PMS – The Jekyll and Hyde Syndrome

Screen Shot 2016-08-12 at 2.39.11 PMDo you feel like the typical “split personality” prior to your period?

Or are you holding your breath in anticipation of the physical discomfort that surrounds your menstrual cycle?

PMS affects 90% of women and it has been estimated that almost 3000 days of severe symptoms occur during a woman’s reproductive years.

Yet despite its high prevalence, PMS remains poorly understood and therefore inadequately prioritised and treated.

It is widely believed (incorrectly) that PMS is just part of the menstrual cycle process that has to be endured.

In the recent two decades, various treatments have been used to prevent this syndrome.

To date, treatment is aimed primarily at symptom relief.

The medical profession routinely uses pain relief medication (such as ibuprofen), the Oral Contraceptive Pill (OCP), diuretics or even the anti-depressants in the SSRI family (Selective Serotonin Reuptake Inhibitors).

Studies however have not supported their effect in treating PMS. Approximately 40% of women who try an SSRI do not see a benefit.

These medications also come with their own litany of side effects – from headache, nausea, sleep problems, sexual side effects to an increased risk of suicidal behaviour in teenagers and young adults.


What is PMS?

A 2007 Obstetrics and Gynaecological text defines PMS as a “recurrent set of physical and behavioural symptoms occurring cyclically 7-14 days before menstruation (the luteal phase) and are troublesome enough to interfere with some aspects of the female’s life.”

Also included is the pain that can occur just prior and during the length of menstruation.

Theories abound as to the cause of PMS so much so that there are more than 150 individual symptoms associated with the condition.

The most common symptoms of PMS include:

  • Abdominal bloating
  • Anxiety
  • Back pain
  • Breast tenderness
  • Change in appetite – from specific cravings to an increase in appetite
  • Clumsiness
  • Constipation
  • Depression
  • Dizziness
  • Fatigue
  • Headache
  • Insomnia
  • Irritability
  • Joint pain
  • Lethargy
  • Low self-esteem
  • Mood swings
  • Nervousness
  • Social isolation
  • Fluid retention

In Integrated Medicine circles, a number of possible causes are proposed for the onset of PMS.

The following list is some of the most prominent causes:

  • A Genetic risk based on your mother’s reproductive history
  • Hormonal factors – high oestrogen in relation to progesterone, elevated prolactin
  • Inflammatory indicators – specifically prostaglandins
  • Fluid and electrolyte balance – the ratio of sodium to potassium, an excess of aldosterone
  • Biochemical factors – various vitamin and mineral deficiencies or even a deficiency in the neurotransmitter dopamine
  • Psychological / Social factors – poor coping skills, the impact of stress, beliefs and attitudes about PMS

In 1983, Dr Guy Abraham publicised a system for the classification of PMS into four distinct subgroups. These groups are widely referred to by Naturopaths and can be useful for administering specific treatment.

However, as with most classifications, one size does not fit all and it is common for women to rarely sit neatly into one group.

screen-shot-2016-10-06-at-3-14-11-pmThe groups are:

PMS-A (Anxiety)

Regarded as the result of high levels of oestrogen and a deficiency of progesterone, this group displays irritability, anxiety and emotional instability

PMS-C (Carbohydrate Craving)

Thought to be the result of enhanced intracellular binding of insulin, this category is marked by an increased appetite, cravings for sugar / chocolate, headache and heart palpitations

PMS-D (Depression)

Attributed to low levels of oestrogen leading to an excessive breakdown of neurotransmitters. It is also possibly the result of enhanced androgen or progesterone production.

PMS-H (Hyperhydration)

Characterised by weight gain, breast tenderness and fullness, fluid retention / swelling and abdominal bloating. This category is linked to elevations of aldosterone due to excessive oestrogen, sodium consumption, adrenal stress or a magnesium deficiency.


If you feel like you belong in each category, you are certainly not alone! In fact, if your menstrual symptoms are leaving you thoroughly emotional, depleted and overwhelming, it is important to rule out the possibility of PMDD.

PMDD (Premenstrual Dysphoric Disorder) is regarded as a more severe form of PMS and has been added to the classification of Mental Disorders. Not to be disregarded lightly, a woman is diagnosed with PMDD if she is experiencing at least five of the following symptoms.

  • Feelings of sadness, hopelessness and even suicidal thoughts
  • Feelings of tension or anxiety
  • Mood swings marked by periods of teariness
  • Persistent irritability or anger
  • Lack of interest in daily activities and relationships
  • Difficulty concentrating
  • Fatigue or low energy
  • Food cravings or bingeing behaviour
  • Sleep disturbances
  • Feeling overwhelmed and out of control
  • Physical symptoms such as bloating, breast tenderness, headaches and joint or muscle pain


Emed Comment

It is well within your right to expect a normal menstrual cycle free from the discomfort associated with PMS or PMDD.

Rather than continually using symptomatic relief strategies, treatment can instead be targeted at the normalisation of hormones. The most effective way to regulate hormones is via the hypothalmic-pituitary-ovarian (HPO) axis.

This very scientific term refers to the way the brain influences the ovaries in its release of particular hormones.

In fact, dietary and lifestyle factors can significantly disrupt the functioning of the HPO axis.



nourish-bowl1Women with PMS will typically consume more dairy products, refined sugar and high sodium foods than women without PMS. (Proving why the PMS rate is 90% – how much of the average diet contains these very elements?)

A reduced incidence of PMS is associated with a diet high in fish, eggs, fruit and fibre. Period pain has been consistently linked with diets that are low-fat, predominantly vegetarian and which include high amounts of fibre.

Regulating blood sugar levels can also impact upon hormonal status. The body appears to be more sensitive to insulin during the luteal phase indicating that hypoglycaemia can actually account for some of the premenstrual symptoms.

For more information on dietary habits to prevent PMS, consider the following articles:



Within the herbal pharmacy are a number of herbs that have demonstrated a positive effect on PMS. Here are the front runners:

  • Chaste Tree (Vitex agnus-castus) – can reduce prolactin via its action on the dopamine receptors. One study has also shown that it can normalise progesterone levels in women with hyperprolactinaemia within 3 months
  • Black Cohosh (Cimicifuga racemosa) – has a strong tradition of use in period pain and menstrual disorders due to its effects on modulating oestrogen via its action on lowering LH secretion.
  • St Johns Wort (Hypericum perforatum) – useful for women who display irritability or depression during the menstrual cycle.

Other herbs used for PMS include Chamomile (Matricaria recutita), Passionflower (Passiflora incarnata), Wild Yam (Dioscorea spp), Valerian (Valeriana officinalis), Withania (Withania somnifera)



  • Calcium supplementation between 1000 – 1200mg has reportedly reduced menstrual pain by half.
  • Magnesium can reduce PMS mood instabilities, fluid retention and breast tenderness.
  • Zinc levels have been significantly low in women with PMS.


Final Word

So, you do not have to suffer through your PMS. There are many options available to restore your reproductive health and re-claim back some of those lost days.

Talk to an E-med Consultant to get the right prescription for your PMS.


Further Reading: