PRE-MENSTRUAL SYNDROME NATURALLY
By Stephen Holt, MD, NY, NY
INTRODUCTION
Pre-menstrual syndrome (PMS) defies clear definition. In its classic form, it is a disorder of biorhythm that results in a series of unpleasant cyclical symptoms and signs, prior to menstruation. It is naïve to believe that PMS is a simple hormonal disorder requiring merely focused hormonal intervention. Complex socio-behavioral issues or adverse life events make PMS worse and PMS amplifies such events or exacerbates several diseases.
Among the most common symptoms of PMS are: emotional change, tiredness, irritability, anxiety, change of appetite, food craving and a litany of upsets in many body structures, resulting in: headaches, sinus problems, acne, joint pain and general clumsiness. PMS is often confused with many diseases or disorders and it can even masquerade as simple depression, chronic fibromyalgia, neurosis, organic disease of the female genital tract…to name a few misdiagnoses.
NATURAL MANAGEMENT STRATEGIES FOR PMS
Before any management strategies for PMS are proposed, an understanding of the causes of this clinical conundrum is advisable, but no simple or single cause of PMS can be defined. Suggested causes of PMS include: hormonal problems, water retention, body toxins, specific nutrient deficiencies, metabolic disturbances, imbalance of neurotransmitters in the central nervous system or, in isolated cases, frank neuroticism…and other matters.
The complex causes of PMS require multi-pronged interventions and the idea that there is a magic hormonal manipulation to treat PMS in a consistent manner is a “fairy tale”. Table 1 summarizes natural interventions that are linked to suggested causes of PMS.
SUGGESTED CAUSECOMMENT
Hormonal Problems Various studies have identified changes in hormone balance in women with PMS, but there are no consistent changes that permit a clear diagnosis. High levels of estrogen and low levels of progesterone have been associated with PMS. Failure of function of the corpus luteum which forms in the ovary after ovulation may be involved. Progesterone supplementation is a popular intervention and it may be effective in some women with PMS. A preferred approach, in my opinion, is the use of herbs, botanicals and nutrients that are adaptogenic or modulators of hormonal profiles. These natural substances can be used in synergistic formulations with good effects. The use of single supplements for PMS management are obsolete and the same may apply to disturbances around the menopause. Dietary supplement ingredients with the greatest evidence base for the management of menstrual disturbance include: black cohosh, soy and red clover isoflavones, L-theanine, evening primrose oil, dong quai, chasteberry, ginkgo biloba…and others with anecdotal benefit.
Water Retention Excessive salt and water retention is common in PMS, but it may be a result rather than a cause of PMS itself. Natural diuretics and herbal teas may be valuable (e.g. chamomile, dandelion root, green tea, etc.).
Body ToxinsThe concept of premenstrual intoxication was first reported 50 years ago, but scientific evidence that detoxification of the body with herbs or colon cleansing is universally effective has not been presented. Many women describe benefits of intermittent attempts to detoxify the body. One preferred route of detoxification is colon cleansing. Synergistic gentle colon cleansing formulae are most advisable with enhanced intake of fluids and dietary fiber.
Specific Nutrient DeficienciesDeficiency of vitamin B-complex has been linked to mood changes and depression in women with PMS or those taking progesterone hormone supplement. Excessive sugar intake and deficiency of omega-3 fatty acids have been variably implicated as a cause of PMS. For example, cramps may be caused by excess prostaglandin F2 alpha and alterations in prostaglandin
production occurs with deficiencies or imbalances in the dietary intake of essential fatty acids. I recommend enteric coated fish oil capsules for all women with PMS, but I stress the advantages of delayed release, targeted delivery of fish oil in special gel capsules to improve absorption of the active omega 3 fatty acids EPA and DHA.
Hypoglycemia/Syndrome X Episodes of low blood sugar may occur in women with PMS and specific studies have shown that hypoglycemia may tend to occur more often in the premenstrual phase of the cycle. Alterations in the metabolism of glucose by the body due to insulin resistance and compensatory excess secretions of insulin are key factors in the metabolic Syndrome X, which is strongly associated with polycystic ovary syndrome (PCOS) and PMS. Lifestyle change and nutritional factors for Syndrome X are valuable.
