First, a look at what premenstrual syndrome (PMS) is exactly. After ovulation, midway through your cycle, your hormones transition from higher levels of estrogen to higher levels of progesterone. This shift can trigger such symptoms as moodiness, irritability, anxiety, breast tenderness, and bloating. These symptoms escalate in intensity, then magically disappear when menstruation begins and the hormones reboot. Many of my patients with severe PMS describe a sense of relief when they start their period as they begin to “feel like themselves again.” (If you experience anger and irritability throughout the month, that is not hormonal PMS – it could be a sign of depression, so talk to your doctor)
If you experience mild to moderate PMS symptoms and are looking for some relief, there are some natural therapies that might help:
Aerobic exercise almost always makes you feel better, but especially in the weeks leading up to your period. The endorphins of exercise can help counteract the hormonal blues of PMS and the unpleasant bloating sensation that occurs after ovulation. Thirty minutes of aerobic exercise daily during the week before your cycle has shown to work as well as antidepressants for treating mild PMS symptoms. While exercise may be the very last activity you feel like doing when you have PMS, if you will make it a priority during that time, you will most likely feel better.
There are a lot of herbal therapies that claim to treat PMS. Most of these claims are flimsy, but there are a couple that do have some science to back them up. Though the studies were small, Vitex (chasteberry) is an herbal therapy that has been shown to reduce PMS symptoms over placebo with minimal side effects. It is available over the counter, and the recommended dosing is 20-40 mg daily. Serenol is another herbal supplement composed of Swedish pollen extract that has also been shown to help PMS symptoms. Be sure to talk to your doctor before starting any herbal therapies or supplements.
There is increasing data linking low magnesium to mood changes. Magnesium supplementation in the second half of the cycle is a reasonable option for women whose main symptoms are mood related.
Cognitive Behavioral Therapy
Therapy has been used successfully to treat depression and anxiety, and some women also find it helpful for PMS as well. Studies are conflicting on the effectiveness of therapy for PMS, but if your symptoms are primarily mood related, cognitive therapy might be an option for you. If your primary symptom is anxiety, stress relieving activities such as meditation, yoga or practicing mindfulness might also be good options to try.
Acupuncture has been shown in a few small studies to be helpful for both the physical and emotional symptoms of PMS, reducing symptoms by up to 20 percent over placebo.
My gynecology textbooks instruct me to tell my patients to avoid salt, chocolate, caffeine and alcohol to help reduce their PMS symptoms and increase their carbohydrate intake. I am assuming that was written by a man who has never actually HAD PMS because that advice seems quite impossible to adhere to (other than the increasing carbs part). However, if you find yourself with more willpower than I have and want to try this strategy, then definitely go for it and let me know how you feel. A more realistic plan may be to cut out each of those items individually during different cycles and track your symptoms in a diary to see how they affect your symptoms.
What Doesn’t Help
In the past, calcium and vitamin B6 supplementation have been recommended for PMS symptoms, but newer studies are suggesting these are not effective. They can also cause side effects at larger doses (kidney stones for calcium and nerve problems with vitamin B6).
If natural therapies haven’t worked for you and your co-workers are demanding that you work from home the week before your cycle, then perhaps it might be time for tradition medications. Oral contraceptives (the birth control pill) works by keeping your hormone levels at a steady state to prevent ovulation and therefore preventing the hormonal shifts that cause PMS. Antidepressants are also effective at treating PMS, reducing symptoms by up to 70% in most women.
PMS can be a real nuisance, but luckily the offending symptoms can often be helped by increasing exercise, using herbal and other therapies, and being mindful of your stress during that portion of the month. If the more natural solutions don’t help and you find your PMS affecting your life and relationships, talk to your provider about medical options that might work for you.
BY HEATHER RUPE, DO