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Menopause and Premenstral Tension (PMT)
A condition characterised by nervousness, irritability, emotional instability, depression and possibly headaches, edema and mastalgia; it occurs during the 7 to 10 days before menstruation and disappears a few hours after onset of menstrual flow..
These terms describe a broad range of symptoms that occur cyclically which are severe enough to disturb a womans' life patterns or cause her to seek help from a health practitioner. Most women experience some body change cyclically during the menstruating years corresponding to the pattern of cycling hormones. The subtle shift in mental and emotional focus as well as body response is observed and ritualised in many cultures. Women often express a positive attitude toward the conscious observance of these patterns within their own bodies, however when the hormonal and chemical changes result in debilitating symptoms they may disrupt functioning in virtually all body systems.
- Behavioral Symptoms.
- Personality alteration in the form of nervousness, irritability, agitation, unreasonable temper, fatigue, depression. Violent crimes and suicide are often committed at such a time. Symptoms that suggest clinical depression such as anxiety, palpitations, tightening in the chest, hyperventilation are common.
- Neurological Symptoms.
- Headache, vertigo, syncope, paresthesias of the hands or feet, aggravation of seizure disorders have all been recorded.
- Respiratory Symptoms.
- Asthma may be intensified.
- Gastro-intestinal Symptoms.
- Constipation, and an increase or decrease in appetite, carbohydrate craving particularly sugar and chocolate.
- Miscellaneous.
- Edema, weight gain, backache, enuresis, oliguria, capillary fragility, exacerbations of dermatologic disease, breast changes, and eye complaints
Four categories of PMT have been identified corresponding to the major symptoms patterns :
PMT-A: Predominantly anxiety, associated with excess oestrogen, and CNS stimulation resulting in anxiety. Excess oestrogen can be caused by deficiency in progesterone (high oestrogen/progesterone ratio), or by inability of the body to break down oestrogen (poor liver function, or Vitamin B deficiency resulting in same).
PMT-H: Predominantly hyperhydration (bloating, edema), increased ACTH, water/salt saving by kidneys.
PMT-C: Carbohydrate craving, due to increased responsiveness to insulin.
PMT-D: Depression, due to excess progesterone, CNS depression PMS is diagnosed on the basis of when symptoms are present. There is (by definition) a period of time when symptoms are absent, usually just after the onset or end of menses. PMS occurs during the proliferative or luteal phase of the menstrual cycle when levels of oestrogen and progesterone are relatively high. Oestrogen is a central nervous system stimulant. Progesterone is a CNS depressant. What is important in the relationship of oestrogen to progesterone during the luteal phase.
A number of etiological factors have been identified for primary PMT:
- Oestrogen excess.
- Progesterone deficiency.
- Fluid retention.
- It is believed that many of the symptoms of PMS/PMT relate to a shift in the fluid in the water compartments, intra and extracellular and intravascular with increased retention of water and water moving into the extracellular spaces. Mediated by increased ACTH and aldosterone.
- Hypoglycemia.
- The cells are more receptive to insulin in the premenstruum, causing relative hypoglycemia resulting in carbohydrate craving.
- Decreased production of Prostaglandin E1, and the advice to use Gamma-linolenic acid, which is found naturally in human milk and oil of evening primrose. Other nutrients encouraging the conversion of fatty acids to Prostaglandin E1 are: Magnesium, B6, Zinc, Niacin, and Vitamin C.
- Increased production of other prostaglandins.
- Magnesium deficiency leading to decreased dopamine in the brain resulting in increase levels of CNS stimulators (norepinephrine and serotonin).
- Increased prolactin levels causing decreased progesterone.
Nervine herbs will usually remove the symptoms, but rarely clear the recurrent pattern. Anti-spasmodic herbs will ease any dysmenorrhoea that accompanies the PMT. Diuretic remedies would be indicated if water retention is part of the picture. Hormonal Normalizers would be indicated if the diagnosis suggests a pivotal contribution by hormonal imbalance.
System Support
In addition to the reproduction system, the nervous system usually needs aid. In some intransigent cases, attention must be given to endocrine function.
Specific Remedies
Different remedies may act as specifics for specific women, so generalisations can be difficult. Scutellaria spp. in the short term is as close to a specific for relief of symptoms as possible. Longer term `specific' herbs would be the hormonally focused ones such as Vitex agnus-castis.
The dosage of the symptomatic medication may be increased until the desired relief is experienced. The dosage regime may be altered as necessary, varying time of day and quantity of dose to suit individual needs. For example this may be the whole dose first thing in the morning, or smaller amounts at frequent intervals throughout the day. The womens' experience is the guiding principle.
