Premenstrual Syndrome and Menstrual Irregularities

References

Hormonal dysfunction is found to be the cause of many menstrual complaints, the most prominent being premenstrual syndrome, commonly called PMS. Premenstrual syndrome or premenstrual tension syndrome (PMS) is a collection of symptoms occurring during the second half of the menstrual cycle (Moline 1993), becoming progressively worse, interfering with family, social, and work related activities, and generally ending with the onset of menstrual flow (Frackiewicz et al. 2001).

PMS has been the subject of much discussion and controversy since its description more than 60 years ago by Frank. The discussion has ranged from whether it really exists as a disease entity, whether it is treatable and, if so, how it should be treated. The controversy has ranged from a consideration of whether it is primarily a physical disorder to whether it is a mental disorder.

There are dozens of uncomfortable and painful symptoms of PMS, and their appearance may occur from a few days before menstruation begins to several weeks before bleeding starts. Some women with PMS tend to have relatively high levels of estrogen coupled with relatively low levels of progesterone (Dhar et al. 1991; Seippel et al. 1992). This estrogen-progesterone balance is critical to most of the health problems discussed in this protocol. Other factors associated with PMS are diet, obesity, vitamin and mineral deficiencies, and an imbalance in hormone-like compounds called eicosanoids (which may be corrected with dietary and supplement alterations, to be discussed later).

CLASSIFICATION AND DIAGNOSIS

Interestingly, both estrogen and progesterone have effects on mood. Estrogen tends to produce assertiveness, aggression, and hostility, whereas progesterone produces deference, nurturance, and affiliation (de Lignieres et al. 1982). The balance of these two hormones is the aim in any treatment of PMS and should be done with the minimum of interference from any synthetic medications or hormones. Balance is the sine qua non of any treatment process.

The prevalence of PMS has doubled over the last 50 years, most likely due to increased diagnostic recognition. More than 100 symptoms have been reported. PMS has been classified into four main groups for the purpose of clarifying diagnosis and treatment (Abraham 1983; Ugarriza et al. 1998):

Most people have a mixture of the four types, and they are not mutually exclusive.

PMS-A and PMS-D both seem to be caused mainly by changes in the ratio of estrogen to progesterone in the luteal phase between ovulation and onset of menses. In normal subjects, this P/E ratio is 120:1. In PMS-A, it plunges to 48:1. In PMS-D, it rises to 274:1.

Symptoms of PMS can span most body symptoms and include:

Changing dietary patterns over the last 60 years have produced significant deficiencies in many of the vitamins and cofactors needed to maintain a proper, balanced hormonal system. Most significant is the change in the level of fat consumption in our diet. We have gone from a diet of a relatively low level of fat consumption (15%) to a high level (30-40%). The type of fat has also changed from relatively unsaturated vegetable fat to saturated animal fat, causing a significant shift in the hormones that promote or modulate inflammation in the body called prostaglandins. It is likely that many diseases of the 20th and 21st centuries are related to this shift. Our persistent and unrelenting intake of more and more processed foods devoid of vitamins and minerals has left us with relative deficiencies of many of these important cofactors.

General TreatmenTS

PMS-A
In the treatment of PMS-A, the relative increase in estrogen must be addressed by (1) more natural progesterone, (2) correcting the nutrient deficiencies through proper change in diet, and (3) providing extra vitamins and minerals to help offset the effects of nervous stimulation by estrogen.

PMS-D
In the treatment of PMS-D, there is a relative increase in progesterone. You should not take progesterone in this type if it is in pure form (rare). Animal fats may be taken in moderation. Clinical depression is due to low levels of neurotransmitters at the synapse. Decreased estrogen may increase the breakdown of some of the neurotransmitters involved in nervous system stimulation. Lead toxicity may prevent estrogenic effects. Progesterone itself tends to depress the CNS. Natural estrogen from soybeans may be tried. Magnesium is critical to the balance of estrogen and progesterone. Tryptophan, an amino acid, may be helpful for insomnia and depression.

