Q:I suffer from terrible premenstrual syndrome 10 days to two weeks before my period. Recently, I went to see my doctor about it, and he said he'd like to put me on Prozac, which he says has been proved to work against PMS. If that doesn't clear it
A:Ordinary medicine is a bit stumped by premenstrual tension. Many doctors don't really take it seriously, believing women who claim to suffer terrible physical and psychological problems have underlying mental problems to begin with. This is a typical example of blaming the patient for the problem when you don't have any solutions.
Doctors subdivide premenstrual problems into PMS and PDD, or premenstrual dysphoric disorder. PMS includes physical symptoms such as bloatedness, severe pain in the breasts, headaches, and psychological problems such as aggression, depression, tension and loss of control. According to medicine, PDD differs only in its severity and ability to impair; sufferers are profoundly depressed, anxious, ineffective at work and home, and lose interest in activities the week before their period.
For PMS, medicine has been regarded by many doctors as a progesterone deficiency disease requiring supplemental progesterone. However, both high doses of oral, micronized (that is, digestible) progesterone and progesterone suppositories have proved ineffective (The Lancet, December 2, 1995). In fact, a comment in that same issue of The Lancet argues that progesterone deficiency isn't actually the cause of the cyclical changes.
Medicine has also tried tranquillizers with PMS, although the results haven't been very encouraging. In one study, 37 per cent of women taking alprazolam improved, which was nearly comparable to the 30 per cent taking a sugar pill (and 29 per cent taking progesterone), suggesting that any improvements resulted from a placebo effect (JAMA, 1995; 274: 51-7).
As for PDD, researchers have theorized that the problem in PDD, as with classic depression, has to do with a deficiency of serotonin, a brain hormone. Fluoxetine (Prozac) works by increasing the availability of serotonin in the brain by slowing the passage of this neurohormone into nervous system cells, lifting mood. However, fluoxetine has only been studied in women fitting the PDD category, but again the results weren't terribly encouraging. Although 52 per cent of the women getting the drug felt 50 per cent better, compared with 22 per cent of those getting a placebo, the number of women still noting improvement dropped to 37 per cent after three cycles (N Eng J Med, 1995; 332: 1529-34).
This leaves the only effective method that medicine knows of, which is to demolish your menstrual cycle so you don't ovulate and produce progesterone, either by drugs or surgery. However, even the Pill, estrogen patches and implants don't work, since many of their side effects are similar to those of PMS and no research has demonstrated their effectiveness. In one study, new PMS symptoms developed in 58 per cent (BMJ, December 4, 1993). Danazol (usually given for endometriosis), an anti estrogen hormone, and gonadotrophin releasing hormone agonist analogues (which block the hormones controlling the production of estrogen and progesterone) may stop your PMS, but the former may cause masculinizing side effects and the latter will create a pseudo menopause (BMJ, December 4, 1993).
Even surgery doesn't completely get rid of the problem, unless the surgeon takes out your ovaries, and that leaves you open to an instant menopause and brittle bones (see WDDTY vol 7 no 1). The latest experiment being researched is a vaccine which would make the body's immune system destroy the hormone controlling your estrogen and progesterone production, but of course this would also bring about an instant, intense menopause.
Against these desperate and extreme measures, compare the success of a variety of nutritional approaches, simply modifying diet and supplements. One study found that 82 per cent of severe PMS sufferers had deficiencies of magnesium or magnesium and potassium in their red blood cells (Mag Bull, 1986; 8: 314-316). Interestingly, other studies have shown that neurotic men and women have deficiencies of magnesium in the blood. As the patients recovered, so did their levels of magnesium (Br J Psych, 1969; 115: 1375-7). The reasons for these deficiencies have a lot to do with our modern diet and agricultural habits, which have depleted magnesium from the soil. Another problem is impaired absorption, which may have to do with inadequate stomach acid or a high intake of wheat bran.
Besides magnesium, calcium and manganese are also vital. In one double blind study, 10 women with PMS were assigned to four diet periods, containing either 587 or 1336 mg per day of calcium and either 1 or 5.6 mg per day of manganese. The study found that those on a high supplement of calcium reduced symptoms relating to mood, concentration and behaviour during the entire month, and reduced pain and water retention. But only those taking manganese also had reduced mood and pain symptoms. The study concluded that dietary calcium and manganese play a role in the development of PMS (Am J Obste Gynecol, 1993; 168: 1417-23). As nutritionist Alan Gaby wrote, in his article about the study (Townsend Letter, February/March 1996): "Premenstrual syndrome is beginning to look more and more like a nonspecific manifestation of a nutrient depleted diet and a sedentary lifestyle."
Another vital nutrient for PMS is B6, which aids in the cellular transportation of magnesium. In another study, women given 100 mg of vitamin B6 twice a day for four weeks raised deficient blood cell magnesium (Ann of Clin & Lab Sci, 1981; 11: 333-6).
It's logical that these nutrients would eliminate PMS as they are cofactors in synthesizing neurotransmitters such as serotonin. Omega-6 fatty acids such as occur in evening primrose oil have also been shown to help, particularly with breast pain.
The usual dosages (although these need to be individually tailored) are 100 mg of B6, 6 to 8 capsules of evening primrose oil, 400-600 mg magnesium, 500-1000 mg of calcium and 5-25 mg manganese.
We would recommend that you pay a visit to an experienced nutritionist, who can determine your daily doses of all these nutrients. Also avoid sugar and caffeine (especially chocolate), which make PMS worse, and engage in regular aerobic exercise, which can also help.