Serotonin Balance Serotonin is an important factor in central nervous system and other body functions. Deficiencies in serotonin have been described in women with PMS. This has led to dietary recommendations to boost serotonin levels in the body and the use of supplements that are precursors of serotonin, such as 5-HTP. Serotonin levels in the brain are increased by some antidepressant drugs, e.g., Prozac.
Sleep Deprivation Restoration of the biorhythm of sleep is the most underestimated of all interventions in women with menstrual problems. Appropriate lifestyle changes and combination supplements can restore healthy sleep patterns. Without sleep PMS and menopause gallop in their progression.
NeuroticismPMS is real. While emotional disturbances are common in PMS, it is not acceptable to adopt the attitude that PMS is “all in a woman’s head.” Patients who visit physicians who have this opinion should vote with their feet.
Table 1. Potential causes of PMS with general comments about management options.
SYNDROME X AND PMS
The variable combination of hypertension, high blood cholesterol and an overweight status are fueled by insulin resistance. These problems form in the constellation of the metabolic Syndrome X. I emphasize that there is still widespread lack of knowledge about the importance of Syndrome X in women’s health, especially in relationship to menstrual function. The occurrence of cystic ovaries in young women has been quite clearly linked to Syndrome X. This condition is called polycystic ovary syndrome or Stein-Leventhal Syndrome. In popular medical literature, PCOS has been referred to as Syndrome X of the ovaries (or even Syndrome O). The typical female with PCOS is premenopausal, 18 to 28 years old, with variable degrees of obesity, excess body hair, irregular menstruation, period pains, acne and infertility. Lifestyle change and nutritional factors can be used to combat the Metabolic Syndrome X.
CONCLUSION
While topical progesterone cream has been proposed as a mainstay in the management of PMS, the application of this approach may require medical supervision and topical hormonal creams are not dietary supplements. Clearly, the general management approach to PMS involves its clear recognition together with good holistic management approaches, including but not limited to, psychosocial interventions, positive lifestyle changes and a first line approach with tailored nutritional medicine.
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Topical Bio-similar Progesterone
Stephen Holt, MD
Many reports in the medical literature and lay press have concluded that conventional hormone replacement therapy [HRT] with estrogen and synthetic progesterone [progestins] combined, has often greater risks than benefits. Conventional HRT has been associated with an increased risk for breast and other types of cancer, blood clotting, and enhanced risk of cardiovascular disease, including stroke, pulmonary embolism, and thrombophlebitis. In an exclusive interview with Dr. John R. Lee, MD, [best selling author of the book “What Your Doctor May Not Tell You About Menopause”], published in the July/August 2000 issue of Natural Pharmacy, the late Dr. Lee revered the health benefits of natural progesterone applied to the skin for the support of premenstrual syndrome [PMS] and menopause.
Several authors have supported the assertions of Dr. Lee, that topical progesterone is well-absorbed and highly effective for the suppression of unpleasant symptoms of the menopause or PMS, but it does not carry the apparent risks of conventional HRT. The proposals of several protagonists of natural therapies have ignited intense interest in the use of topical progesterone creams for a variety of women’s complaints. Several progesterone creams exist in the market, in various dosages, formulations, and dispensation systems, with or without the addition of other natural substances, such as phyto-estrogens [soy or red clover isoflavones etc.]. While progesterone is readily absorbed through the skin, its absorption can be highly variable depending on many circumstances such as blood flow to the skin, room temperature, quality of formulation, etc.
It is clear that requirements for progesterone applications can vary depending on a woman’s hormonal status, and indications for usage in any circumstances of doubt, mature females should obtain the advice of a skilled healthcare giver before any attempts to self-medicate. That said, unique dispensation systems in convenient pumps that deliver predictable amounts of progesterone cream are to be preferred. There is no doubt that the application of progesterone cream involves some degree of trial and error to find an optimum required dosage, but new technology has resulted in the use of tiny, microbubbles of special fats in progesterone cream, to help deliver predictable amounts of progesterone. This technology is called liposome-delivery, and when used in a unit dispensing pump, it is the best and most convenient way of applying progesterone cream to the skin.
