Menstruation is the essence of a woman’s health. It involves all the glands, all her body energy, her blood and her emotional balance. If issues are occuring early in life, there will definately be greater problems later in life. This is troubling since PMS is said to be one of the most common health problems in our society. The reality, however, is that many women have developed an irregularity in their cycles which produce these often debilitating symptoms, and that is not normal. The normal menstrual cycle should be free of pain, bloating, cramping or mood swings. How can you finally have a normal period? There are more than 137 million women in the United States, and very little attention is paid to the health of a women’s cycle. Both cardiovascular disease and cancer are the top two causes of death in women in the United States. In order to reduce risk, it is important for women to balance their menstrual cycles and hormone levels as they age. Menstruation is the essence of a woman’s health. It involves all the glands, all her body energy, her blood and her emotional balance. If issues are occuring early in life, there will definately be greater problems later in life.
The first thing to realize is that it is not normal to have pain, excessive bleeding or clotting, emotional distress, fluid retention, painful breasts or no period at all. Each of these symptoms indicates an imbalance in the body’s normal cycle. Most of these symptoms can be corrected, and 90% of the time without resorting to oral contraceptives, muscle relaxants or anti-anxiety medication. Try my natural suggestions first, and for at least three months before considering stronger alternatives.
Another thing to remember is that birth control in the form of oral contraception should not be used for regulating the cycle, instead it should be used strictly for birth control. From a holistic perspective the use of any oral hormones will create side-effects and may cause disturbances in the delicate female hormonal balance that can last for years. So we recommend using an oral contraceptive that will have minimal side-effects for your particular body or an alternative form of birth control. As an example, one of the new oral contraceptives is known as Yaz, and one of the stated side effects is an increase in potassium. This can cause adrenal fatigue issues, one of the most overlooked problems among women today. At our clinic, one out of every two women that enter our door has an adrenal imbalance that is creating symptoms such as fatigue, heart palpitations, thyroid dysfunction, blood pressure issues, circulatory imbalances and weight gain, particularly around the mid-section. So if you are prone to adrenal fatigue, then don’t consider an oral contraceptive that can further exacerbate that problem.
Let’s begin with a normal cycle...
Typically the normal menstrual cycle is 28 days beginning with the first day of menstruation, which clears the uterus of the endometrium, unfertilized egg and excess hormones. After the menstrual shedding, Follicle Stimulating Hormone is released from the anterior pituitary gland and stimulates the growth of the follicles, which now begin to secrete estrogen. By about the sixth day, whichever of the follicles is the largest becomes the dominant follicle and levels of estrogen start to inhibit the release of additional FSH. The dominant follicle becomes mature and ready for ovulation, while the minor follicles atrophy. If the follicles do not atrophy, particularly if the hormonal signals are imbalanced, they can become functional cysts. During this final maturation, the dominant follicle continues to increase its estrogen production under the influence of an increasing level of Luteinizing Hormone, and small amounts of progesterone will be produced by the mature follicle a day or two before ovulation.
The estrogens that are released into the blood by the growing ovarian follicles stimulate the preparation of the endometrium, including repair. The estrogen levels determine the thickness of the developing endometrium tissue, which means that estrogen dominance will cause excessive thickening and development of endometrial tissue and potentially over time, endometriosis.
When estrogens are high enough in concentration, they stimulate the hypothalamus to release additional gonadotropic releasing hormone, and the anterior pituitary gland produces a surge of LH. This causes the dominant follicle to rupture and the egg is released. This usually occurs on day 14 of the cycle. If progesterone levels are too high at this point, it will cause suppression of LH and FSH and the cycle will lengthen, creating irregularity and when ovulation occurs quite a bit of pain. In fact, there should be no pain with ovulation.
The blood that is released with the ruptured follicle causes a clot which is then absorbed by the remaining follicular cells. They then enlarge forming the corpus luteum under the influence of LH and the corpus luteum now begins to secrete increasing quantities of progesterone and estrogens. This is called the luteal phase. The hormones produced by the corpus luetum promote the growth of the endometrium a process which peaks about one week after ovulation. This is one of the most common places for infertility to occur. If the corpus luteum does not form correctly due to low levels of hormones, then the endometrium cannot sufficiently develop and even if fertilization is taking place, there won’t be any implantation of the egg, and a period will always occur.
