Q&A: PMS, Why? And What I Can Do For Relief!

 --Do you know what percent of women experience period cramps? 

At least 60% of menstruating women experience PMS including menstrual cramps but less than half that number have difficulties that affect their quality of life due to pain and discomfort and requiring the need for intervention. Cramping can also be noted in some women at midcylce during ovulation, called “mittleschmerz.” This pinching sensation often passes quickly in a few hours to days and can be noted but unremarkable.

--What makes a woman more likely to experience period cramps? 

Menstrual cramps are a natural process in the female cycle pronounced in the luteal phase(second half of the cycle) closer to the onset of menses. If fertilization and pregnancy is not intact in the uterus then within 24-48 hours of starting your period the hormones estrogen and progesterone start to drop initiating a cascade of hormones to be released. These hormones create mild contractions in the uterus to break down the endometrial lining and expel it over the next 3-7 days as a normal menstrual period. Although a natural process it should be an easy and tolerable transition without upsetting ones quality of life. Some women make more of the contractile hormones called prostaglandins and leukotrienes. They are not only associated with contraction and relaxation of muscle tissue but they also create an inflammatory processes in the body to spark healing on the surrounding tissues. If there is excess contraction and inflammation in the pelvic cavity pre-menses then cramping will be more severe. Dysmennorhea is the term for painful menses that can be associated with an underlying cause including heightened contracture, inflammation, high emotional stress, as well as physical causes like uterine fibroids, endometriosis and cervical polyps.

--What are some hormonal and emotional reasons women may experience cramps, irritability, bloating or other PMS-related symptoms during their monthly cycle? 

PMS symptoms can be exacerbated for most women during times of stress. This is due to the relationship between sex hormones(estrogen and progesterone) and stress hormones(cortisol). When the body is producing high amounts of cortisol to deal with stressors, biochemically, it uses the same cholesterol backbone from food in the diet to make cortisol as it does to make estrogen and progesterone(E/P). This then upsets the E/P ratios in the body and steals from its reserves to make cortisol instead of keeping E/P in balance. Stress and cortisol also take a lot of energy in the form of blood sugar using up reserves more quickly. Simultaneously at the onset of menses as the progesterone drops this causes another drop in blood sugar so women can become irritable, anxious, depressed and crave sugar. Some studies have hypothesized that some neurotransmitters are intimately linked to the menstrual cycle and that specifically serotonin, “the happy hormone,” drops after ovulation. Women with lower levels of serotonin can suffer form more severe depression and mood instability in the second half of there cycle and worse at menses.

Bloating and cramps are worse for some women than others based on the levels of inflammation in the body that will be elevated pre-menses due to the stimulation of prostaglandins and leukotrienes.

--With such easy access to over-the-counter pain relievers of all sorts, it's easy for women to forget that their are alternative ways to ease these monthly pains. What are some types of foods you'd recommend to a patient to help ease period symptoms naturally? 

Diet and lifestyle intervention can have an enormous affect on PMS and cramps. A whole foods diet with a focus on anti-inflammatory foods can decrease pelvic inflammation and help support E/P ratios. Animal fats are high in inflammatory prostaglandins where as vegetable oils will an have antagonistic effect. A high fiber, vegetable based diet will lower overall inflammation. Fruits, legumes, whole grains, nuts and seeds all support reducing inflammation in the body as well as preventing constipation. Easily moving bowels will decrease pressure in the pelvic cavity and lessen bloating and potential cramping. Fiber also promotes excretion of excess estrogens that are not in balance to progesterone in women with estrogen dominant cycles and generally present with more aggressive PMS. Foods high in B6 such as fish, eggs, walnuts, bananas, prunes, avocado and cauliflower can support serotonin pathways and mood changes. Dark leafy greens. Almonds, pecans, cashews, brown rice, avocado and dried apricots are all high in magnesium that can promote relaxation of the muscle contractions easing cramps. Foods high in iron(beans. Nuts, salmon, kale, spinach, dandelion, broccoli, black strap molasses) can also improve energy levels and prevent fatigue due to blood loss during menses. Staying hydrated and preventing water retention will decrease overall bloating systemically and lower pelvic congestion. It is recommended to drink half of your body weight in ounces of water daily. Ie at 150 pounds you would drink 75 ounces of water daily. Foods high in potassium can help reduce water retention(spinach, peas, parsley, tomatoes, oranges, apples, avocados, raisins).

--What are some types of foods you'd advise your patients to avoid during their period -- or foods that may make their symptoms worsen during that time of the month? 