PMS-C
In the treatment of PMS-C, the central factor is simple carbohydrate (sugar) intolerance. There is an increased intake of simple carbohydrate in order to offset the effects of a relatively low blood sugar level. There may be an increase in the receptivity of insulin receptors to sugar in the luteal phase. A high sugar diet increases insulin receptor sensitivity, and sugar gets dumped into the cells. This leads to increased appetite, cravings, and eventually fatigue and dizziness. Increasing magnesium intake reduces this response (Abraham 1983).

There is a decrease of the anti-inflammatory prostaglandin (PGE1) due to chronic ingestion of saturated fats and poor micronutrient intake, again particularly magnesium. PMS-C sufferers should eliminate refined sugar and take gamma linolenic acid (GLA) as a PGE-1 stimulator. Zinc, vitamin C, B complex and B6, fish oil (especially DHA), and chromium are also indicated.

PMS-H
In the treatment of PMS-H, the hormone aldosterone is partly responsible for fluid retention; stress, magnesium deficiency, B6, and refined sugar consumption all tend to increase aldosterone and therefore fluid retention. The fatty acids GLA and DHA inhibit aldosterone production. Vitamin E at 400 IU a day gives significant improvement to breast symptoms, as does vitamin B6. Zinc and vitamin A may also be helpful. Breast symptoms may also be reduced by removing caffeine. The general inflammatory nature of breast tenderness is also helped by GLA.

Menstrual cramps are not the same as PMS. It is common to have PMS and painless periods, although women without PMS may have severe cramping during their periods. Cramps are caused by uterine contractions and have been treated with birth control pills (hormones) to eliminate the ovulation-related hormonal changes that lead to cramping. Because excess prostaglandin E2 production causes contractions of the smooth muscles, another treatment is to use fish oil-derived DHA and EPA that inhibit prostaglandin E2.

A Calming Effect for the Symptoms of PMS
Tea contains a unique amino acid known as theanine that can lessen the effects of PMS. Theanine readily crosses the blood-brain barrier and exerts subtle changes in biochemistry. An increase in alpha waves has been documented and the effect has been compared to getting a massage or taking a hot bath. Theanine does not cause drowsiness and unlike tranquilizers, it does not interfere with the ability to think. In fact, in rodent studies, just the opposite was shown; theanine enhanced the ability to learn and remember (Juneja et al. 1999). By shutting down the "worry" mode, thea-nine increases concentration and focuses thought. As an additional benefit, theanine offsets the "hyper" effect of caffeine (Kakuda et al. 2000). Green tea contains a much higher quantity of theanine than other teas.

Using a distress questionnaire, Japanese scientists tracked the reactions of 20 women taking a theanine supplement for 2 months. The use of theanine resulted in reductions in mental, social, and physical symptoms in women taking 100 mg twice a day during the questionable days (Anon. 2001).

Theanine is now available as a dietary supplement in the United States. To help alleviate PMS symptoms, 100-200 mg can be taken at different times of the day (up to 400 mg a day for most people).

Irregular Menstruation
When a woman regularly misses her menstrual period or commonly bleeds (spots) between periods, the condition is called "dysfunctional uterine bleeding," which frequently is associated with an estrogen-progesterone imbalance, although thyroid or pituitary problems are other possible causes. Conventional medical treatment utilizes standard birth control pills to regulate periods. It should be noted that modern contraceptive pills are far safer than they once were. Additionally, they offer a quick and easy solution to the problem. Unfortunately, they don't act precisely or individually in the manner of true hormone modulation.

Excessive menstrual bleeding, called "menorrhagia," is uncomfortable and is often an incredibly inconvenient problem, interfering with the natural patterns of life. In its most severe forms, menorrhagia can lead to anemia, requiring nutritional supplements just for that deficit alone. Treatment may include raising progesterone levels and taking prostaglandin inhibitors to decrease the flow of blood forced out by uterine contractions.

The most common form of benign breast pain comes from the hormonal changes of the menstrual cycle. Breast tissue is affected by cyclic change, just like the uterus. Fluid buildup occurs premenstrually, but has no way of being discharged in the way the uterus releases its menstrual flow. Breast fluid must be reabsorbed and sensitivity and pain may result. In other cases, breast pain seems unrelated to menstrual patterns and the causes aren't always clear, but alterations in hormones such as estrogen, progesterone, and prolactin (a hormone whose function is to stimulate lactation) have been implicated.

