Premenstural syndrome (PMS) management

Do you yell, scream and show anger for small things, only to realize later that you over reacted? Do you then remember that you are just a week away from your monthly cycle, which makes you realize that you are already in distress – bouts of headache, stomachaches, and backache have all returned after 28 days. Your body is unwillingly welcoming those dreadful days of the month and those thoughts of painful days haunt you. Ever looked for a solution to get freedom from these pains and live those days like just any other day of the month – happy, active and feeling healthy? If you are looking for a solution, then you have banged on the right page. For a start let’s first understand the melancholy of hormones and their effect and what works the best for you....

Hormones are chemical messengers produced by the endocrine glands into the bloodstream; they travel to target distant organs to carry out their physiologic or behavioral functions. One could even say that these hormones play a major role in designing the personality of an individual. Now coming to the hormones that are dear to the women’s health and happiness, it has been studied that the level of hormonal signals communicating within a woman’s body largely defines her health and moods too. Hormones that are exclusive to females are estrogen, testosterone and progesterone; all secreted by the ovaries and are collectively known as the female sex hormones [1].

Sparing a moment to learn the surge and plunge game of sex hormones in a female could give us a better understanding of a woman’s physiologic and psychological behavior around a month. Starting from the day 1 count of the menstrual cycle, let us take a look at the 3 hormonal levels and their effects during the course of the underlying 4 weeks before the start of the next cycle [2].

Graphical representation of rise and fall of the three hormones during a month’s cycle period considering a 28 days cycle [4]
Graphical representation of rise and fall of the three hormones during a month’s cycle period considering a 28 days cycle [4]
Cycle Week Hormonal levels Physiologic and psychological changes
Week 1 (Day 1-7) Estrogen rises Gradual decrease in fatigue, boosting energy, Socially active
Week 2 (Day 8-14) Estrogen and testosterone rises Boost in your outward looks, optimistic, confident, sharp memory, socially and romantically active
Week 3 (Day 15-22) Initially: Progesterone rises; Estrogen and testosterone level drops; Then Estrogen rises again Pre-PMS phase: Light irritability, fatigue, less social interests, decreased libido and orgasm; craving for sugar, fat and salt-rich foods.
Week 4 (Final 6 days) Estrogen and progesterone level drops PMS-related symptoms: Moodiness, the blues, hot flashes, muscle aches, insomnia, headaches, and fatigue.

As we see in the above graphical representation of hormone level and its effects as jotted down in the table above, we observe that the week 4 of the month’s cycle is not a very happy and happening time of the month in a woman’s routine life due to the unpredictable mood swings and tiredness one comes across, these changes are termed as Premenstrual Syndrome (PMS).

Premenstrual syndrome is the occurrence of few or more symptoms during a week or two before the start of menstrual cycle. The symptoms are likely to disappear once the menstruation starts. While for some woman the symptoms are mild with very little or no discomforts affecting their routine, but for some other women the effects may be so severe that it makes it hard to even get through the day arising need for medical attention. PMS goes away when your monthly periods stop, such as when you get pregnant or go through menopause [3]. PMS can affect menstruating women of any age and the intensity of symptoms may vary in each woman depending their body nature, lifestyle, diet etc.

Evangeline-Lilly

"For years, I'd struggled with depression. I'd tried medication, but I hated it and went off of it after two weeks. But within a year or two of eating organic as I could, I realized that without even being conscious of it, the fog of depression had been lifting."

Evangeline Lilly, Canadian actress and author
Representation of physiological and psychological symptoms of PMS during the luteal phase of the monthly cycle
Representation of physiological and psychological symptoms of PMS during the luteal phase of the monthly cycle

Some of the symptoms indicating PMS are acne issues, swollen or tender breasts, fatigue, insomnia, bloating, constipation, or diarrhea, headache or backache, appetite changes or food cravings, hot flashes, joint or muscle pain, trouble with concentration or memory, tension, irritability, mood swings, anxiety or depression. However, these symptoms can be brought to control by changing one’s routine lifestyle and diet plan. Below is a list of natural herbs and food spices that helps in dealing with severe PMS conditions.

Crystina-Northup

"If you do not get your PMS under control in your 20s and 30s, it will come screeming into your 40s", Northrup also states "Perimenopause can be the mother of all PMS attacks. And it can last quite a while".