As the luteal phase continues, progesterone should be the dominant hormone. Estrogen levels will remain higher than in the Follicular phase, but still secondary to progesterone. During this phase if estrogen levels are too high, there can be many prementrual symptoms. In fact, most premenstrual symptoms are due to an imbalance between estrogen and progesterone during this time.
If the egg remains unfertilized, the corpus luteum will degenerate decreasing the levels of progesterone produced. Eventually it drops below estrogen levels and menstruation begins around the 28th day.
So what exactly is premenstrual syndrome? This name really is misleading, because it is not a disease and should not be a chronic problem. It is a combination of symptoms that many women suffer prior to, and sometimes during menstruation and often for years. PMS is said to be one of the most common health problems in our society. The reality, however, is that many women have developed an irregularity in their cycles which produce these often debilitating symptoms, and that is not normal. The normal menstrual cycle should be free of pain, bloating, cramping or mood swings.
So let’s look at what can cause these irregularities. Recent studies have shown that there may be a strong correlation between nutrition and PMS. Excess coffee, fats, sugars and cigarette smoke, to name a few, can increase the symptoms of PMS, as can lack of exercise and an insufficient supply of certain nutrients. Vitamin B6, magnesium, zinc, vitamins E, C, certain essential fatty acids are essential for healthy menstruation.
A second cause of PMS is an intestinal tract that is constipated. Since the colon and the uterus are virtually wall to wall, it is very easy for the permeable membranes to allow toxic material from the intestinal tract to pass into the uterus. This toxicity can cause the muscles of the uterus to contract, causing pain. This is especially true in cases of Candida yeast overgrowth, which will take advantage of the change in pH with a woman’s cycle creating painful yeast infections.
A third cause of PMS symptoms is simply the poor positioning of the uterus in the abdominal cavity. The balance of the pelvis controls the strength and flexibility of ligaments and supporting soft tissue. If the pelvis is imbalanced, it can cause the uterus to fold in on itself and "tip". This improper angling of the uterus can cause severe cramping when the uterus swells with the pre-menstrual lining that the body builds. A simple adjustment of the uterus, nutrition to strengthen connective tissue in the abdominal cavity, and a few sessions of Myofascial Release therapy for pelvic balance can correct this problem in virtually a few weeks.
However, the most frequent cause of premenstrual symptoms is an hormonal imbalance during the follicular and luteal stages of the menstrual cycle, often with estrogen becoming the dominant hormone in relation to progesterone throughout.
PMS symptoms can be categorized generally into one of five categories. Women may have one or more than one. Each type has its own specific set of symptoms. Being able to distinguish between the types will help to determine the best course of treatment for you. Then you can browse through my list of specific PMS symptoms below for additional suggestions to round out your monthly protocol.
Craving PMS — this type of PMS symptomology includes increased appetite, headaches, fatigue, dizziness and a pounding heart. Core treatment is the indian herb Gymnema.
Anxiety PMS - this type of PMS symptomology includes nervousness, tension, irritability, mood changes and anxiety. Core treatment is Skullcap, Valerian, Corydalis and Ashwaganda.
Depression PMS - this type of PMS symptomology includes depression, forgetfulness, crying, confusion and insomnia. Core treatment is high grade St. John’s Wort.
Hyperhydration PMS — this type of PMS symptomology includes fluid retention, weight gain, swelling of the extremities, breast tenderness and abdominal bloating. Core treatment is Gingko and Horsechestnut with Black Currant Seed oil for breast swelling.
Pain PMS -this type of PMS symptomology includes aching pains and sensitivity. The Core treatment I prefer is Cramplex by Australia’s Mediherb. Pain really is one of the most common issues with premenstrual syndrome. There are two types of pain issues, spasmodic dysmenorrhea in which the pain is directly related to the onset of menstruation and so is based in the uterus and congestive dysmenorrhea which occurs before or late in menstruation and can arise in other organs as well as the uterus. Chaste Tree can only be used for congestive dysmenorrhea. Estrogen function must be supported with Wild Yam over the long term. For short-term treatment, I use uterine spasmolytics which decrease prostaglandin production such as Dong Quai, Cramp Bark and Ginger particularly if there is also excessive bleeding. Black Cohosh is an antiinflammatory which is useful and Corydalis helps as an analgesic.
Now, since estrogen dominance is the primary motivating factor behind PMS, take a moment to look as well at the most common causes of estrogen dominance in women, to see if this might be a contributing factor for you. If it is, or you suspect it may be, then be sure to add to your Core Treatment Vitex or Chaste Tree. This will help to correct any hormonal imbalance particularly due to high levels of prolactin in the blood, and is often suggested throughout the cycle on a long-term basis. Usual dosage is 2 tablets or 2 ml. upon rising each day with an additional dose before dinner if your premenstrual condition is severe.
