Premenstrual syndrome (PMS)

A symptom diary should be kept for a minimum of 3 months in order to correlate symptoms with the menstrual cycle. The diary will greatly assist the health care provider not only in the accurate diagnosis of PMS, but also with the proposed treatment methods.

The following is a list of recommendations for treating PMS using alternative healing practices. Veria strongly encourages consultation with expert practitioners before beginning any treatment plan.

Ayurvedic Treatments
The best herbs for treating PMS are Chitrak mool (Plumbago zeylanica) and Nirgundi (Vitex negundo).

The following spices are recommended for treating PMS:

• Turmeric
• Coriander
• Fennel
• Saffron
• Safflower flower combined with antispasmodic spices such as nutmeg

Other Ayurvedic herbs good for PMS include

• Aloe gel
• Shatavari
• Cyperus
• Manjishta
• Lodhra
• Gotu kola ginge
• Calamus
• Bhringaraj

Drugs like Sundarikalp, Rajahpravartini bati and Kumariasava are helpful in relieving PMS.

Homeopathic Treatments
The following homeopathic remedies are recommended, in accordance with the symptoms described below:

• Chamomile: for intense menstrual pain; this remedy is most appropriate for individuals who are extremely irritable, angry, and have frequent mood swings
• Cimicifuga: for feelings of hysteria, frustration, and being overwhelmed; this remedy is most appropriate for individuals who have labor-type pains that migrate from one side of the body to the other and may involve the back or even sciatic nerve (the largest nerve in the body; extends from the lower back down through the legs and knees)
• Colocynthis: for cramps that are relieved by bending forward, abdominal massage, and warmth (such as a heating pad); this remedy is most appropriate for individuals who are extremely irritable and restless.
• Ignatia: for emotional symptoms such as grief, panic, and mood swings. This remedy is most appropriate for individuals who feel particularly vulnerable.
• Lachesis: for individuals who tend to be annoyed, caustic, talkative, and envious and whose pain and bloating is worse on the left side; symptoms tend to worsen upon awakening in the morning and with exposure to heat or light pressure; symptoms improve dramatically when menstruation begins.
• Lycopodium: for bloating with backaches and gas that are the worst during early evening and in warm weather.
• Magnesia phos: for sharp cramps that are relieved by warmth (such as a heating pad), but are worsened by cold air.
• Nux vomica: for individuals who are extremely irritable, confrontational, and feel nauseous.
• Pulsatilla: for irregular periods with cramps, bloating, and/or mood swings as the predominant symptoms; an appropriate candidate for Pulsatilla is gentle and yielding but clingy and cries easily; may have nausea and water retention that is aggravated by heat.
• Sepia: for bloating, mood swings, constipation, drowsiness, and irritability.

Naturopathic Treatments
A balanced diet that is high in fiber, moderate in fat and protein and low in salt, sugar, caffeine, and alcohol is good. Include lots of fresh fruits and vegetables, starches, raw seeds and nuts, and whole grains in the diet. Watermelon juice or watermelon seed infusion 2 times a day helps to reduce water retention.

The following herbs may be helpful in alleviating symptoms.

1. Chaste tree (175 mg a day)
2. Black cohosh (100 to 600 mg a day)
3. Valerian (150 to 300 mg one to four times a day, or before bed for insomnia) Reduce dose if drowsiness occurs.
4. Kava kava (200 mg one to four times a day, or before bed) Reduce dose if drowsiness occurs.
5. Milk thistle (200 to 600 mg a day)
6. Dandelion root (and/or leaves as a tea or tincture) Note: If you have liver problems, consult with an experienced practitioner before using this potent diuretic.
7. St. John's wort (300 mg two to three times per day) for depression associated with PMS. Must be taken consistently throughout the month.

Yoga
Yogasanas can be very helpful in relieving menstrual cramping. They accomplish this by aligning body structure, helping body fluids to circulate, and relieving nerve pressure. Also, they relieve pent-up stress, and often that lessens physical and emotional pressure, thereby helping to relieve many PMS symptoms.