Decreasing fat intake especially animal fats can lower prostaglandin induced inflammation and contractions as well as reduce circulating excess estrogens in the body. Less animal foods, more plants! Avoid sugars. I know your body may crave it but it will increase inflammation in the body, increase water retention, increase cravings and disturb the glycemic balance in the body causing hyper then hypoglycemia, exacerbating mood swings and irritability. Sugar also impairs estrogen metabolism. PMS is more common in women with high sugar diets and is associated with higher estrogen levels. Caffeine in concert with sugar has a detrimental affect on mood and PMS. Caffeine over time heightens the hypoglycemic response and therefore anxiety, depression, irritability and insomnia. Excess salt reduces potassium in the blood and stresses the kidneys ability to maintain fluid volume leading to water retention and increased sensation of bloating. Alcohol also upsets the blood sugar balance as well as dehydration and retention. It is best to stick to 0-1 alcoholic beverages daily during menses to reduce symptoms associated with PMS.

--Are there any old wives' tales you've heard patients talk about? Care to set the record straight?

I have seen many patients with moderate to severe PMS have a huge improvement in symptoms with a general multivitamin and whole foods diet. Castor oil packs applied to the abdomen can provide muscle relaxation to the pelvis and warm comfort. Homeopathic remedies for you constitution can reduce symptoms and overall well being.

--Are there any activities you'd recommend/not recommend to a patient who experiences period symptoms? 

Exercise and stress reduction are the two best activities you can indulge in for PMS. Women who exercise regularly report no to less PMS and improved concentration, mood, endorphins and less pain. Exercise elevates serotonin levels and lowers cortisol. Yoga, biking and swimming can be great ways to increase blood flow and circulation to the pelvic cavity and reduce pain and inflammation. Exercise lowers stress levels in the body but for more reflective relaxation meditation, reading, laughing with friends and creative hobbies can be a way to lower cortisol.

-Anything else on this topic you'd like to add? Any additional expert advice is welcome and encouraged!

If all else fails and the cramps begin I love to use Viburnum(crampbark)  as a uterine tonic for period pain pain that is crampy and comes in waves. If PMS affects your life every month where you need medical intervention, pain management or birth control I highly suggest a full naturopathic evaluation for simple natural solutions for peace of mind and pain free quality of life!

Vitamins to Relieve Menstrual Cramps

Calcium and Magnesium

Calcium and Magnesium supplementation can decrease cramping symptoms secondary to PMS. Although lacking thorough scientific evidence the theory is that calcium can alter smooth muscle responsiveness associated with PMS while magnesium can increase the pain threshold. Muscles need calcium to maintain muscle tone and relax after contraction. Not having enough calcium in the body can increase muscle cramping including PMS cramping. Ruth Trickey, author of “Women’s Hormones and the menstrual cycle states that magnesium deficiencies can cause premenstrual tension, cramping and an overall increase in PMS.

Take 800-1000 mg of calcium a day and up to 1000 mg of magnesium per day.

B Vitamins

B vitamins, especially B3 and B6, can act as enzyme catalysts to improve cellular function. B6 can improve cramping associated with PMS by increasing the levels of magnesium being absorbed into the cells. Pizzorno, in his book, “The Clinician’s Handbook of Natural Medicine,” states that patients given a multivitamin with hi-doses of B6 and magnesium have 70% reductions in premenopausal and postmenopausal symptoms, this is including menstrual cramping. B3 may relieve menstrual cramping by causing vasodilation which increases blood flow and oxygen to the uterus.

You can take up to 100 mg of B3(niacin) twice a day and 50 mg of B6 three times a day.

EFAs

EFAs are hormone like substances that make omega-3 and omega-6 fatty acids. Prostaglandins(PGs)are made from omega-6 fatty acids, linoleic acids, that are consumed in the diet. Linoleic acid(omega-6) needs enzymes like magnesium and B vitamins to convert it to linolenic acids(omega-3) which are anti-inflammatory and antispasmodic. Omega-6 derived PGs are inflammatory markers that can lead to painful uterine contractions and decrease blood flow to the uterus. High levels of PGs can lead to increased muscle contraction, inflammation and pain. Tori Hudson, N.D. and professor of gynecology at The National College of Naturopathic Medicine, claims that menstrual cramping or dysmenorrhea, has been associated with an increased level of prostaglandins.  In order to decrease levels of inflammatory PGs consume 500 – 1000 mg of Omega-3 fatty acids, one to three times a day. Omega-3’s can be found in flax seed oil and fish or cod liver oil. Do not take EFA’s if you are on blood thinners or have a bleeding disorder.

Dr. Hillary Martin

Naturopathic Womens Wellness

www.naturopathicwomenswellness.com

1295 Yellow Pine Ave.

Boulder Co 80304

303 545 2021