There are also a number of considerations that can affect a woman’s cycle and her premenstrual experience. Consider this list carefully to be sure that none of these are true for you. If they are, then you should consult a professional for a personalized protocol to address all your potential issues.
Stress and adrenal fatigue — chronic stress can cause excess cortisol to be released by the adrenal glands, which can displace progesterone and cause levels of estrogen to remain high in relation to progesterone.
Xenohormone exposure — this means excess hormones in your food such as beef, chicken and soy, as well as topical treatments for the skin that actually contain hormones.
Oral contraceptives or conventional Hormone Replacement Therapy — the use of oral contraceptives can actually increase estrogen levels beyond the body’s ability to balance. Many of the side effects listed for oral contraceptives are due to an artificial estrogen dominance.
Poor diet — a diet unusually high in carbohydrates and low in fat can cause excess estrogen to accumulate in the body tissues and blood.
Consumption of trans-fats — consuming hydrogenated or partially hydrogenated oils in food can block the absorption and use of essential fatty acids that control estrogen / progesterone balance.
Synergistic nutrient deficiencies — minerals and many vitamins work in synergistic pairs to enhance the absorption and balance of each. Deficiencies in magnesium, zinc, copper and B vitamins can all lead to estrogen dominance.
Luteal insufficiency — without sufficient development of the endometrium of the uterus, estrogen and progesterone levels tend to become imbalanced.
Pelvic Inflammatory Disease, Fibroids, Endometriosis & Cysts — all of these conditions can create issues with the normal hormonal sequencing and physical shifts that occur during normal menstruation. Spotting, pain, digestive problems can all be due to an untreated condition affecting your pelvic area. Even an undiagnosed STD can create problems with the normal pH shifts that occur during menstruation.
Anovoluatory cycles — this is where menstruation occurs, but no ovulation and therefore no ovarian progesterone is produced, leaving high levels of estrogen throughout the cycle.
Obesity — estrogen can be stored in adipose tissue, and in obese women, there is excessive amounts of adipose tissue available for estrogen storage.
My Formula Suggestions for PMS Symptomology
There are many things that we already do to try and mitigate the symptoms of PMS, often without even realizing that there is a physiological need behind these bizarre cravings. One of the most common is the mad dash for chocolate. There is a definite reason for this: to relax the muscles of the body which is accomplished with the high levels of magnesium in chocolate. So if chocolate is your best friend, try increasing your levels of magnesium, and you may lose your taste for the chocolate fix.
So begin with writing down each of the things that you crave or do during your premenstrual time so that you can see the needs that your body is trying to address. Then, it is easier to address each of your body’s requirements. First, begin with the Core Treatment that you have developed with my symptom categories above.
Now, you must correct any Essential Fatty Acid deficiencies with Evening Primrose Oil in doses of 3000-4000 mg per day. This is especially necessary for symptoms of increased appetite, headaches, fatigue, dizziness and heart pounding which may be associated with a prostaglandin deficiency.
Next, add Standard Process Ovex which is essential to balance ovarian function, if you have low libido issues as well as severe symptoms of PMS and menstrual irregularity.
Now pick from the list below the top symptoms that you notice with your PMS time. These are the ones that you should add to your protocol. However, you may want to try just the Core Treatment for at least two months first to see if that alone may correct your symptomology.
Breast tenderness — this condition is often part of estrogen dominance, but also can be the result of an inability to convert linoleic acid to gamma-linolenic acid (GLA). Using Black Currant Seed Oil can bypass this problem and provide essential GLA levels to reduce breast tenderness. Ginkgo throughout the cycle can also be effective for many breast symptoms.
Fibrocystic breasts — Organic Iodine & Iodide is particularly excellent for fibrocystic breasts which can be a sign of a need for higher amounts of iodine. Also, lymphatic blockages due to calcium deposition or sluggish lymphatic drainage can contribute to fibrocystic breasts. I recommend Poke Root, Cleavers or Standard Process Thymex with Lymphatic Drainage Therapy to clear out sluggish lymphatics. To reduce calcium deposition, I use Liquid Phosphorus and Standard Process Cal-Amo. Their Mammary PMG is also good for the long-term treatment of cystic breasts.
