Really frustrated by the lack of progress on her bevy of unexplained symptoms, Hillary’s primary care provider and a couple of specialists, unable to make a diagnosis of her symptoms, a combination of joint pains, skin eruptions, mood swings and minor abnormalities in blood tests, agreed to refer her to the Mayo Clinic. The symptoms had been going on for years, and now in her early forties, slowly getting worse.
The docs at Mayo suggested starting Hillary on meds for an undiagnosable autoimmune disease, really not unreasonable, as the symptoms certainly sounded like one. But Hillary wanted to see if there were alternatives: nutritional intervention, supplements, herbs, acupuncture and so forth. The Mayo doctors were supportive and wished her luck.
When we saw her, one important fact emerged: by keeping a symptom diary on a calendar, there were definitely good days and bad days which correlated to her menstrual cycle, and now, as she was slowly but steadily approaching menopause, her symptoms worsened. The condition(s) were definitely related to hormone levels.
Years, or maybe it was decades ago, I had taken courses in Naturopathic Approaches to Women’s Health taught by Tori Hudson, N.D. and Christiane Northrup, M.D. From this, two PMS facts were permanently etched into my brain: any symptom or group of symptoms that has a menstrual cycle component is a PMS variation AND there are over two hundred symptoms, physical and emotional, associated with PMS.
The corollary to these two chunklets of information: treat the PMS first, then see what’s left over in terms of chronic symptoms that may have been plaguing a patient for years. Interestingly, it turned out Hillary had many other PMS symptoms she simply never bothered to mention because (a) her severe symptoms were so severe, and (b) “I thought every woman had bad PMS and we just lived with it.”
The often distressing symptoms of premenstrual syndrome, or PMS, are familiar to many women. A week or two before their menstrual period, three out of every four women experience some combination of bloating, breast pain, fatigue, headaches, depression, crying, angry outbursts, or any of 200 other symptoms associated with PMS. For most women, the number and severity of symptoms varies from month to month, and most of the time PMS is no more than a bothersome inconvenience. But for another 5% to 10% of women, PMS affects body and mind so severely that it interferes with everyday activities.
For most women, PMS is an event in the second half of their cycle. Some women have what’s termed ‘bimodal PMS’, 3 days of symptoms at ovulation, then a temporary respite, then a week of progressively worsening PMS discomfort ending about the second day of flow.
Some women are so unlucky that their PMS begins five to seven days from their last day of flow so in reality they have only one decent week a month. That “one decent week” is a pretty universal phenomenon among menstruating women: they feel sexual, actually purchase sexier clothes, waitpersons unconsciously flirt for tips (these aren’t my opinions, BTW, but published interviews in clinical psych journals). If you think about it, this “behavior” just shows how your hormones are trying to get your egg fertilized and your PMS grouchiness is hormonal irritation that you did not.
At the same time, PMS can have a positive aspect. Some experts say that women who have PMS are very attuned to their surroundings and have a sharp memory, not just in the days or weeks immediately before their period but all month long.
Scientists have never explained why some women have no PMS and others, like Hillary, can be devastated by it. Most likely several factors are involved including lifestyle, diet, and family history.
Hormonal PMS is just what it sounds like: an imbalance of the female hormones estrogen and progesterone following ovulation. Ovulation occurs at the midpoint of the menstrual cycle. When the estrogen overwhelms the amount of progesterone in a woman’s system (called “estrogen dominant PMS”), the brain has more difficulty producing chemicals that control mood and pain. This hormone imbalance may lead to the mood shifts and food cravings, headaches and fluid retention. It also may trigger the release of the hormone prolactin, which causes breast tenderness and blocks the liver from efficiently clearing excess estrogen from the body.
“Mood” PMS symptoms are related to low levels of serotonin, a brain chemical, that acts as a stress buffering system. The female level of serotonin is only 25% that of a male, so women start out life more susceptible to stress than men. Then, to make matters worse, serotonin is linked to estrogen, so that when estrogen falls during PMS days, so does stress buffering serotonin. This is why you’ll cry at a Hallmark commercial or bite the head off your significant other, all the while telling yourself, “This isn’t me.”
You’re right. It isn’t you. It’s your sex hormones and your serotonin.
Treatment
Tori Hudson, N.D. comes to the rescue here. Her supplement line, Vitanica, contains herbs from menarche (the term for your first period, pronounced ‘menarky’) through menopause. For PMS, get her Vitanica PMS Tasty Tonic, one teaspoonful daily through the entire month for mild to moderate PMS, two daily for severe.
If you are planning a family, get Dr. Hudson’s Prenatal Prep.
Self-Care Remedies
Keep a symptom diary. Many women feel more in control when they note PMS symptoms as they ebb and flow. A written record may come in handy if things get bad enough that you need to talk with your doctor.
Regular aerobic exercise can help you restore a sense of balance and control and improve your mood. It also can help relieve water retention.
Learn to relax. Low levels of progesterone can leave you feeling more exposed to the stresses of life. But there are methods other than drugs to restore your physical and emotional reserves. Yoga, meditation, and progressive muscle relaxation can relieve stress-related symptoms. Tori also makes a tonic for calming: Quick Calm Tonic.
And another for menstrual cramps: Cramp Soothe Tonic.
Watch what you eat. Lifestyle decisions you make can put additional stresses on your system. Cut down on caffeine, refined carbohydrates, refined sugar, dairy, alcohol, and salt. If you smoke, stop. No one is certain how these changes affect the symptoms of PMS, but it may have to do with the overall toxin load on the body that reduces its ability to process estrogen. Or it may be the added stimulation these substances put on already reduced reserves. Nobody knows for sure, but virtually all women report significant improvement when they make healthy choices. In the final analysis, Hillary of course did not need any of the Mayo Clinic medications for the autoimmune disease that she did not have. Her primary care provider and her rheumatologist were both very pleased when they saw her a few months later virtually symptom free, eating healthfully, exercising, and planning a pregnancy.
Be well,
David Edelberg, MD