYou may be able to ease PMS symptoms by cutting back on these foods:
- Salt, which can increase bloating
- Caffeine, which can cause irritability
- Sugar, which can make cravings worse
- Alcohol, which can affect mood
* Stress ReliefBecause PMS can cause tension, anxiety, and irritability, it's important to find healthy ways to cope with stress. Different strategies work for different women. You may want to try yoga, meditation, massage, writing in a journal, or simply talking with friends. It also helps to make sure you get enough sleep.
* OTC DrugsOver-the-counter pain relievers can ease some of the physical symptoms of PMS, such as breast tenderness, headaches, back pain, or cramps. OTC drugs that work well for these symptoms include:
- Ibuprofen (Advil, Motrin, Midol Cramp)
- Naproxen (Aleve)
* Hormone TreatmentsBirth control pills prevent ovulation by regulating hormones. This usually leads to lighter periods and may reduce the symptoms of PMS. Other hormonal treatments may include GnRH agonists lupron or nafarelin, or synthetic steroids such as danazol. You may need to try more than one type before you find one that gives you relief.
* Other MedicationsAntidepressants may help women with severe mood swings or PMDD. The most commonly used drugs are known as SSRIs. However, other types of antidepressants are often prescribed to treat PMDD. Some antidepressants may be taken for 10 to 14 days before each period or throughout the menstrual cycle. Those prescribed to treat PMS include:
- Fluoxetine (Prozac, Sarafem)
- Paroxetine HCI (Paxil CR)
- Sertraline (Zoloft)
- Nefazodone (Serzone)
- Clomipramine (Anafranil)
- Other treatments for PMS include anti-anxiety medications (Xanax, Buspar) and diuretics (HCTZ, Aldactone).
Studies suggest the following vitamin and mineral supplements may reduce PMS symptoms:
- Folic acid (400 mcg)
- Magnesium (400 mg)
- Vitamin E (400 IU)
- Calcium (1,000 mg to 1,300 mg)
- Vitamin B6 (50 mg to 100 mg)
* Herbal ExtractsHerbal remedies for PMS haven't been well studied, but some women get relief with chaste berry, black cohosh, and evening primrose oil. Check with your doctor before trying these herbs. They may interact with medications or be harmful to people with certain chronic conditions.
There are a lot of herbal therapies that claim to treat PMS. Most of these claims are flimsy, but there are a couple that do have some science to back them up. Though the studies were small, Vitex (chaste berry) is an herbal therapy that has been shown to reduce PMS symptoms over placebo with minimal side effects. It is available over the counter, and the recommended dosing is 20-40 mg daily. Serenol is another herbal supplement composed of Swedish pollen extract that has also been shown to help PMS symptoms. Be sure to talk to your doctor before starting any herbal therapies or supplements.
There is increasing data linking low magnesium to mood changes. Magnesium supplementation in the second half of the cycle is a reasonable option for women whose main symptoms are mood-related.
Cognitive Behavioral Therapy
Therapy has been used successfully to treat depression and anxiety, and some women also find it helpful for PMS as well. Studies are conflicting on the effectiveness of therapy for PMS, but if your symptoms are primarily mood-related, cognitive therapy might be an option for you. If your primary symptom is anxiety, stress-relieving activities such as meditation, yoga or practicing mindfulness might also be good options to try.
Acupuncture has been shown in a few small studies to be helpful for both the physical and emotional symptoms of PMS, reducing symptoms by up to 20 percent over placebo.
My gynecology textbooks instruct me to tell my patients to avoid salt, chocolate, caffeine, and alcohol to help reduce their PMS symptoms and increase their carbohydrate intake. I am assuming that was written by a man who has never actually HAD PMS because that advice seems quite impossible to adhere to (other than the increasing carbs part). However, if you find yourself with more willpower than I have and want to try this strategy, then definitely go for it and let me know how you feel. A more realistic plan may be to cut out each of those items individually during different cycles and track your symptoms in a diary to see how they affect your symptoms.
What Doesn't Help
In the past, calcium and vitamin B6 supplementation have been recommended for PMS symptoms, but newer studies are suggesting these are not effective. They can also cause side effects at larger doses (kidney stones for calcium and nerve problems with vitamin B6).
If natural therapies haven't worked for you and your co-workers are demanding that you work from home the week before your cycle, then perhaps it might be time for tradition medications. Oral contraceptives (the birth control pill) works by keeping your hormone levels at a steady state to prevent ovulation and therefore preventing the hormonal shifts that cause PMS. Antidepressants are also effective at treating PMS, reducing symptoms by up to 70% in most women.
PMS can be a real nuisance, but luckily the offending symptoms can often be helped by increasing exercise, using herbal and other therapies, and being mindful of your stress during that portion of the month. If the more natural solutions don't help and you find your PMS affecting your life and relationships, talk to your provider about medical options that might work for you.