Of the most concern is that breast tissue is extremely sensitive to estrogen. High estrogen levels lead to tissue growth, cyst formation, and pain (as well as cancer, to be discussed later). Because progesterone balances estrogen by "downregulating" the estrogen receptor cells in the breast, it blocks estrogen's "grow" signals. The result is to decrease the proliferation of cell tissues, protecting them from the dangerous, negative effects of even modest amounts of estrogen.

Too Many Sex Hormones Cause Excessive Tissue GrowTH

Benign Fibroid Uterine Tumors
Benign fibroid uterine tumors are often a reason for hysterectomies in the United States. The cause of fibroid uterine tumors is unknown. Often they are asymptomatic, depending on their size and location. However, some may lead to excessive bleeding, pelvic pressure, and frequent urination. Fibroids causing health problems such as anemia must be treated, often with different levels of surgery. In some cases, fibroids may be managed with the help of progesterone. Typically, fibroids shrink after menopause because of the reduction in endogenous (self-produced) estrogen that occurs. As we have mentioned, estrogen is a growth-stimulating hormone (GSH). Women with fibroid uterine tumors should have their blood estrogen level checked. If the test reveals too much estrogen, consider asking your doctor to prescribe a low dose (1 mg every few days) of an aromatase-inhibiting drug such as Arimidex. By adjusting the dose of Arimidex, women may be able to lower excess estrogen, thereby helping to shrink fibroids and possibly reducing breast cancer risk.

Polycystic Ovaries
Polycystic ovaries is a condition directly caused by a hormone imbalance. Because of an excess of androgens (the "male" hormone), normal egg development is prevented. When eggs are underdeveloped, numerous small cysts are formed. Standard medical treatment includes prescription birth control pills, anti-androgenic medications, or synthetic progestin to prevent the uterine lining from suffering from excessive hormonal stimulation. Alternatively, natural progesterone may reduce symptoms without the side effects of progestins.

Endometrial Hyperplasia
Another tissue-growth health concern is endometrial hyperplasia, an excess of glandular tissue in the uterine lining. This condition is most common in women with irregular periods, irregular egg production, and irregular sloughing of the lining of the uterus. Usually it is not dangerous and often simply goes away. Physicians monitor hyperplasia to make sure that abnormal cells are not present and that the condition does not become chronic. Traditional treatment involves giving a synthetic progesterone, such as Provera, to the patient to cause the uterine lining to slough off, removing the excess tissues. If this fails, a D and C (dilation and curettage) may be performed. Again, the safe alternative of natural progesterone will decrease estrogen receptor cells, often clearing up the problem.

Endometriosis
Endometriosis is a condition involving the migration of endometrial tissue to other areas of the body, typically within the pelvis (but occasionally even further away from its point of origin). It may lead to pelvic pain, menstrual dysfunction, bowel pain, or infertility. Endometriosis is hormone-dependent, involving high levels of estrogen. Its actual causes are only theoretical at this time, although its pain is extremely factual. Again, conventional treatment is hormonal, using birth control pills, synthetic progesterone, or drugs such as Lupron, which make a woman temporarily menopausal. The goal is to reduce the level of estrogen in the system, leading to a drop in "grow" signals to the endometrial tissues. Innovative physicians prefer the use of natural progesterone applied as a topical cream.

Possibly the most controversial area involving the use of exogenous (produced outside the body) hormones is the effect such treatment has on breast tissue. The concerns regard birth control pills as well as standard menopausal hormone replacement therapy and range from enlarged, tender breasts to deadly breast cancer. Breast tissue may be the most estrogen-sensitive area of the body. Combine this with essential fatty acid imbalances and possible links to the growth hormones used in the dairy industry and there are multiple reasons why breast cancer rates rise with age and are the leading cause of death in women in the menopausal years (National Center for Health Statistics, 1987).

Again, primary focus is on the relative balance of estrogen and progesterone. While the breasts are saturated with estrogen receptor cells, the presence of sufficient progesterone "downregulates" such receptors, protecting against the powerful "grow" signals of estrogen. In addition, a compound called I3C (indole-3-carbinol) affects estrogen metabolism in ways that reduce the risk of breast cancer (Telang et al. 1997). Indole-3-carbinol is a phytochemical found in cruciferous vegetables. It has been shown to have an inhibitory effect on cancer cell proliferation and can reduce breast cancer incidence through the increased conversion of estradiol to "weaker" (2OHE) estrogen. For this reason I3C is especially effective in estrogen receptor-negative breast cancer cells.

