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WOMEN'S HEALTH: PREMENSTRUAL SYNDROME
What is PMS?
Premenstrual syndrome, also called premenstrual tension, is a term applied to a group of physical and emotional symptoms which occur in women during a specific period of time before the onset of the monthly menstrual period, with a symptom-free period of time following the monthly menses.
What are the symptoms?
The symptoms vary for each woman. They may include mood swings, anxiety, hostility, headache, irritability, craving for sweets along with increased appetite and a craving for chocolate, depression, forgetfulness, crying, and confusion. Physical symptoms may include weight gain, swelling of extremities, breast tenderness and abdominal bloating. In general, PMS is described as a feeling that makes coping difficult.
Is PMS common?
Some people do not believe PMS exists except as another vague and general complaint. Others think it is a mental attitude and still others believe it is "part of being a woman"--being unpredictable, changeable, moody, and even hysterical. It is most common in women in ages 20-40. An estimated 15-20 million women are affected. Studies indicate that 20-40% of all women suffer some degree of PMS that alters their life style.
What causes PMS?
The causes of PMS are not yet known or fully understood. Explanations include progesterone deficiency, vitamin deficiency, prolactin excess, stress, and psychosomatic causes. It is believed to be a neuro-endocrine disorder occurring from altered hormonal balance. One current theory is that of an imbalance of the two females hormones, estrogen and progesterone. Just after ovulation, levels of progesterone should be higher than levels of estrogen. Excess estrogen should be inactivated by the liver with the help of the B vitamins, especially B-6. If the liver is unable to deactivate estrogen, an imbalance of progesterone and estrogen occurs. The symptoms appear during the ovulatory phase of the menstrual cycle, the last two weeks before menstruation begins. Treatment based on this theory is aimed at helping the body correct the hormone balance.
Diet and PMS
Diet plays an important role in controlling the symptoms of PMS and needs special attention, especially during the last two weeks of the cycle. The old saying "garbage in, garbage out" is multiplied for the woman with PMS symptoms.
Food is necessary to absorb and utilize vitamin and mineral supplements. Proteins are essential building block for hormone production including neuroendocrine substances (dopamine) needed for balance and a sense of well-being. It is thought that some of the PMS symptoms are caused by a deficiency of B-6 which is necessary for the breakdown of estrogen and allows for an increase in the level of progesterone.
Magnesium is needed for dopamine production and kidney function. Dopamine is a hormone which produces a sense of well-being and helps to balance adrenal and kidney function thus minimizing fluid retention as well as other activities. Calcium is needed to absorb magnesium but too much calcium blocks magnesium. Therefore, excessive use of dairy products can create a high calcium balance and inhibit magnesium. Likewise, use of refined sugars interferes with kidney and adrenal function and adds weight through fluid retention. Refined sugars also tend to create erratic insulin response and causes mood changes, increased appetite, headaches, and fatigue.
General Dietary Guidelines
- Regular eating schedule with small portions and snacks between meals. Eat larger meals earlier in the day.
- Aim at high protein foods and rely more on poultry, fish, whole grains, and legumes as the source of protein instead of red meats and dairy products.
- Limit or avoid refined sugars, alcohol, and caffeine (coffee, colas, and chocolate).
- Limit salt and tobacco use.
- Increase complex carbohydrates found in green, leafy vegetables, whole grains and cereals. These foods are high in magnesium and calcium.
- Add vitamin and mineral supplements:
Vitamin B complex, especially B-6. Recommended dose is to be started mid-menstrual cycle (two weeks after starting menses) and stopped on first day of the next menstrual cycle. Take 50 mg of B6 twice daily with food (to avoid stomach acidity) during the first month. During the second month of treatment, increase dose to 100 mg B6 twice daily during last two weeks of the cycle. Maintain this dose for at least 6-9 months. Improvement in symptoms may not be noticed for 2-3 months.
Magnesium supplements found in tablets or in Milk of Magnesia. Start with 500 mg or 2 tsp daily, but no more than 3 grams daily during the last two weeks of the cycle.
Other Treatment Suggestions
- Regular aerobic exercise program. Aerobic means a measurable effect on the heart rate and respirations and not just active at work! Exercise early in the day before you get tired.
- Reduce stress--do not over-schedule yourself during week before menses. Cancel appointments/comittments as needed. Ask for help from significant other, family or friends.
- Stop negative thinking and avoid playing the victim. Negative thinking creates a vicious cycle.
- PMS does not excuse our behavior and communication. You are responsible for everything you say and do.
Written by: Pam DeVisser, FNP
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