These compounds are referred to as essential because they are required for the production of prostaglandins, which are involved in the regulation of many many processes and bodily functions. They are also involved as precursors in the production of a number of hormones, and they serve as building blocks in the production of cell walls. A deficiency of essential fatty acids can produce a myriad of symptoms such as those in PMS.
There are several sources of essential fatty acids available as supplements, to include borrage oil, flaxseed oil, evening primrose oil, and fish oil. We believe the best supplement for essential fatty acids in treating the symptoms of PMS is fish oil. Clinical trials involving evening primrose oil for the treatment of PMS show it t o be no more effective than placebo. Dietary sources of EFA’s, cold water fish, should also be addressed.

PROPER GASTROINTESTINAL FLORA:
The bacteria in our intestines are involved in the process whereby a variety of substances including estrogen are either eliminated from or recycled back into our bodies. If the intestinal flora is not balanced, an excess of estrogen can occur, worsening the symptoms of PMS. Proper intestinal flora can be encouraged by supplementation with Lactobacillus Acidophilus daily. Dosages are given on the label of the Lactobacillus supplement.

DETOXIFICATION: Before estrogen is excreted into the intestinal tract, it must first be metabolized by the liver. As such, proper liver function is requires for the elimination of estrogen from the body. A detoxification program should be considered in patients with PMS especially those who have not responded to other methods. Please see our handout on detoxification for guidance.

There are available nutritional supplements and botanical preparations that can support the liver in its role of detoxification and elimination of estrogen. An adequate supply of anti-oxidants is essential for this function. As well, a variety of what are known as “lipotropic agents” are also involved in this process. These are substances such as methionine, betaine, and choline, and are available individually or combined into a liver support/detox formula. Milk thistle is an herbal remedy which, likewise, supports liver function and the detoxification process. Milk thistle is the flavonoid extract from plant Ssylibum marianum. The daily dose of milk thistle is 70 mg three times a day.

HERBAL THERAPY:Fatty Acid Supplementation for PMS
The scientific evidence supporting the use of herbal therapy for PMS is less strong than for the dietary or supplementation advice. However, the herbal therapies used carry with them the support of thousands of years of successful use in Traditional Chinese Medicine. As well, there is an understanding of their mechanisms of action, which would lend theoretical support for their use. The mechanisms of action are believed to be from phytoestrogens contained in the herbs, acting in a way similar to those in soy. The herbs currently used for the treatment of PMS are as follows:

ANGELICA, OR DONG QUAI:
The mechanism of action of Dong Quai is felt to be through its phytoestrogenic activity. In addition to PMS, Dong Quai has also been successfully used to treat dysmenorrhea (painful menstrual cramps). Treatment is started on the 14th day after the onset of menstruation, and can be taken as follows:

  • Powdered root or as tea- 1-2 gm per day.
  • Tincture- (1:5)-1 tsp. per day, or as a fluid extract, 1/4th tsp. per day.

LICORICE ROOT:
The mechanism of action of licorice root is by inhibiting an enzyme involved in the metabolism of progesterone, thereby increasing the estrogen/progesterone ratio. It also blocks the binding of the hormone aldosterone, which regulates sodium excretion and fluid balance and retention. As such, licorice root is especially helpful in patients with significant fluid retention and edema. Treatment is started on the 14th day following menstruation, and can be given as follows.

  • Powdered root or tea-1-2 gm per day.
  • Fluid extract- (1:1)- 1 tsp. per day.
  • Solid extract- (4:1)- 250-500 mg per day.

Because of the effect on sodium metabolism, licorice root is not to be used by patients with hypertension, renal failure, or who are taking digitalis preparations.

BLACK COHOSH:
Black Cohosh has been studied in Europe and found to be effective in treating the PMS symptoms of depression, anxiety, and mood swings. The active ingredient is 27-deoxyacteine, available commercially as “Remifemin.” The dosage is in the form of an extract containing 4 mg of 27-deoxyacteine twice a day.

CHASTEBERRY:
This is the most popular herbal approach to treating PMS, with improvement in symptoms noted in several European studies. The mechanism of action is felt to be through regulation of pituitary function that controls ovulation and, therefore, estrogen and progesterone. The pituitary also regulates production of prolactin, a milk-producing hormone, and this herb is especially helpful in treating breast tenderness. The dosage is as follows:

  • Extract- tablets of 175-225 mg per day.
  • Liquid extract- 2 ml per day.

GINKGO BILOBA:
Ginkgo has been shown to be helpful for patients experiencing breast tenderness and fluid retention. Treatment is started the 15th or 16th day after the onset of a period and continued until the 5th day of the next. The dose is 80 mg twice a day.

LIFESTYLE CHANGES AND SELF-HELP:
EXERCISE:
The benefits of exercise in improving the symptoms of PMS are without question, most notably in improving mood swings, irritability, and depression. Exercise increases the brains’ production of endorphins, our “natural opiate.” Likewise, research has shown that women who exercise regularly do not have symptoms of PMS as often as do sedentary women.

REST AND RELAXATION:
Getting the right amount of sleep is important, as it is during sleep that our brains’ neurotransmitters undergo changes that restore or maintain the balance responsible for normal mood, behavior, and coping with stress. Likewise, relaxation assists in achieving a balanced lifestyle, with time away from work and/or family for enjoyable activities, self-fulfillment, and personal growth.

STRESS MANAGEMENT:
The ability to handle stress is an important aspect of dealing with the symptoms of PMS. It has been shown that patients with PMS, as a group, show a higher degree of negative coping skills. The following characteristics are considered indicative of negative coping skills, considered negative as they do not support good health:

  • Overeating.
  • Too much TV.
  • Emotional outbursts.
  • Overspending.
  • Behaviors to excess, including work.
  • The reliance on chemicals: drugs, alcohol, and smoking.

Learning positive coping skills is an essential part of handling stress. A variety of paths can be taken to develop positive coping skills, including self-help literature, individual and group therapy, the development of a more balanced life-style, and the strengthening of a spiritual connection. A type of therapy known as cognitive-behavioral therapy is especially useful in this process.

The physicians and staff of Nature’s Healthcare welcome the opportunity to become partners in your care, and to assist you in achieving your goal of improved health and wellness.

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