The cause of ovarian cancer is far less evident than the causes of breast cancer, but hormonal levels do appear to have a role. For example, Helzlsouer et al. (1995) discovered a strong connection between ovarian cancer and the "male" hormone androgen. Another hormonal connection involves birth control pills. Women taking these medications have a lower risk of getting ovarian cancer, possibly because of the decrease in ovarian stimulation. Conversely, fertility drugs increase ovarian activity and are linked to higher rates of ovarian cancer.

The most important fact about uterine cancer is straightforward and the same as in other malignancies of the reproductive system: estrogen encourages the growth of uterine tissue.

NUTRITIONAL SUPPLEMENTS

Specific vitamins and minerals are required for the production and utilization of regulatory hormones responsible for the menstrual cycle. The negative symptoms of premenstrual syndrome (PMS) are frequently caused by deficiencies of these supplements. Therefore, the first choice in home treatment measures would be to add nutritional supplements to a healthy diet. For some women, increasing their intake of vitamins and minerals may relieve some PMS symptoms.

Calcium and Vitamin D
Calcium is an essential mineral with many biological roles. It is a major constituent in teeth and bones, crucial in muscle contractions and nerve conduction, as well as hormone regulation. In a study conducted by St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, at Columbia University in New York, it was found that calcium supplementation is a simple and effective treatment in premenstrual syndrome. Further, this study, published in the August 1998 issue of the American Journal of Obstetrics and Gynecology, reported that disturbances in calcium regulation underlie the pathophysiologic characteristics of PMS (Thys-Jacobs et al. 1998).

Healthy, premenopausal women between the ages of 18 and 45 years who suffered with moderate-to-severe, cyclically recurring premenstrual symptoms were studied. Symptoms were prospectively documented over two menstrual cycles with a daily rating scale that had 17 core symptoms and 4 symptom factors (negative affect, water retention, food cravings, and pain). Participants were randomly assigned to receive 1200 mg of elemental calcium per day in the form of calcium carbonate, or else placebo, for three menstrual cycles. Routine chemistry, complete blood cell count, and urinalysis were obtained on all participants.

Daily documentation of symptoms, adverse effects, and compliance with medications were monitored. During the luteal phase of the treatment cycle, a significantly lower mean symptom complex score was observed in the calcium-treated group for both the second and third treatment cycles. By the third treatment cycle, calcium effectively resulted in an overall 48% reduction in total symptom scores from baseline. All four symptom factors were significantly reduced by the third treatment cycle (Thys-Jacobs et al. 1998).

Further investigation by Columbia University in New York, published in the April 2000 Journal of the American College of Nutrition, demonstrated that there is scientific evidence that calcium and vitamin D support cyclic fluctuations during the menstrual cycle and may help explain some features of PMS. The study found that ovarian hormones influence calcium, magnesium, and vitamin D metabolism, and it is estrogen that regulates calcium metabolism, intestinal calcium absorption, and parathyroid gene expression and secretion, triggering fluctuations across the menstrual cycle.

Alterations in calcium homeostasis (hypocalcemia and hypercalcemia) have long been associated with many affective disturbances, and PMS shares many features of depression, anxiety, and the dysphoric states. The investigators discovered that the similarities between the symptoms of PMS and hypocalcemia were remarkable. Clinical trials in women with PMS have found that calcium supplementation effectively alleviates the majority of mood and somatic symptoms. Furthermore, the evidence to date indicates that women with luteal phase symptomatology have an underlying calcium dysregulation with a secondary hyperparathyroidism and vitamin D deficiency. The investigators conclude that the research strongly suggests that PMS represents the clinical manifestation of a calcium deficiency state that is discovered following the rise of ovarian steroid hormone concentrations during the menstrual cycle (Thys-Jacobs 2000).