Natural progesterone creams are not drugs, and they are not simple cosmetics, but they should be used with self-education on hormonal needs. Topical progesterone should be used only by mature females, and it is not recommended for use in childhood or pregnancy. Over-dosing with progesterone or rapid transfer into the bloodstream of progesterone can cause troublesome side effects, such as dizziness, headache, and nausea. Therefore, progesterone applications should strictly follow label guidelines.
Dr. Lee and others have emphasized that natural progesterone is much more desirable than synthetic progesterone [progestins] and one cannot assume that al types of progesterone have the same biological effects. Indeed, there has been an increasing interest from doctors and healthcare consumers about the use of hormones that are more similar to naturally occurring hormones, and this is the concept of bio-similar hormones, which has been incorrectly called “bio-identical” hormones. I emphasize the importance of correct dosing of natural progesterone, with more predictable absorption and monitoring hormone applications by a healthcare professional in any cases of doubt.
References:
Lee, J.R., What Your Doctor May Not Tell You About Menopause, Warner Books,
Lee, J.R., Natural Progesterone: The Multiple Roles of a Remarkable Hormone, BLL Publishing, 1993
Laux, M., Conrad, C., Natural Woman, Natural Menopause, New York HarperCollins 1997
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NATURAL WAYS TO HEALTHY MENSTRUATION
Stephen Holt, M.D., MRCP (UK), FRCP (C), FACP, FACG, FACN, FACAM, Scientific Advisor to Natures Benefit Inc, New Jersey, info@naturesbenefit.com
There are two major feminine concerns that face adult women through their lifetime. The first is problems that occur prior to the menstrual cycle. This is termed Premenstrual Syndrome or PMS. The second is the cessation of menstruation in the mature female or menopause. A major milestone in a mature female's life is menopause when periods cease.
For the past 40 years or more, hormone replacement therapy (HRT) has been used to manage unpleasant symptoms that commonly occur around the menopause. This hormone replacement therapy has been in the form of estrogen medications or estrogen medications combined with synthetic preparations of progesterone, which are called progestins. Unfortunately, the disadvantages and limitations of hormone replacement therapy (HRT) have become apparent in recent research, where it is now known that HRT can be potentially dangerous.
In general terms, modern scientific literature shows that the use of hormone replacement therapy by conventional means may have many more risks than benefits for the woman who is going through the transition of menopause or peri-menopause. While the menopause can precipitate unpleasant symptoms such as hot flashes, lack of psychological well-being and urinary problems, the real significance for the post-menopausal years is the onslaught of age-related disease, such as breast cancer, cardiovascular disease, thin bones (osteoporosis) and age-related declines in brain function.
There is no doubt that major hormonal changes occur around the menopause, but the idea that menopause is merely a deficiency of the female hormone estrogen is a misleading, naive concept. This concept has been accepted, perhaps inappropriately, by many women. The recent scientific information on the safety and effectiveness of certain kinds of conventional hormone replacement therapy is "spine-chilling." It appears that certain combinations of conventional hormone replacement therapy may actually cause breast cancer and other diseases.
While this type of conventional therapy may help reduce symptoms in the menopause, it does not fulfill its promise of protecting mature females against heart disease or mental decline with age. In fact, some studies show that quality of life is not enhanced by taking conventional hormone replacement therapy. For these reasons, many mature women are seeking natural and viable alternatives to hormone replacement therapy, at least in the context of attempts to control unpleasant symptoms around the menopause, by simple and gentle means.
In my book entitled "The Menoplan" (www.wellnesspublishing.com), I point
out that there may be natural pathways. I have pointed to the importance
of positive lifestyle for health in the menopause and the use of natural substances for improving a mature woman's experience during the menopause.
In recent medical literature, scholarly physicians have examined the evidence behind the use of many dietary supplements for the management problems surrounding the menopause or altered menstrual function. The science of nutritional support for menopause and PMS using dietary supplements is emerging with much strength and there are an increasing number of evidence based studies now showing variable benefits of a number of natural agents in the management of menopause.
There are hundreds of thousands of women who have achieved help with their menopausal transition with natural substances including soy isoflavones, black cohosh, chasteberry, L-theanine, red clover extracts and selected vitamins. I have written extensively about the benefits of soy Inclusion in the diet in the menopausal female in my two books "The Soy Revolution" (Dell Publishing, Random House, NY, 2000) and "Soya for Health" (Mary Ann Liebert Publishers Inc., NY 1994).
