Symptoms of pre-menstrual syndrome (PMS) can start up to two weeks before each period and usually stop when the period starts. 1 in 3 women have some symptoms of PMS, and 40% of women who suffer from dysmenorrhoea (painful periods) will also experience symptoms of PMS.

There is no clear understanding of why PMS occurs but it is thought that it is due to oversensitivity to the hormones responsible for the menstrual cycle, namely oestrogen and progesterone. Researchers believe that PMS symptoms relate to changes in neurotransmitters (brain chemicals) due to the influence of progesterone and oestrogen. These neurotransmitters include

It has also been suggested that PMS occurs because of poor general health, i.e. a diet lacking in all necessary nutrients, stress, lack of exercise and being run down. These factors act as precursors to hormonal fluctuations responsible (Glenville, 2002).

Signs and symptoms of PMS include: mood swings, abdominal pain, irritability or aggression, poor concentration, crying, feeling bloated, weight gain, tender breasts, headaches, tiredness and insomnia, feeling clumsy, night sweats, depression or anxiety.

Traditional chinese medicine perspective
There is a similar pattern of disharmony responsible for PMS and dysmenorrhoea (painful periods) often caused by a constriction of energy in the body around your period time. This can cause:

Women are also prone to becoming low on body fluids, blood and energy. So some of the symptoms experienced around your period time are because of this lack of reserves. You may have pain at the end of your period, feel tired, dizzy, tearful or clumsy, have difficulty sleeping, experience night sweats, or be very cold.

Because we are all different it is essential to have an individualised diagnosis and treatment plan based on your specific pattern differentiation. With a course of treatment and some good nutritional advice it is possible to build these reserves, and regulate the flow of energy and blood in your body.

In a study conducted by Habek et al (2002) acupuncture was found to have a 77.8% success rate in treating the symptoms of PMS and was recommended as a safe and effective treatment method.

Nutritional and herbal perspective
Diet plays an important role in the pathophysiology of PMS. Foods high in refined carbohydrates can cause fluctuating blood glucose level, resulting in increased production of adrenaline, which blocks the uptake and utilisation of progesterone, leading to imbalance of progesterone and oestrogen.

Therefore balancing your blood sugar levels by eating more complex carbohydrates such as whole grains, pulses and vegetables and avoiding refined sugars like white bread, pasta, biscuits and sugar is very important.

Hormones are broken down in the liver at the end of each menstrual cycle. Supporting the livers function of detoxifying and excreting old hormones is important so limiting alcohol and fatty food is a good idea. You can also eat foods which support the liver, such as green tea, dandelion tea, carrots, beetroots, oily fish, green vegetables, garlic, and shitake mushrooms.

Certain micronutrients play a role

However vitamins and minerals are synergistic (work together) and therefore a balanced approach to supplementation is necessary. Individual diagnosis and recommendations are required.

Herbs are available which help to balance female hormones and can be very useful in the treatment of PMS.

The role of stress
Emotional and physical stress impacts on the adrenal glands and causes high levels of cortisol and adrenaline with the following results; cortisol and progesterone compete for the same receptor sites in cells therefore high cortisol will impair progesterone activity and will over time have a direct effect on premenstrual symptoms. High cortisol causes blood sugar to enter body cells for energy use thereby lowering blood sugar levels, leading to carbohydrate craving as you try to get your blood glucose and energy back up fluctuating blood sugar then leads into a negative feedback cycle with adrenaline and cortisol, as outlined above. (Lee, 1999)

Again individual diagnosis and recommendations are required.

Self help tips

• Get regular exercise throughout your cycle, this increases circulation of energy and blood and also reduces stress levels
  
• Learn some form of relaxation technique which works for you.
  
• Eat plenty of fruit and vegetables
  
• Eat foods containing good sources of Omega 3 and Omega 6 oils such as oily fish (organic), raw nuts, seeds, olive oil, hemp and linseed oil (not heated but used as dressing for salads and vegetables)
  
• Reduce your intake of saturated fat, choose lean meat and reduce dairy products
  
• Eat more wholegrains such as brown rice, oats, quinoa, buckwheat, ryebread, wholemeal bread
  
• Keep well hydrated with water, tea and coffee dehydrate
  
• Reduce your intake of caffeine throughout your cycle. If you have breast tenderness it may be necessary to avoid caffeine altogether.
  
• Reduce alcohol
  
• Avoid sugar in your diet
• Where possible try not to overwork or burn the candle at both ends during your period
  
• Try to allow yourself some time for you during your period, whether that's taking a bath, having a massage, watching your favourite movie, listening to music or reading a book
  
• Get a good nights sleep.

References
Glenville, M., 2001, The Nutritional health handbook for women, London, Piatkus.

Facchinetti, F., Borella, P., Sances, G., Fioroni, L., Nappi, R.,Genazzani, A., 1991, Oral magnesium successfully relieves premenstrual mood changes., Obstetrics and Gynaecology. 78(2):177-181.

Habek, D., Cerkez Habek, J., Barbi, A., 2002, Using Acupuncture to treat Premenstrual Syndrome, Archives of Gynecology and Obstetrics. 267(1):23-26

Halbreich, U., 2003, The etiology, biology and evolving pathology of premenstrual syndromes, Psychoneuroendocrinology 28:55-99

Lee, R., Hanley, J., Hopkins, V., 1999, What your doctor may not tell you about premenopause: Balance Your Hormones and Your life from thirty to fifty, Warner Books.

Shellenberg, R., 2001, Treatment of the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study, BMJ 322:134-137

Thys-Jacobs, S., Starkey, P., Bernstein D., Tian J., 1998, Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual
Symptoms, American Journal of Obstetrics and Gynecology 179:444-452.

Walker, A., De Souza, M., Vickers, M., Abevasekera, S., Collins, M., Trinca, L., 1998, Magnesium supplementation alleviates premenstrual symptoms of fluid retention, Journal of Womens Health 7(9):1157-1165.