Another study published in a 1994 issue of the journal Headache suggests that vitamin D and calcium therapy should be considered in the treatment of women who suffer with menstrually related migraines and premenstrual syndrome. When treated with a combination of vitamin D and elemental calcium for late luteal phase symptoms, a major reduction in headache attacks as well as premenstrual symptomatology was cited within 2 months of therapy (Thys-Jacobs 1994).

Based upon the current research, 1200-1500 mg of elemental calcium daily, in divided doses, with the last daily dose to be taken at bedtime, and 400 IU of vitamin D daily are suggested. (Please note that magnesium and vitamin D are necessary for the body's absorption and use of calcium and, therefore, all three supplements should be taken in combination.)

Magnesium
Magnesium is involved in over 300 metabolic reactions and is an essential mineral necessary for every major biological process. Magnesium is involved in the production of cellular energy and the synthesis of nucleic acids and proteins. It is important for the electrical stability of cells, maintenance of membrane integrity, muscle contractions, nerve conduction, and the regulation of vascular tone. Magnesium is important for hormone production and transformation, as well as for the proper use of calcium and vitamin D. Magnesium deficiencies have been noted in women with PMS. Chocolate, especially dark chocolate, is a natural source of magnesium, and that may be the root of many women's PMS chocolate cravings.

A study published in the November 1998 Journal of Women's Health found that magnesium supplementation alleviates premenstrual symptoms of fluid retention. The study investigated the effect of a daily supplement of 200 mg of magnesium (as MgO) for two menstrual cycles on the severity of premenstrual symptoms in a randomized, double blind, placebo-controlled, crossover study. An analysis of 38 women showed no effect of magnesium supplementation compared with placebo in any category in the first month of supplementation. However, in the second month there was a greater reduction of symptoms of PMS-H (weight gain, swelling of extremities, breast tenderness, abdominal bloating) with magnesium supplementation compared with placebo. Compliance to supplementation was confirmed by the greater mean estimated 24-hour urinary output of magnesium during supplementation (100.8 mg) compared with placebo (74.1 mg). Researchers concluded that 200 mg of Mg (as MgO) daily reduced mild premenstrual symptoms of fluid retention in the second cycle of administration (Walker et al. 1998).

In another published study found in the March 2000 Journal of Women's Health and Gender Based Medicine, investigators tested the single and combined effects of daily dietary supplementation with 50 mg of vitamin B6 and 200 mg of magnesium (as MgO) for one cycle for the relief of mild premenstrual symptoms. A randomized, double blind, placebo-controlled, crossover design was used, in which 44 women with an average age of 32 years took part in the study.

Each woman was randomly assigned to take consecutively all four of the following treatments daily for one menstrual cycle: (1) 200 mg magnesium, (2) 50 mg vitamin B6, (3) 200 mg magnesium + 50 mg vitamin B6, and (4) placebo. Throughout the study each volunteer kept a daily record of symptoms using a 5-point ordinal scale in a menstrual diary of 30 symptoms. Symptoms were grouped into six categories: anxiety, craving, depression, hydration, other, and total. Urinary magnesium output for 24 hours was estimated using the magnesium/creatinine concentration ratio. The study demonstrated a significant effect on reducing anxiety-related premenstrual symptoms (nervous tension, mood swings, irritability, or anxiety) when 200 mg/day Mg + 50 mg/day of vitamin B6 was consumed. The study concluded that there was synergistic effect of a daily dietary supplementation when a combination of Mg and vitamin B6 was demonstrated. However, the study indicated that absorption from magnesium oxide was poor and daily supplementation for longer than 1 month is necessary for tissue repletion (De Souza et al. 2000).

Elemental magnesium in a dose of 300-400 mg daily in three divided doses is recommended. As previously noted, magnesium and vitamin D are necessary for the body's absorption and use of calcium. Therefore, all three minerals should be taken in concert. As with the supplementation of calcium, the last daily dose of magnesium should be taken at bedtime.

Zinc
Zinc is an essential element in human nutrition with a variety of biological roles. Zinc is involved in nucleic acid and protein metabolism and the production of energy. It is vital for growth and development, sexual maturation and reproduction, and insulin storage and release. Copper competes with zinc for intestinal absorption and serum protein binding sites. Therefore, the zinc to copper ratio can reflect the availability of zinc in the body.