Christiane Northrup, MD, Authority in women's health and wellness

Natural herbs that are well studied and proved to treat PMS symptoms

Black cohosh (Actaea racemosa, Cimicifuga racemosa):

black-cohosh

The plant is native to North America and belongs to the buttercup family. The underground stems and roots of black cohosh are used to make strong teas (infusions), capsules, solid extracts used in pills, or liquid extracts (tinctures) [6].

Remedial cure of PMS symptom: Reduces hot flashes and night sweats

Scientific proof: Black cohosh acts as a phytoestrogen that acts very much like estrogen in your body and knocks out progesterone in luteal stage and causes a balance among the hormones to be restored [9]. It is shown to significantly decrease depression, anxiety and vaginal dryness symptoms in a study consisting of women less than 40 years. It is concluded that black cohosh may be a safe and effective alternative to estrogen replacement therapy (ERT) for women [7].

Dosage: 20-80 mg once or twice daily [8].

Chasteberry (Vitex agnus-castus):

chasteberry

The chaste tree originated in Central Asia and the Mediterranean region. The extracts obtained from the dried ripe chasteberry fruit is used to prepare capsules and tablets [6].

Remedial cure of PMS symptom: Used to treat acne, headaches and migraines, inflammation, nausea, diarrhea and joint pain; and helps to restore hormonal balance during PMS [9].

Scientific proof: Randomised, double blind, placebo controlled study on observation on the effects of vitex treatment over three menstrual cycles resulted in significant improvement in PMS related symptoms like irritability, mood alteration, anger, headache, and breast fullness in the vitex-treated group compared to the placebo-treated group [10].

Dosage: The most common dosage of chaste berry when for pms is between 80 and 220 milligrams [9].

Evening primrose oil (Oenothera biennis)

evening-primrose-oil

An origin of North America, but is also found growing in Europe and parts of the Southern hemisphere. The oil is extracted from the seeds of the primrose plant and filled into capsules. Evening primrose is rich in the fatty acid gamma-linolenic acid (GLA) [6].

Remedial cure of PMS symptom: PMS-related hot flashes, breast soreness and abdominal cramps and pain [9]

Scientific proof: Three double-blind, placebo-controlled studies, and one large open study on new patients all demonstrated that evening primrose oil increased prostaglandin E1 to maintain the levels of prolactin and is a highly effective treatment for the depression and irritability, the breast pain and tenderness, and the fluid retention associated with the premenstrual syndrome [11].

Dosage: 500 to 1,000 mg once daily [12]

Raspberry leaf (Rubus idaeus)

raspberry-leaf

Red Raspberry is native to Europe and Northern Asia and popularly known for the small red fruits they bear. Their leaves are of therapeutic value and are processed and sold as dried leaf powder, leaf extract and dried capsules [13].

Remedial cure of PMS symptom: To treat pms symptoms of cramping, vomiting, nausea and diarrhea. It helps to slow down cramping during PMS by slowing down the speed of blood flow through the body [9].

Scientific proof: Raspberry leaves are studied to have estrogen-like effects [8]. Tannins and flavonoids are the two primary constituents of raspberry leaves [7]. A study done on animal models tested dried raspberry leaf extract for relaxant activity. The study results showed that at least two components of the extract exhibited relaxant activity [9].

Dosage: 2-3 cups of Raspberry leaf tea per day to maintain hormonal balance [9].

Dong Quai root (Angelica Sinesis)

dong-quai-root

Popularly known and grown in China and Japan, also called the “female ginseng”. The root of this herb is dried, processed and sold as tablets, dried herb, extract, tea and tinctures. They function as phytoestrogens.

Remedial cure of PMS symptom: symptoms such as PMS cramps, heavy menstrual bleeding, headaches and migraines, as well as mood swings, bloat and water retention [9]

Scientific proof: The essential components of dong quai are coumarins that dilate blood vessels, stimulate the CNS and increases blood flow throughout the body. They also relax the smooth muscles of the uterus, and help to reduce menstrual cramps [13].

Dosage: Take 600 mg daily, either in the form of 200 mg pills three times a day, or 30 drops (1.5 ml) of fluid extract three times a day [13].

Cramp bark (Viburnum opulus)

cramp-bark

Grows in North America. The bark and root bark are used for medicinal purposes and generally infused to make tea [8].

