The case of premenstrual syndrome (PMS)
Much has been written about the management of premenstrual syndrome and it is said to affect up to 90 per cent of menstruating women in varying degrees of severity.
A 35-year-old woman visited the clinic complaining of significant premenstrual symptoms that were interfering with her lifestyle — and they seemed to be getting worse. During the week prior to her menstrual cycle, she was experiencing swollen breasts, fluid retention, sugar cravings, abdominal bloating, constipation and fatigue. On the first day of her cycle, she had severe abdominal cramping (dysmenorrhea), which necessitated her taking four-hourly Nurofen to get her through the day. Her anxiety also increased during this time and sleep patterns deteriorated.
Her cycle was about 29 days and reasonably regular, indicative of a relatively normal follicular phase (the first two weeks of the cycle), but the luteal phase (the second half of the cycle) was where the problem manifested. The symptoms she was experiencing were typical of an oestrogen excess/progesterone deficit in the luteal phase of her cycle — a very common problem today.
She often had a recurrence of acne premenstrually and her skin was very dry overall. She had been trying to conceive a baby for 12 months but was having problems. Her daily temperature showed she was ovulating most months, but her temperature was generally low, indicating subclinical thyroid under-function.
While she was trying to eat well, she had a busy life, substantial stress and rarely had time to cook at home, so eating out or takeaway was the usual option. She was trying to be largely vegetarian, was very fond of pasta and ate these three to four times a week. Generally, she consumed a high carbohydrate and dairy diet with inadequate variety of nutrients. She was drinking about 2L of tap water daily (with two cups of coffee with one sugar) and exercising sporadically.
From a naturopathic perspective, she had the classic symptom of a luteal phase defect where her oestrogen levels were too high in the second half of her cycle. These days, many people in Western societies are increasingly oestrogen dominant, partly due to the chemical overload of the liver detoxification pathways that normally would metabolise oestrogen correctly.
Changing her diet and filtering her water supply were crucial items. She needed to introduce non-farmed fish into her diet about three to four per week — providing zinc, protein and iodine for thyroid function. She also needed to significantly increase her intake of leafy green vegetables for folate and magnesium. Foods high in dietary prebiotic fi bre along with high-probiotic foods (kefir) were recommended to improve gut function. Filtering tap water removes copper (dissolved from the water pipes), which competes with zinc in the body — increasing zinc excretion.
A zinc formula, which included zinc and its cofactors — magnesium, B6 and manganese — was added along with twice-daily fish oil capsules (omega-3). Magnesium powder was included. The omega-3 fatty acids were recommended as they reduce inflammation and are highly indicated when a person has dry skin.
Higher levels of oestrogen are also associated with an increase in candida albicans (symptoms of increased sugar cravings, bloating and constipation), so this also needed to be managed.
Herbally, the main herb to consider was Vitex anguscastus (Chaste tree) — a major herb to improve luteal phase defects (increases progesterone and lowers oestrogen in the luteal phase). This only needs to be taken for the last two weeks of the cycle, so is usually given separately. This potentially would also improve her chances of conceiving as low luteal progesterone reduces the ability to retain a fertilised embryo.
A herb mix to improve liver function, hormonal balance, reduce dysmenorrhea and manage the candida overgrowth and sugar cravings was prescribed consisting of cramp bark, dandelion leaf and root, gymnema, pau d’arco, schisandra and St Mary’s Thistle.
A regular exercise programme was introduced four times a week and she was advised to avoid coff ee for the last two weeks of the cycle.
While this took some weeks to gradually incorporate into her lifestyle, she progressively improved. Premenstrual problems, due to their cyclical nature, often take several months to manage, but she stuck with it and 12 months later has become almost symptom free and is feeling much healthier and happier.