A study was conducted at the Department of Obstetrics and Gynecology, Baylor College of Medicine in Houston, Texas to determine whether changes in peripheral zinc and copper levels are associated with symptoms of premenstrual syndrome (PMS). Ten PMS patients and ten controls gave blood at 2- or 3-day intervals through three menstrual cycles. Lower levels of zinc were noted during the luteal phase in PMS patients compared with the controls. Copper levels were noted to be higher during the luteal phase in PMS patients compared with the controls. The researchers concluded that zinc deficiency occurs in PMS patients during the luteal phase, and the elevated copper further reduces the availability of zinc in PMS patients during the luteal phase (Chuong and Dawson 1994). The recommended dose of elemental zinc is 30 mg daily to help relieve PMS symptoms.

Vitamin B6
Vitamin B6 is involved in a wide range of biochemical reactions, including the metabolism of amino acids and glycogen, hemoglobin, the synthesis of nucleic acids, and the synthesis of the neurotransmitters serotonin, norepinephrine, and gamma-amino-butyric acid (GABA). It is believed that insufficient amounts of vitamin B6 may play a role in an imbalance of neurotransmitters and thus contribute to depression and mood swings. Vitamin B6 is also required by the liver to break down and deactivate estrogen. Therefore, providing the body with sufficient amounts of vitamin B6 can help the body naturally balance estrogen levels. Adequate vitamin B6 can also reduce food cravings by aiding in the metabolism of carbohydrates and proteins.

A meta-analysis was performed to evaluate the efficacy of vitamin B6 in the treatment of premenstrual syndrome by a systematic review of published and unpublished randomized placebo controlled trials. Nine published trials representing 940 patients with premenstrual syndrome were reviewed by researchers in May of 1999. Their conclusions showed that up to 100 mg/day of vitamin B6 is likely to be beneficial in treating premenstrual symptoms and premenstrual depression (Wyatt et al. 1999).

In another study published in 1987, researchers conducted a double-blind controlled study of the effects of vitamin B6 supplementation on premenstrual symptoms experienced by 55 women who reported moderate to severe premenstrual mood changes. Analysis of the data suggested that vitamin B6 may improve premenstrual symptoms related to autonomic reactions (e.g., dizziness and vomiting) and behavioral changes (e.g., poor performance and decreased social activities). However, the researchers suggested caution using vitamin B6 because there are potentially toxic effects if it is taken in large amounts (Kendall and Schnurr 1987).

Based upon the current research, 100-200 mg of vitamin B6 daily in divided doses is recommended. B vitamins work best together. Therefore, a B complex containing B6 as well as the other B vitamins is recommended. (Please note that there have been rare reports of sensory neuropathy occurring at doses less then 500 mg per day. However, the weight of the evidence indicates that toxicity occurs at doses upward of 500 mg per day and typically at or above 2000 mg per day.)

Vitamin E
Vitamin E is a powerful antioxidant and free radical scavenger. It protects the integrity of the cellular membranes in the body, and may help reduce vaginal dryness. Vitamin E also enables estrogen, whether naturally produced or from hormone replacement therapy, to last longer, thus reducing hot flashes (Cabot S., 1995).

In a preliminary study, alpha-tocopherol supplementation was effective in reducing specific symptoms of PMS. To confirm these findings, a randomized, double blind study using D-alpha-tocopheral and placebo in a carefully screened population of women with PMS was performed. A daily treatment with 400 IU D-alpha-tocopherol was administered for three cycles. A significant improvement in affective and physical symptoms was noted in subjects treated with D-alpha-tocopheral (London et al. 1987).

Since much of the research into the use of vitamin E for PMS has been conducted with the alpha-tocopherol form of vitamin E, it is recommended that a vitamin E product that provides a combination of tocotrienol and tocopherol be considered. A suggested daily dose is 400 IU of vitamin E (in the form of alpha-tocopherol) along with a supplement that provides at least 200 mg of gamma-tocopherol.

GLA
GLA (gamma-linolenic acid) is a long-chain polyunsaturated fatty acid found in evening primrose oil and borage seed oil. GLA has been demonstrated to promote healthy bones and joints, reduce high blood pressure, enhance the immune system, reduce or eliminate the symptoms of certain types of eczema, and reduce some of the symptoms of PMS.

