Premenstrual Syndrome (PMS)

Are you one of the millions of women who suffer from premenstrual symptoms without knowing that it is a disease and that there is now a treatment for it?

Symptoms of Premenstrual Syndrome

Tension: This can be in the form of depression, tiredness or irritability.
Water retention: Bloating, heaviness, weight gain (2-4 Kg), breast soreness and swelling, generalized rheumatic pain, abdominal bloating and heaviness.
Headaches: Sinus or vacuum headache, tension headache and migraines.
Recurrent problems: Premenstrual epilepsy, rhinitis or hay fever, premenstrual asthma, loss of sense of smell, dizziness and vertigo, cystitis and urethritis, varicose veins, boils, sties, acne, conjunctivitis and glaucoma.
Food cravings and alcohol binges.
Pain (congestive dysmenorrhea): Starts up to 14 days before a period as heavy continuous lower abdominal pain increasing in severity on the first day of menstruation then gradually ceasing.
Postpartum (after delivery) depression after a symptom free pregnancy.

Three Requirements must be fulfilled in Order for the Correct Diagnosis to be made

Symptoms should be present every month for at least the previous three months.
Symptoms must be present premenstrually and should not start before ovulation (14 days before the start of menstruation).
There must be complete absence of symptoms after the start of menstruation for a minimum of seven days.

Hormones, the Menstrual Cycle and Premenstrual Syndrome

The average length of the menstrual cycle is 28 days, although this can vary between women and from one cycle to the other. The length of the cycle is calculated from the first day of the period (bleeding) till the day before the next period begins.

A variety of glands and their hormones control the menstrual cycle, and it is divided to the following phases:

a) The menses (bleeding or period) phase:

This phase commonly lasts from day 1 to day 5. If no fertilisation takes place, a drop in the level of estrogen and progesterone hormones causes the lining of the uterus (endometrium) to shed out, and together with some bleeding from the damaged blood vessels will pass out through the vagina.

b) The follicular phase:

Days 6-14. Under the effect of the pituitary gland hormones (mainly FSH), one follicle in an ovary matures and forms an egg (ovum). Under the effect of the estrogen secreted from the ovary, the uterus builds up to about 3 mm in thickness. Just before day 14 (mid cycle) a surge of hormones (with a peak of estrogen) stimulates the follicle in the ovary to release the egg, which then passes through the fallopian tube to the uterus.

c) The luteal or secretory phase:

Days 15-28. After the follicle releases the egg, it transforms into the Corpus luteum which secretes progesterone. If the egg is not fertilized, the corpus luteum gradually disappears and stops progesterone production which causes the lining of the uterus to break down and bleeding starts.

Progesterone May Help Premenstrual Syndrome

In many women who experience PMS, progesterone and its metabolites (allopregnanolone) may be low during the luteal phase [1, 2]. In some women a true progesterone deficiency may not exist, however they may not have enough progesterone to balance out excessive estrogen levels [3]. Studies have shown that supplementation of progesterone can give relief of PMS symptoms [4]. In a double blind placebo controlled trial using vaginal progesterone suppositories (200mg twice daily), nervous symptoms experienced by women suffering from PMS were shown to decrease [5]. Specifically, tension, mood, irritability, anxiety and lack of control were modulated.

Click here for more information on Progesterone Supplementation.

How to help yourself

Make a chart to confirm the diagnosis: the menstrual chart is used to record actual days of menstruation and the days when symptoms or complaints are present. We suggest that this is completed for 2-3 months.
Progesterone cream 10-20 mg once or twice daily, or 100-200 mg orally at bedtime, from day 14th to the 25th day of the cycle or until the onset of menstruation.
Have small meals or snack frequently every three hours (starchy food) to prevent blood sugar levels dropping and adrenaline surges. This will assist in reducing attacks of irritability, panic, migraine, epilepsy, weakness, shivers and faintness.
Other Nutritional supplements that may help PMS:
- Magnesium (200-400mg daily) [6]
- Calcium and vitamin D [7]

References

1.Monteleone, P., et al., Allopregnanolone concentrations and premenstrual syndrome. Eur J Endocrinol, 2000. 142(3): p. 269-73.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10700721
2.Rapkin, A.J., et al., Progesterone metabolite allopregnanolone in women with premenstrual syndrome. Obstet Gynecol, 1997. 90(5): p. 709-14.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9351749
3.Munday, M.R., M.G. Brush, and R.W. Taylor, Correlations between progesterone, oestradiol and aldosterone levels in the premenstrual syndrome. Clin Endocrinol (Oxf), 1981. 14(1): p. 1-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7194756
4.Dennerstein, L., et al., Progesterone and the premenstrual syndrome: a double blind crossover trial. Br Med J (Clin Res Ed), 1985. 290(6482): p. 1617-21.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3924191
5.Baker, E.R., et al., Efficacy of progesterone vaginal suppositories in alleviation of nervous symptoms in patients with premenstrual syndrome. J Assist Reprod Genet, 1995. 12(3): p. 205-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8520187
6.Quaranta, S., et al., Pilot study of the efficacy and safety of a modified-release magnesium 250 mg tablet (Sincromag) for the treatment of premenstrual syndrome. Clin Drug Investig, 2007. 27(1): p. 51-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17177579
7.Bertone-Johnson, E.R., et al., Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med, 2005. 165(11): p. 1246-52.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15956003