Wednesday, October 03, 2001

October 2001 Newsletter

FHN Complementary Medicine Monthly Newsletter October 2001

An alternative look at PMS

Premenstrual syndrome (PMS) is defined as a recurrent cyclical set of physical and behavioral symptoms that occur 7 to 14 days before the menstrual cycle, and are troublesome enough to interfere with some aspect of a woman’s life. PMS affects up to 40% of menstruating women. More than 150 symptoms have been associated with PMS. The most common include nervousness, anxiety, irritability, fatigue, lethargy, depression, mood swings, water retention, abdominal bloating, tender breasts, headache, change in appetite, back pain, acne, sugar cravings, diarrhea, low libido, constipation, clumsiness, dizziness, low self-esteem, social isolation, insomnia, and joint pain.

The causes of PMS are many and varied. In some cases not well understood. To get a better handle on causes….and therefore treatment, Dr. Guy Abraham categorized PMS into 4 subgroups.

1. PMS-A (anxiety) believed to be related to high estrogen and low progesterone.

2. PMS-C ( carbohydrate craving) there is a increased sensitivity to insulin during the luteal phase , causing in some woman hypoglycemia ( low blood sugar).

3. PMS-D (depression) May be due to low levels of estrogen leading to the breakdown of neurotransmitters. ( ie seratonin)

4. PMS-H ( hyperhydration) Another hormone aldosterone elevates leading to increased estrogen , increased salt intake ( salt stimulates the adrenal gland) ,and a magnesium deficiency.

It is interesting to note that in Chinese medicine gynecology, developed several thousand years ago ,PMS symptoms were divided into these types:

1. Excess syndrome due to liver stagnation ( the liver is where estrogen production starts)

2. Deficient syndrome due to lack of qi and blood ( symptoms are similar to PMS-D )

3. Spleen qi deficiency ( in Chinese medicine the spleen deals with control of digestion. ie Carbohydrates)

4. Heat in the blood ( which has similar symptoms to PMS-H)

It is important to have a thorough evaluation that includes a careful history including nature, timing, severity, diet, exercise, drug ,and alcohol use. Obviously a complete physical and pelvic exam and lab test to rule out anemia and hypothyroidism need to be done. In addition to those we might run additional tests to evaluate adrenal stress ( a saliva or urine test) ,or a 28 day salivary hormone analysis.

Natural Treatment Options

Obviously treatment options depend on specific causes….the more we know the more refined the treatment.


Regular , REASONABLE, physical exercise improve all symptoms of PMS!

Diet and Nutrition

Reducing sugar and simple carbohydrate (pasta, bread, etc.) intake is essential….I know that is what you are craving! Replace them with something that has a lower glycemic index. Such as vegetables or a protein food.

Decrease salt intake at these periods

Decrease caffeine intake, that includes coffee, tea, cocoa, chocolate, pop, caffeine supplements (diet pills)

Shift fat intake to eat more Omega 3 oils (fish ) and reduce both arachadonic acid ( red meat) and omega 6 oils 9 ( corn, soy, palm, etc). Some women can’t convert linoleic to gamma linolenic acid. They may need to use oil of evening primrose.

Increase calcium and magnesium 1000-1500 mg /day

Increase B vitamins especially B6. 50-100mg/day. The active form of B6, P5P is actually better in this instance.



This herb has been used for centuries for PMS. It helps normalize both LH and progesterone.

Black and Blue cohoshes

These herbs seem to effect both homone and serotonin levels.

St John’s wort

This also seems to effect serotonin levels which can help with some depression and mood swings. Care should be taken if you are already on SSRI medicaton.


This herb has been used to help alleviate anxiety type symptoms.

Wild Yam creams

Both the progesterone and estrogen type of creams, that are biologically active, ( there are only a few brands that are), can be used effectively. We recommend that we have hormone levels checked with the 28 day saliva test before we use this therapy.

Chinese Medicine

Acupuncture is a wonderful tool to help during the pain and to help to normalize the hormone imbalances.

Chinese botanical medicine has a number of different formulas to treat PMS depending on the symptoms. We have found these to be very effective in restoring normal function.


Dr. Julie and Glenn Smith

PS Past copies of the newsletter can be found on the “P” drive in the Complementary Medicine folder.

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