Hormonal acne — cold-pressed Wheat Germ oil provides vitamin E and anti-oxidants with estrogen support for menopausal symptoms such as hormonal acne, hair loss and capillary problems. Also a good herbal depurative with Burdock, Cleavers and Poke Root as well as a good combination of organic zinc and mineral compounds can provide support for clearer, healthier skin.
Nervous tension, insomnia, anxiety and depression — St. John’s Wort can help as a tonic for depressive symptoms, while Valerian is excellent for anxiety or insomnia. Mediherb’s Nevaton can also be a complex for many varying emotional symptoms. For PMS with crying spells, depression and fatigue or excessive perspiration, add a combination of Wild Yam, Shatavari, Sage, Black Cohosh and Panax Ginseng. Since estrogen levels are crucial during this premenstrual time, there can be a severe change in brain chemistry because estrogen is an excitatory hormone. This causes the limbic system to overact, which means that memory and emotion will be sporadic and unstable, a typical reaction with an estrogen surge during premenstrual time. The use of Chaste Tree here is essential to stabilize this estrogen surge, reducing many of your emotional symptoms.
Fluid retention — use Dandelion Leaves to reduce fluid accumulation.
Fatigue — during the premenstrual time, a body that is already under stress may exhaust its’ resources quickly. Compensate for the adverse effects of stress with adaptogenic herbs such as Eleuthero and Withania. Changing the diet during this time to exclude processed foods can also be very beneficial.
Aches and pains — use herbal analgesics such as White Willow Bark or Yellow Jasmine.
Sweats — typical herbal preparations of Sage are effective for PMS sweats.
Constipation — premenstrual constipation usually indicates a sluggish liver or gallbladder if the issue is not a tipped uterus. Other accompanying symptoms such as nausea or reduced appetite can also be treated as biliary sluggishness. Try Milk Thistle Extract, Schisandra and Dandelion Root.
Menstrual Migraines — 2 ml of ginger in hot water each day can do wonders to relieve menstrual migraines.
Amenorrhea, the missing of a period, is usually caused by a condition of less than optimal health. There are a variety of things that can cause this normal process to cease or to become irregular. A diet extremely low in fat contains insufficient quantities of cholesterol to produce the hormones needed to activate the menstrual cycle. Insufficient levels of various nutrients can also prevent normal functioning.
Glandular insufficiency, stress, low body weight and low blood quality are also factors which can cause or contribute to menstrual irregularity. One of our clients even lost her period for six months because she was visiting California during an earthquake.
An important element is the blood level of female hormones such as FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone). As mentioned above, these are key to the regular progression of the female cycle through each month, leading to menstruation. When FSH is low, I suggest 1200-2400mg of Tribulus per day, which also regulates DHEA, increases anabolic activity and intensifies protein synethesis. It also does wonders for your libido. By increasing FSH, your levels of estradiol will increase. If the follicle does not respond to FSH, I will add 2-3 Standard Process Ovatrophin PMG per day to encourage the follicle to produce estrogen. To help the Corpus Luteum make progesterone, I will give 6-9 Standard Process Ovex per day.
Testosterone levels in women is also a good indicator of follicular health. Excess levels of testosterone can decrease the amount of bound hormones in women, while higher levels of testosterone generally indicate cyst formation in the follicles. Tribulus is perfect as a testosterone precursor, but I will also add Chaste Tree and Blue Cohosh to correct hypothalamic malfunction. Often the body energy must be increased with Withania and Panax Ginseng. I will also add Dong Quai where amenorrhea has followed periods of excessive bleeding with anemia.
Another irregularity with the menstrual cycle is menorrhagia or excessively prolonged or profuse bleeding. First and foremost here is maintaining normal iron levels, which are lost in excess with the heavy bleeding. An herbal blend of Codonopsis, Nettle Leaf, Ashwaganda, Licorice, Ginger and iron is my key treatment for this, providing everything women need to maintain healthy levels of iron and red blood cells. Fibroids tend to be the most likely cause, but other issues such as hormone imbalances, infections and endometriosis can also be present. Again, Chaste Tree is a basic formula and then I will add antihemorrhagic herbs such as Tienchi ginseng and Horsetail, and uterine formulas such as Shepherd’s Purse.
If you have a complex case or your premenstrual woes have been ongoing for years, then you really should consult a professional so that you can receive a protocol of therapy and nutrition that will meet your individual needs. Remember, you don’t have to suffer every month and lose vital days from your life just because you are a woman.