Pre-Menstrual Syndrome

Many women are all too familiar with the often unpleasant symptoms of PMS. Affecting both body and emotions, this condition can be difficult to diagnose – except that it begins the weeks or so before menstruation and then disappears.

What is it?

Before their period, many women experience fits of crying, cravings for sweets and outbursts of anger. These, as well as some 200 other symptoms, including fatigue, depression, bloating, headaches, and breast pain, characterise the condition known as premenstrual syndrome (PMS). Typically, these monthly symptoms vary in number and severity. Most women experience few of them or are only mildly inconvenienced by them. For 5-10% of women, however, PMS can be so severe that it interferes with their ability to live a full and rich life.

What causes it?

Just why some women suffer from PMS and others don't is not known. Some experts believe PMS may stem from an imbalance of the female hormones oestrogen and progesterone during the second half of the menstrual cycle, after ovulation. Too much oestrogen, along with too little progesterone, limits the production of the brain chemicals that control mood and pain, and this hormonal abnormality can lead to mood changes and carbohydrate cravings. The imbalance also triggers increased levels or the hormone prolactin, which results in breast tenderness. If the liver isn't working as well as it should, its ability to clear excess oestrogen from the body is reduced.

Another theory is that PMS symptoms are caused by low levels of serotonin, a brain chemical (neurotransmitter) that sends signals from nerve cell to nerve cell. Although the results of studies examining the connection between serotonin and PMS are inconsistent, may women report that their PMS symptoms improve when they undergo treatment designed to return serotonin levels to normal. Improving the body's production and use of serotonin is particularly helpful in lifting depression.

What are the symptoms?

One to two weeks before monthly menstruation begins:

• Irritability; mood swings; anxiety; depression.
• Abdominal bloating; swelling of hands and fingers.
• Breast pain and tenderness.
• Fatigue; lack of energy; insomnia.
• Headache; backache; joint and muscle aches.
• Constipation; diarrhoea; various urinary disorders.
• Cravings for specific foods, especially carbohydrates.

Are there any natural supplements?

Chaste tree is a leading PMS remedy in Europe. It acts on the pituitary gland in the brain (which controls the production of oestrogen and progesterone in the body) and may be useful in correcting hormonal imbalances. The herb dong quai (200 mg three times a day) may enhance chaste tree's effectiveness; combination products with additional herbs such as black cohosh are often available.

In place of chaste tree, try vitamin B6. It assists the liver in processing oestrogen, increases progesterone levels and enables the brain to make serotonin. (Some practitioners recommend combining chaste tree and vitamin B6.) Evening primrose oil, with its essential fatty acids, may help ease breast tenderness and control carbohydrate cravings. Many women with PMS have been found to be deficient in magnesium and may benefit from taking a supplement.

Start taking chaste tree and/or vitamin B6 in combination with evening primrose oil at ovulation and continue until your period beings; also have magnesium every day. If your primary PMS symptoms is depression, or if the other supplements are not effective, add St John's wort to yoru supplement program.

What else can I do?

• Exercise several times a week to lift your spirits and help your body release fluids that cause bloating and breast tenderness.
• Cut back on caffeine, alcohol and salt, which can contribute to PMS.
• Keep a symptoms diary. It can give you a sense of control and a better understanding of your physical and emotional feelings, help with accurate diagnosis and help to determine which treatments work for you.

Did you know?

Evening primrose oil, chaste tree and St John's wort are widely used in Europe to alleviate PMS, and have withstood the test of time. Such treatments are becoming more common in Australia and New Zealand.