In several studies including three double-blind, placebo-controlled studies, one large open study on women who had failed other kinds of therapy for PMS, and one large open study on new patients, published in the Journal of Reproductive Medicine, researchers investigated the use of GLA for PMS. Investigators found that many of the features of premenstrual syndrome are similar to the effects produced by an injection of prolactin (the hormone secreted by the pituitary to stimulate lactation during pregnancy). However, when tested, some women with PMS had elevated prolactin levels, but in most, prolactin concentrations were normal. The researchers postulated the possibility that women with PMS are abnormally sensitive to normal amounts of prolactin.

Further, since there is evidence that prostaglandin E1, derived from dietary essential fatty acids, is able to attenuate the biologic actions of prolactin, in the absence of prostaglandin E1, prolactin has exaggerated effects. Attempts were made, therefore, to treat women who had premenstrual syndrome with gamma-linolenic acid (GLA) in the form of evening primrose, an essential fatty acid precursor of prostaglandin E1. All test subjects demonstrated that evening primrose oil is a highly effective treatment for depression and irritability, breast pain and tenderness, and the fluid retention associated with PMS.

The study also suggests that other nutrients known to increase the conversion of essential fatty acids to prostaglandin E1, such as magnesium, pyridoxine, zinc, niacin, and ascorbic acid, should be considered since the clinical success obtained with some of these nutrients may in part relate to their effects on essential fatty acid metabolism. For the treatment of PMS symptoms, 900 mg of GLA should be taken twice a day.

Chasteberry
Chasteberry (Agnus castus) are the berries of the chaste tree, a large shrub indigenous to southern Europe, the Mediterranean region, and Asia. Chasteberry has been used since ancient Greek times as a treatment for menstrual problems. It is the fruit (dried ripe berries) that contains a mixture of iridoid glycosides (agnoside and aucubin), fatty oils, and flavonoids. Chasteberry has medicinally active components that act upon the pituitary gland, specifically on the production of luteinizing hormone to influence progesterone levels during the luteal, or late, phase of the menstrual cycle. A 1997 double-blind, placebo-controlled study found that chasteberry offered significant relief for women suffering from symptoms of PMS, especially breast tenderness, cramping, and headaches (Lauritzen et al. 1997).

In a randomized, double-blind, placebo-controlled trial reported in the January 20, 2001 British Medical Journal, German researchers assigned 170 women diagnosed with PMS to a daily dose of Vitex agnus-castus (chaste tree) extract or to placebo for three menstrual cycles. The women assessed themselves before and after treatment on measures of irritability, mood, anger, headache, bloating, and breast fullness. Clinicians evaluated symptom severity and treatment effects. More than half of the women taking chaste tree fruit extract (chasteberry) had a 50% or greater improvement in PMS symptoms (with the exception of bloating). The researchers concluded that the dry extract of agnus castus fruit is an effective and well-tolerated treatment for the relief of symptoms of PMS. It is important to note that the German government's Commission E, which evaluates herbal remedies prescribed in conventional medical practice in Germany, has approved chasteberry for menstrual irregularities, breast pain, and premenstrual complaints (Schellenberg R., 2001).

The commonly recommended dose from water-alcohol extracts of chasteberry (in dry or fluid form, standardized to agnuside or aucubin) equals 20-40 mg of fresh berries per day. Caution: women taking hormone therapies of any kind, antidepressants, or dopamine-receptor agonists should consult a clinician before trying this herb. Also, women who might be pregnant should not use chasteberry.

SUMMARY

Our nutrition in the last 60 years has produced significant deficiencies of many of the vitamins and cofactors needed to maintain a proper, balanced hormonal system. Increased levels of dietary fat over the same 60 years are believed to contribute to several symptoms of PMS and menstrual irregularities. Lifestyle changes that include dietary modifications and nutritional supplementation can help ease monthly symptoms for the sufferer (Daugherty 1998).

Lifestyle Changes
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Specific Supplements

Product availability

Theanine, vitamin B6, Super GLA/DHA, borage oil, Mega GLA, vitamin E, zinc, magnesium, vitamin C, Life Extension Mix, Pro Fem, and Natural Estrogen are available by contacting us.