OCTOBER 2013 - Practitioner's Corner "PMT"

Optimising Women’s Health & Wellbeing

Premenstrual Tension

Most women at some stage of their reproductive years will experience premenstrual tension (PMT). Symptoms associated can vary and often can be a frustrating and stressful time. Angry outbursts and reduced tolerance are among the many emotions associated with PMT. Pain is a common symptom that can be debilitating, leading to secondary problems including depression, tearfulness and insomnia.

PMT is often joked about and has been used as ‘verbal ammunition’ to make light of emotional distress. Some of us may have very mild symptoms that are of no concern, but for others it can affect their performance of daily tasks.

PMS is thought to be caused by:

·         Hormonal imbalances (excessive oestrogen and inadequate progesterone)^1,4,6.

·         Irregularities in prostaglandins (inflammatory mediators) or neurotransmitters (serotonin)^4,6.

·         Impaired liver function (decreased detoxification and elimination, esp. excess estrogen)^4,6.

·         Stress (elevated levels of cortisol and aldosterone)^4,6.

·         Hypothyroidism (low thyroid function)^4,6.

·         Nutritional deficiencies^1,4,5,6.

·         Poor dietary and lifestyle practices^4,6.

Types of Premenstrual Tension

PMT Types	Symptoms
PMT-A 66-80% 1,3	·         Anxiety, nervous tension1,3 ·         Irritability1,3 ·         Mood swings1,3 ·         Insomnia1,3
PMT-H 60-66% 1,3	·         Water and sodium retention1,3 ·         Abdominal bloating1,3 ·         Weight gain1,3 ·         Breast pain (Mastalgia)1,3
PMT-C	·         Craving for sweets 1,3 ·         Increased appetite1,3 ·         Indulgence in refined sugar followed by palpitation and fatigue1,3 ·         Dizziness, shakiness, headache1,3
PMT-D 1.7-23%	·          Crying1,3 ·          Depression 1,3 ·          Suicidal tendencies1,3
PMT-P	·          Painful periods1,3

Dietary & Lifestyle Recommendations:

Diet

Disruption to healthy oestrogen metabolism is linked to multiple PMT symptoms ⁶. Foods high in fibre such as fruits, vegetables, grains and legumes can help lower elevated circulating estrogen⁶.  Phytoestrogen foods are incredibly beneficial to eat to optimize healthy hormone levels⁶. Some of these include: Fermented Soy, Alfalfa, Oats and Linseed.

Low saturated animal fat diets are beneficial to help remove excess oestrogen. Good fats such as raw nuts, seeds and fish can help reduce inflammation in the body ^4,6.

High sugar consumption has also been associated with inadequate oestrogen metabolism⁶. If you crave chocolate before menstruation you may be deficient in magnesium. 

Women should avoid stimulants like caffeine (tea, coffee, chocolate, energy drinks) and alcohol as these can exacerbate some PMT symptoms. These include: anxiety, irritability, insomnia and depression. High intake of salt increases water retention and bloating associated with PMT ⁶.

Exercise

Regular exercise has a positive effect on mood; decreases fatigue and improve sleep ⁴. Aerobic exercise such as running or walking releases endorphins (chemicals that elevate mood) ⁴.

Several studies have shown that women who exercise regularly do not suffer from PMS as often as sedentary women do^4,6.

Nutritional Recommendations:

Vitamin B6

Vitamin B6 is a micronutrient important in hormonal and neurotransmitter synthesis. It is incredibly beneficial for women who suffer with PMT, especially if anxiety and depression are present ^4,6. This vitamin is necessary for the formation of serotonin and dopamine (happy chemicals) and can also help to alleviate breast pain and fluid retention^4,5,6. Short-term supplemental dosing can be administered 50-100mg/daily⁵. Do not exceed recommended daily intake unless under practitioner supervision.

Magnesium

Low magnesium levels have been linked to premenstrual headaches and migraines^4,6. This mineral is necessary in muscle relaxation and is thought to help with uterine cramping^5,6.

Calcium

Calcium had been found to be an affective mineral to use for alleviating fluid retention, mood swings, food cravings and pain ⁴. It has also demonstrated to improve menstrual migraines in combination with vitamin D ⁴. Calcium in combination with manganese has shown to improve mood, concentration and behavior ⁴.

Evening Primrose Oil (EPO)

Gamma linolenic acid (GLA) found in EPO is an important fatty acid that is useful in relieving PMS. It is thought to regulate prostaglandin production (modulate inflammation) and aid in healthy glandular function ^4,5,.

Vitamin E

In several studies vitamin E has demonstrated to improve breast tenderness, nervous tension, headache, fatigue, depression and insomnia ^4,5 .

Herbal Support:

Vitex agnus castus

Vitex is an effective herb for the treatment of some PMS symptoms such as irritability, anger, headaches, acne and breast tenderness ^4,5,6. Vitex is also highly beneficial for women who suffer from progesterone deficiency and corpus luteal insufficiency (follicle that carries the egg after ovulation)^4,5,6. Advise your practitioner if you are talking prescriptive medications before taking this herb.

Other:

Keep a PMT symptom diary for about 3 months. Some information may include: appetite changes, headaches, constipation/diarrhoea, sleeps disturbances as well as emotional symptoms such as tearfulness and mood swings.

Basal temperature tests can help to detect if your thyroid gland is under/over active. This is done using a thermometer and a recording chart. For additional information see a qualified natural practitioner.

Breast Self-Examination

1.       Examine both of your breasts each month, after your period ².

2.       Stand in front of a mirror and raise your arms and place your hands behind your head².

3.       Assess what your breasts look like².

4.       Place your hands on your hips and apply pressure².

5.       Look for dimpling of the breast skin, unbalanced nibbles and differences between both breasts².

6.       Also check for red scaling or thickening of skin and nipples².

7.       Raise one arm and place hand behind head. With the other hand, apply moderate pressure in a circular motion starting at the outer edge of the breast. Gradually work your way towards the nipple².

8.       Also feel underneath the arm pits (lymph glands)²

9.       Look for lumps that are hard and immobile (cancers are generally attached to underlying muscle or skin) ².

10.    Repeat the same on the other breast².

11.    Lying on your back is also a beneficial position to check for lumps².

12.    Gently squeeze your nipples to check for any blood of discharges².

 NB: Always consult your doctor if you notice any change in your breasts. If you have a family history of breast cancer or over the age of 35 annual checkups are recommended.

What to expect during a Naturopathic Consultation:

·         Personalized treatment plans

·         Salivary Hormone Profile

·         Natural hormonal support including herbal medicine and nutritional therapy

·         Liver detoxification support to optimize hormone metabolism

·         Reproductive disorder management e.g. endometriosis, polycystic ovarian syndrome and unexplained infertility.

·         Hemaview (live blood screening): inflammation, oxidative stress, liver stress, nutritional deficiencies and white blood cell activity.

·         VLA or BIA (Bio-Impendence Analysis): Weight management programs, fat distribution, metabolic age, muscle mass, water distribution, bone density and cellular health evaluation.

·         Stress Management

References are available upon request.

Written by Calanna Pharmacy Naturopath Vanessa Laird

BHSc.(Comp.Med). Adv.Dip.Nat. ATMS Accredited