Remedial cure of PMS symptom: Reduces abdominal pain, back pain and thigh pain caused by menstrual cramping.

Scientific proof: A laboratory study has found an interesting component present in the bark called as viopudial and is observed to have antispasmodic effects on smooth muscle. As of yet, their effects on human are yet to be carried out [15].

Dosage: Boil 2 tsp. dried bark in 1 cup water then simmer for 15 minutes; drink 3 times per day [14].

St. John's wort (Hypericum perforatum)

st-johns-wart

Native to Europe but is commonly found in the US and Canada. The flowering tops and leaves of the plant are used to prepare teas, tablets, and capsules containing concentrated extracts. Liquid extracts and topical preparations are also used.

Remedial cure of PMS symptom: PMS related anxiety, mood swings and depression [8]

Scientific proof: The extracts of St. John's wort contain 2 chemicals namely, hypericin and hyperforin that act as chemical messengers in the nervous system to regulate mood. A study showed the action of hyperforin blocking the reuptake of the neurotransmitters norepinephrine, serotonin, and dopamine and thereby acting as an antidepressant [16].

Dosage: 0.3% hypericin dosed at 300 mg once daily for PMS [8].

German chamomile (Matricaria recutita)

german-chamomile

Chamomiles are grown in many countries throughout Europe. They are a sweeter variety of the two existing chamomiles (namely, German and Roman) [7]. The flowering tops of the chamomile plant are used to make teas, liquid extracts, capsules, or tablets [6].

Remedial cure of PMS symptom: PMS related stress and cramps

Scientific proof: Chamomile is found have sedating and muscle relaxing properties, which helps in addressing menstrual cramps and PMS related insomnia and anxiety disorders [13].

Dosage: 2-3 cups a day for antispasmodic effects [13].

Wild yam (Dioscorea villosa)

wild-yam

This yam is a tuberous root native to North America. The dried root is made in to powder to form capsules or made into cream for topical application. It contains chemical diosgenin, which has to be chemically converted into estrogen and progesterone for its therapeutic use [8]. They are commercially available as tablets, capsules and cream for topical application.

Remedial cure of PMS symptom: Used to treat vaginal dryness, menstrual cramps,

Scientific proof: A study conducted on postmenopausal women to see the effects of serum level of steroid hormones after consuming wild yams in their diet. A significant increases in serum estrone, SHBG, and estradiol was observed, but no changes in serum dehydroepiandrosterone sulfate, androstenedione, testosterone, follicular stimulating hormone, and luteinizing hormone levels. Hence, diosgenin in yams need chemical processing to bring out the estrogenic effects [17].

Dosage: 400 mg pills once daily

Natural food flavoring spices as remedy for PMS

Uses of spices in flavoring of foods have also gained its importance over health benefits for ages. Spices have been researched and studied extensively for their actions at cellular levels in the past few decades. Studies in India have explored the potential of various spices for its anti-inflammatory, cholekinetic and anti-oxidant actions focusing on its preventive effect on precarcinogenic, anti-inflammatory, anti-spasmodic and much more in both animals and humans [19].

Ginger root (Zingiber officinale):

Ginger root is native to Asian countries and have been used for therapeutic purposes for ages. This rhizome is also used as a spice for flavouring in dishes. Medicinally they are made into tablets, capsules, massage oils and dried root tea powder.

Remedial cure of PMS symptom: PMS related menstrual cramps and abdominal pain before start of menstruation [7,8].

Scientific proof: Technically ginger root lowers the level of the body’s natural pain-causing compounds called prostaglandins. In a randomized, double-blinded, and placebo-controlled study, 70 women aged between 18-35 years, received 250 mg/12 hours ginger capsules in comparison to placebo treated groups. Results showed ginger treated groups handled PMS related symptoms better in terms of mood swings and abdominal pains [18].

Suzanne-Somers

"All those spices and herbs in your spice rack can do more than provide calorie-free natural flavorings to enhance and make food delicious. They're also an incredible source of antioxidants and help rev up your metabolism and improve your health at the same time"

Suzanne Somers, Americal actress, author, singer, businesswoman and health spokesperson

Fennel seeds (Foeniculum Vulgare)

This herb is native to Southern Europe and minor parts of Asia. The seeds of this flowering plant is used for medicinal and food flavoring purposes. The seeds are studied to be phytoestrogenic. The seeds can be boiled to make a tea, or the seeds can be chewed as it is with absolutely no side effects.

