Current Understanding
of Etiology and Treatment

Adams and Abraham have recently demonstrated that 300 – 500 mg of Vitamin B6 per day significantly improves PMS symptoms. B6 serves as a cofactor for EFA metabolism, is important in dopamine formation, and for gluconeogenesis. B6 also acts as a diuretic, reducing hyperpermeability of cell membranes, which decreases interstitial fluid shifts. As a cofactor for dopamine production , B6 helps regulate prolactin ( dopamine suppresses prolactin) and as a cofactor for serotonin production, B6 helps stabilize mood swings. Estrogen rise results in relative B6 deficiency, because it releases hepatic enzymes which compete for B6. Supplementation with B6 improves hepatic clearance of estrogen.

Magnesium deficiency (American Journal of Clinical Nutrition, 1964), common in the U.S. and found in PMS, causes hyperplasia of the zona glomerulus in the adrenals leading to water retention. It also causes hyperirritability to muscles and emotional state and increased urination. The suggested calcium to magnesium ratio is 1:1 and at 600 mg per day has been found to significantly reduce many PMS symptoms.

In the Journal of Reproductive Medicine, Volume 28, 1983, Horrobin outlines the crucial role of EFA (essential fatty acids) and GLA in PMS. PMS sufferers demonstrate higher sensitivity to and/or higher levels of prolactin and low PGE in their blood. PGE 1 counteracts the effects of prolactin (which when elevated produces PMS symptoms) and reduces the dysmenorrheic properties of the series 2 prostaglandins. Dietary linoleic acid and GLA are converted to PGE 1 through a biochemical pathway that requires the following cofactors at different steps: B6, Mg, Vitamin C, Niacin, Zinc. This pathway can be disrupted by too much dietary intake of saturated fats, alcohol, the catecholamines of stress or by the lack of available cofactors. Excellent sources of GLA include black currant and evening primrose oils.

Excess estrogen enhances the aldosterone system (renin, angiostensin) causing flud and salt retention. Mastalgia and fibrocystic breast disease(FBD) exhibit low iodine levels which are associated with increased estrogen. Hypothyroid women have increases of mastalgia and FBD due to resultant increased circulating levels of estradiol (JAMA, June 1966).

Abrahms in 1965 demonstrated the use of 400 IU of vitamin E effective in the treatment of FBD as well as the relief of many PMS symptom. Vitamin E and Selenium prevent oxidation of EFA, adrenal and sex hormones.

Due to the relative ineffectiveness of progesterone administration in relieving PMS symptoms (Sampson 1979) one must concentrate on methods of reducing excess estrogen, specifically estradiol. Slower transit time leads to higher estradiol, therefore the addition of mild laxatives (such as Cascara) and dietary advice to treat constipation and liver congestion is warranted. Vegetarians have been shown to have markedly increased estrogen excretion, so reducing meats and dairy products is helpful.

Excess weight reduces the clearance of estrogen. Caffeine and other methylxanthines inhibit enzymes, rise kinin and histamine levels and lower B1; all resulting in estradiol buildup.

The hyperinsulinism and resultant hypoglycemia associated with PMS make chromium and manganese supplementation important. Blood levels of calcium have been shown to drop the 14 days before the menses, and calcium relieves the insomnia, cramps and headache symptoms of PMS. Zinc deficiency is common in PMS, causing irritability, depression and skin changes – it is also critical for the utilization of B6 and EFA.

From a naturopathic and clinical standpoint effective estrogen reduction begins by cleansing the liver where its conjunction for excretion takes place. The lipotropic factors, choline, methionine (sulphur containing A.A.), and inositol, and the botanical Berberis (Oregon Grape), Chelidonium (Celandine), Silybum (Milk Thistle), and Taraxacum (Dandelion) improve liver function by lowering blood triglycerides, improving hepatic circulation, improving digestion and excretion, decreasing hepatic congestion and torpor, promoting bile formation and cholagogue activity and aiding weight loss.

Dong Quai is a time honored menstrual hormone “regulator” – it acts as a sedative for irritability and cramping, reduces headache incidence, is a cerebral nerve tranquilizer, and according to Chinese medical literature “purifies the blood” and ” regulates the cycle”. Sarsaparilla contains steroidal sapogenins, precursors to progesterone production (as do Mexican yams and soybeans). It also server as an excellent general tonic, alternative and diuretic.

Vitamin C enhances the activity of enzyme pathways and strengthens cell wall integrity (decreasing abnormal permeability). Bioflavonoids have anti-histamine activity and inhibit estrogen by competing for receptor sites.

A low level of Vitamin D is important for the utilization of calcium. Folate should be low because it potentiates estrogen, while PABA should be low because it has anti-thyroid properties (thyroid is an integral estrogen antagonist).

Copper is needed to balance the zinc and Betaine HCL allows for better absorption. Potassium acts as a diuretic and aids sodium balance (high sodium is associated with PMS). Iron prevents anemia commonly seen in PMS patients.

PMS has been increasingly associated with general malabsorption, allergies and candidiasis. When PMS is effectively treated, other hyperestrogenic conditions such as fibrocystic breast disease, ovarian cysts, uterine fibroids, and secondary hypothyroidism are improved or prevented.