Premenstrual Syndrome
by Tori Hudson, N.D. Professor, NCMN & Bastyr University and Medical Director, A Woman's Time in Portland, OR

Eighty percent of women experience premenstrual emotional or physical changes; 20-40 percent of these same women experience symptoms that would be classified as premenstrual syndrome (PMS). A much smaller number of these women, about 2.5-5 percent, feel their symptoms have a significant negative impact on their lives, to the point where work, relationships or home life are jeopardized.

There are about 150 symptoms that have been ascribed to PMS; most common are feelings of anxiousness, irritability, and anger. Physical changes include bloating, breast tenderness, food cravings, headache, and gastric upset. PMS is defined as the regular recurrence of symptoms, on a monthly basis, just before menses occurs, that disappear with the onset or within the first days of menses. Symptoms begin somewhere at, or after, mid-cycle ovulation and may last for just a couple of days, or the full 2 weeks.

Numerous natural alternative therapies are appropriate for the treatment of PMS including lifestyle changes, exercise, vitamin and mineral supplementation, herbal medicines, and natural progesterone. Many of these have demonstrated their effectiveness in standard scientific studies. What follows is a brief review of some of the botanical approaches to PMS. For some women, these can be self-selected and one can treat oneself. For others, with more severe or resistant symptoms, seeking the expertise of a naturopathic physician can assure more therapeutic doses, individualized treatment, and the use of natural therapies that require more knowledge.

Chaste Tree (Vitex agnus castus)
The single most important plant for the treatment of premenstrual syndrome is Chaste Tree berry. Two surveys were done covering 1,542 women with PMS who had been treated with a German liquid extract of Chaste Tree for periods of up to 16 years. Effectiveness, as recorded by the patients’ doctors, was either very good, good, or satisfactory in 92 percent of the cases.

The newest study was a clinical trial of 170 women with PMS. Women were assigned to take either a tablet containing an extract of Chaste Tree berry or a placebo tablet, once daily for three months. Reporting of irritability, mood changes, anger, headache, breast tenderness and bloating were recorded. At the end of the three months, women taking the Chaste Tree reported a 52% reduction in PMS symptoms versus a 24% reduction for those in the placebo group.

St. John’s Wort (Hypericum perforatum)
A pilot study using St. John’s Wort standardized extract, 300 mg., three times daily, was recently investigated. After taking St. John’s Wort for two complete menstrual cycles, daily symptoms were rated. The degree of improvement in overall premenstrual syndrome scores was 51%, with over two-thirds of the women demonstrating at least a 50% decrease in symptom severity. Moods showed the most improvement (57%); and, the symptoms with the greatest reductions in scores were: crying (92%), depression (85%), confusion (75%), feeling out of control (72%), nervous tension (71%), anxiety (69%) and insomnia (69%).

Ginkgo (Ginkgo biloba)
A double blind, placebo-controlled study was done in 1993 to determine the effectiveness of a standardized Ginkgo extract on PMS symptoms. One hundred sixty-five women were studied, and received either a Ginkgo extract, 80 mg., twice daily (standardized for 24 percent ginkgo flavonglycoside content), or a placebo from day 16 of their cycle to day 5 of the next cycle. The Ginkgo extract was effective against the congestive symptoms of PMS, particularly fluid retention, breast pain or tenderness and vascular congestion.

Other Herbs
Another basic foundation for many alternative practitioners in treating PMS is the concept of the liver’s role in the detoxification process and the conjugation of steroids. It is important to understand that improving liver function, as a method of treating PMS, is based on theory with minimal scientific support. We do know that the liver influences hormone biochemistry and enzymatic pathways. There may, in fact, be a role for liver function in PMS; but what that is remains unknown. Herbs that are often used to positively affect liver function include Milk Thistle, Burdock and Dandelion.

Black Cohosh (Cimicifuga racemosa) is listed in the German E Monograph as accepted treatment for PMS; however, this is based on historical use. Published studies have focused on Black Cohosh’s use in menopause. Many herbs, such as Wild Yam, Licorice, Chamomile, Pulsatilla, Dandelion, Butcher’s Broom, Dong Quai and Kava, have a historical, and/or logical use in the treatment of PMS, although published human scientific studies are lacking in this specific area.

Many herbal combination formulations for PMS are based on principles of traditional herbal medicine, as well as utilizing herbs that have been scientifically researched.

Nutritional and Herbal Combination Products
Many good combination products are available. These generally include herbs, vitamins and minerals. I look for products that have the herbs we have discussed here. All good nutrient/herbal combination products should have at least calcium, B6, Chaste Tree, St. John’s Wort and an herbal diuretic.

Summary
Historically, conventional medicine has not been able to offer women a known cause for PMS, as it is only recently we have had an increased understanding of serotinin. Nor has it been able to offer a management approach short of pharmaceuticals which bring as much side effect as relief. Self-care with natural therapies has been the dominant method of managing PMS. Women have clearly taken this familiar monthly problem into their own hands; and more often than not, have determined what works for them. The astute and well-educated practitioner can offer additional therapies and clinical insights to help women with severe symptoms who need more specific and effective dosing regimens of natural substances as well as a well thought out comprehensive approach that includes regular aerobic exercise and dietary modifications. Treating PMS naturally can serve as motivation to make lifestyle changes that will have a positive, cascade effect on general health and well-being.