Remedial cure of PMS symptom: PMS related bloating and pain, body water retention

Scientific proof: A single blind randomized clinical trial; consisting of 90 students with moderate to severe PMS were intervened with fennel extracts and compared with placebo group. The results showed significant decrease in the severity of overall symptoms of PMS like anxiety, depression, sleep disorders, headache, sweating, hot-flushes, increased appetite, heart palpitation, fatigue, reduced energy, fluid and electrolyte retention symptoms, breast tenderness, backache, abdominal cramps and pain in muscles and joints in the fennel treated group [20].

Dosage: 2-3 cups of tea in a day is effective

Cinnamon bark (Cinnamomum zeylanicum)

This is a small tree native to Sri Lanka. The bark of the tree is used for both food flavoring and medicinal purposes. Cinnamon bark is used to make powders, capsules, teas, and liquid extracts.

Remedial cure of PMS symptom: PMS related cramps and pains

Scientific proof: The extracts of the bark is considered a painkiller due to its prostaglandin-inhibiting action. The bark extracts has antispasmodic properties. A randomized double-blind trial, consisting of 76 female students received placebo or cinnamon and observed for severity of pain and nausea. Significant effects of cinnamon on reduction of pain, menstrual bleeding, nausea and vomiting with primary dysmenorrhea without side effects were observed [21].

Dosage: 2-3 cups of tea can be taken when in pain

Likewise, introducing a set of health benefitting natural herbal ingredients in form of dietary supplements or freshly brewed concoctions or teas during the days meal helps not only to address PMS but also benefits the overall health of a woman. And in general including dry fruits and fish increases omega-3 and helps in handling depression and mood swings. Exercising everyday for at least 30 minutes would be add on to maintain healthy hormones in natural way [5].

Cynthia-McFadden

"I stopped eating everything that I like. My idea of the perfect meal is pasta with a baked potato and some bread. But instead, I ate a lot of fish and veggies and lost 35 pounds."

Cynthia McFadden, Americal television journalist, Hollywood reporter

References:

  1. HormoneHealth Network: What Are Hormones, And What Do They Do?
  2. Hormone Horoscope: Female Hormone Cycle
  3. WomensHealth.gov: Premenstrual syndrome (PMS) fact sheet
  4. Women in Balance Institute: About Hormone Imbalance
  5. WebMD: 8 Diet Dos and Don'ts to Ease PMS
  6. Herbwisdom.com: Herbs
  7. WebMD: Vitamins & Supplements Center
  8. ThePeriodeVitamin: Home
  9. BMJ 2011: Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study, R Schellenberg
  10. Journal Reprod Med, 1983 - The role of essential fatty acids and prostaglandins in the premenstrual syndrome, Horrobin DF
  11. Univ. of Maryland Medical Center: Premenstrual syndrome
  12. WholeHealth Chicago: Home
  13. Univ. of Maryland Medical Center: Menstrual pain
  14. Wllness Library: Cramp bark
  15. International Journal of Pharmacy and Pharmaceutical Sciences, 2013 - Hyperforin: A potent anti-depressant natural drug, Lala Ram Jat
  16. Journal of the American College of Nutrition, 2015 - Estrogenic effect of yam ingestion in healthy postmenopausal women, Wu WH, Liu LY, Chung CJ, Jou HJ, Wang TA
  17. Obstetrics and Gynecology, 2014 - Effect of Treatment with Ginger on the Severity of Premenstrual Syndrome Symptoms, Samira Khayat, Masoomeh Kheirkhah, Zahra Behboodi
  18. Univ. of Maryland Medical Center: Ginger
  19. Asia Pacific Journal of Clinical Nutrition, 2008 - Traditional Indian spices and their health significance, Kamala Krishnaswamy MD
  20. Journal of Reproduction & Infertility, 2011 - Comparing the Effects of Echinophora-platyloba, Fennel and Placebo on Pre-menstrual Syndrome, Masoumeh Delaram, Soleiman Kheiri, Mohammad Reza Hodjati
  21. Iran Red Crescent Med Journal, 2015 - The Effect of Cinnamon on Menstrual Bleeding and Systemic Symptoms With Primary Dysmenorrhea, Molouk Jaafarpour, Masoud Hatefi,Fatemeh Najafi

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