PMS: It's real – it's treatable

Originally published in the North Lake Tahoe Bonanza (link), January 17, 2010. Your jeans don't fit. You have a headache and zits across your chin. Worst of all, tiny hassles and slights you'd normally ignore can push you to tears, rage or both. You're normally so sane. What happened?

Up to 80 percent of women experience PMS, 10 percent with symptoms so severe that they find prescription medication necessary. Although pharmaceuticals such as antidepressants and anti-anxiety medications may help, many find these give incomplete relief while causing their own side effects including further weight gain and mental fogginess.

Fortunately for most women, a combination of dietary changes, exercise, supplements, and hormonal balancing can dramatically reduce symptoms.

Although cravings for refined carbohydrates, salt, caffeine, alcohol and unhealthy fats are all common during PMS, avoiding these toxins will minimize symptoms. Eating multiple small balanced meals per day reduces both munchies and mood swings. Sleep and exercise are also critical to decrease stress hormones and release endorphins.

Serotonin is a key neurotransmitter, critical in regulating sleep, mood and appetite. Decreased premenstrual levels contribute to depression, anxiety and carbohydrate cravings. Many prescription antidepressants used for PMS increase availability of this chemical, but levels can be naturally raised by supplements such as 5-HTP or foods rich in tryptophan, serotonin's precursor amino acid. Chocolate, eggs, fish and meats, dairy products, nuts and seeds are all good tryptophan sources. Chromium, green tea and zinc may decrease carbohydrate cravings as well.

During the premenstrual period, pro-inflammatory prostaglandin levels rise, contributing to cramping, bloating and back pain. An anti-inflammatory diet that balances proteins, complex carbohydrates and healthy fats reverses this, as do fish or evening primrose oils and vitamin E. Anti-inflammatory herbs such as turmeric, devil's claw or feverfew are also useful.

Several other supplements show promise. Calcium, magnesium and vitamin D3 work together to decrease cramping and bloating and are frequently combined in supplements. B vitamins, particularly B6, are important in decreasing both depression and water retention.

Finally, hormones play a key role in symptoms. In those suffering PMS, during the weeks between ovulation and menses estrogen levels remain too high relative to progesterone, resulting in estrogen dominance. For many women, treatment with progesterone during this time can alleviate some, and often all PMS symptoms.

Progesterone is a natural diuretic and counters the bloating effect of estrogen. It also has an impressive effect on sleep quality, especially when taken at night. This may be through upregulation of GABA, a calming neurotransmitter in the brain. Normalizing the estrogen/progesterone ratio often decreases headaches, breast tenderness, mood swings and acne as well. Over-the-counter progesterone creams are available, but often give poor delivery and inadequate dosing. Prescription formulations are available in both creams and capsules. Provera, a pharmaceutical progesterone substitute, is not bioidentical and studies have linked it development of cancers, particularly of the breast.

Estrogen and progesterone are not the only hormones that come into play in PMS symptoms. A study in the New England Journal of Medicine found some degree of thyroid dysfunction in over 90 percent of severe PMS sufferers. Testing, and treatment when indicated, may alleviate depression, weight gain, body aches and other symptoms common to both disorders.

Finally, high testosterone levels occasionally contribute to irritability, acne and water retention. This is particularly common in younger women. Treatment with spironolactone, a mild diuretic which blocks testosterone's effects, may relieve these symptoms.

PMS is a distinctly individual constellation of symptoms, and for each woman, a different combination of these strategies will prove effective. The key is knowledge that PMS is both real and treatable and there is no reason to resign yourself to spending a quarter of your life depressed, angry, bloated and miserable.

— Dr. Rebecca Gelber is an Incline Village resident and graduate of The Johns Hopkins School of Medicine. She is an adjunct professor with the UNR School of Medicine and practices locally at Tahoe Aesthetic and Integrative Medicine, 775-298-1750,