If water retention predominates symptomatically, then more focus should be given to diuretics. Palpitations would suggest Leonurus cardiaca as a relevant herb. As an example of how this basic approach can be modified to address specific symptoms consider the following.
Broader Context of Treatment
The whole gamut of issues that the holistic practitioner can address must be focussed upon. The herbal treatment can be exceptionally effective, but will benefit from appropriate stress management techniques and possibly dietary support. The following dietary guidelines could be suggested:
- Limit refined sugar as it increases excretion of B Vitamins, Magnesium, and Chromium, and contributes to increased insulin secretion resulting in hypoglycemia.
- Limit salt to under 3 grams per day.
- Limit red meat because of high sodium & high fat content, to 3 oz. per day. Some evidence shows that the hormones in red meat contribute to fibrocystic disease & menstrual cramps.
- Limit alcohol to I oz. per day. Alcohol destroys B Vitamins, Magnesium and Chromium, and may be a potent depressant in some people.
- Limit Caffeine: it intensifies anxiety and contributes to fibrocystic disease.
- Limit dairy products. They are high in fat, interfere with magnesium absorption, & may constipate.
- Limit fats to 30% of total calories.
- Limit protein to 1 gram per kilogram of body weight.
- Avoid licorice: it stimulates the production of aldosterone.
- Minimize spinach, beet greens and other oxalates as they interfere with mineral absorption.
- Increase complex carbohydrates to 40% of diet, with whole grains, green leafy vegetables and legumes. . They are high in fibre, B Vitamins and release sugar slowly.
- Increase potassium rich foods, which are beneficial against water retention: sunflower seeds, dates, figs, peaches, bananas, tomatoes.
- Increase intake of natural diuretics: artichokes, asparagus, parsley, watercress.
Further Reading - Books on Menopause
Embracing Menopause Naturally: Stories, Portraits, and Recipes
Menopause triggers physical & emotional & spiritual changes that call for a redefination of all the feminine self. Supported by research, macrobiotic guidelines, & deliciously helpful recipes, this book is a true companion for any woman. (2007)
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Menopause: A Well Woman Book
A book for these millions of women who are moving into mid-life. Its clear, non-judgmental and factual information will help to answer the many questions women have about the experience of menopause. (1990) 189pp
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Menopause: The Natural Way
This is a compassionate guide that combines mainsteam and alternative medical approaches into a simple,six-step program that helps you create a healthy and empowering passage through menopause. - By Siple and Gordon. (2001) 241pp
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Wisdom of Menopause
This book provides a breakthrough approach to living with and learning from the menopause. It is believed that the change is not simply a collection of physical problems that needs to be fixed, but a mind-body revolution. (2004) 576pp
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Natural Menopause Cookbook
A beautifully presented book packed with valuable information about the menopause and the foods you need to include in your diet. - By Angie Jefferson and Fiona Hunter (2004) 144 pages
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Eat Your Way Through The Menopause
During the menopause three helpful food groups are beneficial to health:phytoestrogens,essential fatty acids & antioxidants.The author draws on recipes rich in these components to create 100 new & delicious recipes.Col.photos.-By M. Glenville(2000)191p
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Managing Menopause Naturally with Chinese Medicine
The author introduces Chinese medical theories and treatments that have been used for millennia to help ease menopausal symptoms. - By Honora Woolfe. (1998) 214pp
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Menopause and Chinese Medicine
This book describes the disease mechanisms, pattern discrimination, and Chinese medical treatment of perimenopausal and menopausal syndromes. The book explains the participating roles of the liver, spleen and heart in the climacteric , not just the kidneys. If you have ever wondered why the kidneys become exhaused at seven times seven years of age in women, this book will tell you. In addition, this book contains numerous reports on clinical trials and real-life case histories from some of the most famous doctors in China. It is a must ofr anyone interested in treating menopausal complaints with Chinese Medicine. (2006) 218pp
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Chinalife Remedies
Angelica Root
Angelica is an important blood tonic for women. It regulates hormones, menstruation & is very valuable for problems relating to periods & menopause. It also enhances the function of the immune system.
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Rose 5% in Grapeseed Oil
This oil can be used as an anti-depressant and to treat insomnia, PMT, irregular menstruation, menopausal symptoms. Also useful as a purifying, regulating skin care product for drying or aging skin.
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Lavender Essential Oil
This oil is beneficial for many things including acne, scarring, anxiety, insomnia, headaches, catarrh, muscular tension, burns, PMT, palpitations, high blood pressure and rheumatism.
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Geranium Essential Oil
Sedative, anti-depressant, antiseptic; this oil is useful for regulating hormones, menopausal symptoms, PMT, cellulite and as part of a skin care routine for combination skin.
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