Incorporate the following asanas into your practice to help deal with PMS:

• Ten rounds of Surya Namaskaram.
• Sitting poses like Padmasana, Vajrasana, Konasana and Siddhasana.
• Forward bending yoga asanas like Shashankasana, Paschimottanasana, and Baddha Konasana.
• Backward bend poses like Bhujangasana, Shalabhasana,Dhanurasana, Chakrasana, Matsyasana, Setubandha Sarvangasana, Vipareeta Dandasana and Ustrasana.
• Meditative asanas like Padmasana, Vajrasana, Siddhasana and Konasana.
• Restorativeasanas like Shavasana and Makarasana.
• Pranayamas such as Nadi shuddhi, Ujjayi, Sheetkari, Sheetali, and Bhramari.
• Meditation and Yoga nidra.

Nutritional Therapy
Decreasing or avoiding caffeine (including chocolate), saturated fats, sugar, salt, dairy, meat, poultry, and alcohol can help reduce the intensity and duration of symptoms.

Nutritional deficiencies may be addressed with these supplements.

• Vitamin B6 (100 to 200 mg a day) with B-complex (50 to 100 mg a day).
• Magnesium (400 mg a day).
• Vitamin E (400 to 600 IU a day), especially if breast tenderness is a symptom.
• Essential fatty acids (3,000 to 4,000 mg a day for three months, then decrease dose by 1,000 mg every two months).
• Chromium (250 mcg one to two times per day) to reduce sugar cravings.
• Evening primrose oil: Women with PMS may have a deficiency of gamma-linoleic acid (GLA) which is found in this supplement.

Psychotherapy and Counseling
Stress may exacerbate PMS. Practices like Jacobson's Relaxation, meditation, and biofeedback help to reduce symptoms. Counseling and cognitive behavioral therapy help to reduce anxiety and depression associated with PMS.

Some of the lifestyles changes often recommended for the treatment of PMS are also useful in preventing symptoms from developing or getting worse.

Regular exercise and a balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine) will prove beneficial. The body may have different sleep requirements at different times during a woman's menstrual cycle, so it is important to get adequate rest.

An exact cause of PMS has not been identified. It can occur with apparently normal ovarian function (regular ovulatory cycles).

PMS is estimated to affect up to 75% of women during their childbearing years. It occurs more often in women between their late 20s and early 40s, those with at least one child, those with a family history of a major depression disorder, or women with a past medical history of either postpartum depression or an affective mood disorder. As many as 50-60% of women with severe PMS may suffer from an underlying psychiatric disorder.

A wide range of physical or emotional symptoms have been associated with PMS. Such symptoms must occur during the second half of the menstrual cycle (14 days or more after the first day of the menstrual period) and be absent for about 7 days after a menstrual period ends (during the first half of the menstrual cycle).

The most common symptoms include:

1. Headache
2. Swelling of ankles, feet, and hands
3. Backache
4. Abdominal cramps or heaviness
5. Abdominal pain
6. Abdominal fullness, feeling gaseous
7. Muscle spasms
8. Breast tenderness
9. Weight gain
10. Acne flare-ups
11. Nausea
12. Bloating
13. Constipation or diarrhea
14. Decreased coordination
15. Food cravings
16. Less tolerance for noises and lights
17. Painful menstruation

Other symptoms include:

1. Anxiety or panic
2. Confusion
3. Difficulty concentrating
4. Forgetfulness
5. Poor judgment
6. Depression
7. Irritability, hostility, or aggressive behavior
8. Increased guilt feelings
9. Fatigue
10. Slow, sluggish, lethargic movement
11. Decreased self-image
12. Sex drive changes, loss of sex drive
13. Paranoia or increased fears
14. Low self-esteem

There are no physical examination findings or lab tests specific to the diagnosis of PMS. It is important that a complete history, physical examination (including pelvic exam), and in some instances a psychiatric evaluation be conducted to rule out other potential causes for symptoms that may be attributed to PMS.