Dietary supplements are best applied with positive lifestyle changes, but several scientists have indicated that some natural substances do present viable alternatives to hormone replacement therapy and they may improve troublesome symptoms in the menopausal female such as hot flashes.
I add the word of caution that our legal system does not permit the sale of dietary supplements with disease prevention or treatment claims. That said, many physicians, including a growing number of "conventional" gynecologists, are using dietary supplements in patients with the intent of disease prevention and/or treatment; and most specifically they are using them in the management of the menopause.
In my approaches in the natural pathways to healthy menopause and menstrual function, I have proposed several natural agents that I believe have good scientific agreement for health benefits. Considering the management of the menopause transition, most scientific support lies with the use of soy isoflavones and black cohosh, which form major ingredients and constituents of the product Menoplan. There is good scientific agreement that red clover which contains isoflavones similar to those found in soy, may help with hot flashes and other symptoms in the menopause. Red clover is found in Menoplan™
Promising information exists on the benefits of certain vitamins and the use of evening primrose oil and/or dong quai for menopause and PMS 'though much of the support for the use of these natural substances is anecdotal in comparison to the studies with soy, red clover, and black cohosh, I believe that these constituents are valuable in PMS and menopause as nutritional support.
I have stressed consistently that it is incorrect to see any dietary supplement as a"magic bullet" for menopause, PMS or any other condition or disease. Certainly dietary supplements must not be used as a substitute for a healthy diet. In several of my writings I have focused on the major public health initiative presented by Syndrome X, sometimes called the metabolic syndrome. Syndrome X is the combination or being overweight, having high blood cholesterol and/or high blood pressure, all linked by the underlying insulin resistance. This entity of Syndrome X has emerged is an important issue now that it may cause irregular menstruation and polycystic ovary syndrome, especially in young females.
In my book "Combat Syndrome X, Y and Z..." (www. wellnesspublishing.com I present a concept that Syndrome X has far-reaching health implications beyond its obvious role, in the causation of cardiovascular disease. I have indicated that menopause may "load the gun" in terms of health problems for some women and I fear that Syndrome X may "pull the trigger" in many mature females.
The natural way to a healthy menopause involves the change of adverse to positive lifestyles together with the appropriate use of simple, gentle, natural substances. For this approach, I recommend dietary supplements and if such things are not effective then women may consider the options of hormone replacement therapy. These issues are best discussed in a doctor-patient relationship because there us no doubt that some women will benefit primarily from hormone replacement therapy in a conventional manner. However, it is apparent that such benefits are often outweighed by the documented risks of this form of conventional medical management (HRT).
Deciding to take hormone replacement therapy with drugs is one of the most important decisions in a woman's lifetime, especially in relationship to menopause sometimes in relationship to PMS. There is growing evidence that natural substances can provide benefits for the nutritional support
of the menopause and many doctors consider these dietary supplements to be quite valuable in these circumstances.
Menoplan™ is all evidence-based dietary supplement that was designed to provide nutritional support for the perimenopause and menopause and it may have value as nutritional support for PMS. Menoplan™ contains those natural substances that have been associated with benefits in
menopausal women in the scientific literature; and it has a unique proprietary formulation that is generally more complete and not found
in any other dietary supplement product.
The ingredients of Menoplan include black cohosh in its well-documented and research standardized extract have of 2%, together with soy isoflavones providing the "power of soy." Contained within Menoplan™ is all extract of green tea called L-theanine which assists with the normal body function of a relaxation response. Added to the formula are evening primose oil which provides nutritional support, for reproductive organ function and breast health, doing quai, a traditional female specific herb, and chasteberry for which there is a long precendent and history of use for female health. Finally, Menoplan™ contains the benefits of ginkgo biloba which supports central nervous system functions and blood flow to the brain.
In comparison with other popular menopause supplements such as Estroven® and Remifemin® Menoplan™ has a more versatile formula. Constituents of Menoplan™ have antioxidant function which can assist in nutritional support For antiaging. Overall, Menoplan™ with recommendations for lifestyle change presents a useful first-line option for individuals experienceing uncomplicated transitions in the menopause and some problems related to menstrual cycles.