One of the most common reasons women come to see me, aside from painful periods, is to help them navigate that often extremely challenging time prior to menses. It can feel as though that calm, collected human we recognised for the rest of the month disappears and is replaced instead by some sort of premenstrual gremlin- trust me, I relate. We might cry at the drop of a hate, we may get angered by things that may not have mildly irritated us a week ago, and we crave chocolate, consolation and our own company, all at the same time. We may experience headaches, swollen breasts, fatigue; the list goes on, and it’s not much fun.
As explored in the previous blog, PMDD is a more severe premenstrual disorder, and aside from hormonal dysregulation, sufferers often share a history of stress and trauma that may not be present in women experiencing PMS.
Both PMS and PMDD are best supported by a comprehensive, personalised treatment plan that looks at your unique causative factors and takes into account your diet, lifestyle and overall health picture. However, listed below are some of the natural medicine and lifestyle approaches we can use to make that time of the month a little less challenging.
Low levels of calcium have been associated with a range of symptoms experienced during PMS, including irritability and agitation.
When 33 women supplemented 1000mg/day of elemental calcium for 3 months, followed by 3 months of placebo, 73% of women reported a reduction in symptoms (especially pain and fluid retention). A further double-blind trial gave 1000mg of calcium a day or placebo to participants and the calcium supplements were found to reduce early fatiguability, appetite changes and depression in women with PMS.
Calcium is found in the plant kingdom in dark green leafy vegetables, nuts, seeds (tahini and sesame seeds being one of the highest sources), oranges, soy products, legumes and fortified food products. For those looking to supplement, I like to use the plant-based marine sources of calcium, whilst ensuring that my vitamin D levels are optimum for absorption, and that I have sufficient vitamin K2 (found directly in Natto, or converted from vitamin K1 in the presence of a healthy gut microbiome.
2. Vitamin B6
As mentioned in the previous blog, GABA and serotonin both have important roles in mood and hormonally-provoked fluctuations in the level of these neurotransmitters can lead to mood symptoms we see in both PMS and PMDD. Vitamin B6 modulates the production of GABA and serotonin, as well as being critical for magnesium transportation in the cell membrane. A review of nine studies showed that B6 supplementation improved symptoms of PMS. Unsurprisingly, due to its role in the body, improvements reported included feelings of depression. It is important to note that appropriate dose of B6 supplementation is critical, due to risk of peripheral neuropathy; please consult your healthcare provider before initiating supplementation.
As the precursor to serotonin, tryptophan depletion has been shown to increase aggression in women during the premenstrual phase. Supplementation with this amino acid at a dose of 6g/day from the time of ovulation until the third day of menstruation was shown to reduce premenstrual mood swings, tension and irritability in women with PMDD over a 3-month period. What’s not to love? However, it should be noted that those using medication to enhance serotonin MUST consult with their prescribing physician before self-administering tryptophan or 5-HTP.
4. Vitex agnus-castus
Whilst there are SO many more herbs available to assist with women’s health, and whilst Vitex may NOT be appropriate for everyone, it is one of the most famous and noticeably effective herbs we have at our disposal. Also known as Chaste Tree, this herb works as a prolactin inhibitor (which can indirectly increase progesterone) as well as a dopamine agonist.
One study of 1634 women with PMS given Vitex agnus-castus over three menstrual cycles found 93% of women to observe a decrease in the number of symptoms, with entire cessation in some cases. Improvements have been seen in irritability, mood alteration, anger, headache and breast fullness. Excitingly, Vitex agnus-castus has also been to be similarly efficacious as fluoxetine in PMDD.
Vitex is best taken at the same time each day, preferably before breakfast, and given a break of five days each menstrual cycle from the first day of your period. Vitex is best used for a 6 month period before giving at least a couple of months break, and recommencing only if required. For further assistance with selecting the right herbs and dosing regimen for you, ensure you speak to your naturopath or herbalist.
5. Address lifestyle factors
Optimising your diet, reducing caffeine intake, and addressing stress and trauma are pivotal parts of the PMS/PMDD jigsaw puzzle. Naturopaths can work with your unique case and assist you with diet and stress management using nutritional and herbal medicine, and helpful lifestyle practices. In addressing trauma, talking therapy can be extremely beneficial; whilst future therapies to keep an eye on include psilocybin and MDMA therapies, undertaken supervised in a controlled environment.
I hope you found this information beneficial; for information on the services I offer click here, or drop me an email at Camilla@CamillaClare.com 💕