What is PMS?
Premenstrual syndrome (PMS) is the most common complaint of premenopausal women. PMS involves a variety of physical, mental, and/or behavioral symptoms related to a woman’s menstrual cycle. These symptoms typically occur during in the two weeks before a woman’s period starts, which is known as the luteal phase of the menstrual cycle. They usually become most intense in the 2-3 days prior to the period and then resolve after the first day or two of flow. The symptoms are nothing to laugh at or make light of. For many women, PMS’s accompanying headaches, bloating, food cravings, breast tenderness, mood swings, cramping, and other symptoms, can be debilitating.
Why do women experience PMS in the first place?
There can be several reasons, but typically it relates to fluctuating hormone levels prior to menstruation, specifically falling progesterone levels. Progesterone is a hormone secreted in women’s bodies by the ovaries (and to a lesser amount by the adrenal glands). Progesterone levels rise in preparation for the implantation of an embryo at pregnancy. I often refer to progesterone as the “feel good hormone” because when levels are optimal (i.e. high), women report feeling euphoric, relaxed, and confident. If no embryo implantation occurs (that is, no pregnancy occurs), progesterone levels fall, triggering a period. It’s this dramatic fall in progesterone levels that is very likely to cause PMS symptoms.
How do most doctors treat PMS?
The traditional medical approach to dealing with the symptoms of PMS is administering anti-depressants, non-steroidal anti-inflammatories (NSAIDS), like Motrin or Advil, or birth control pills.
Really? Anti-depressants? Which cause low libido, abdominal distress, and thoughts of suicide in some? I believe it’s a lazy doctor’s way of improving the mood and emotional swings of women who have PMS. The thinking is basically, “this will make you less emotional so everyone feels better.”
NSAIDS can be helpful for pain and headaches, but again, don’t address the root cause.
Birth control pills do work, but they solve the problem by wiping out ovarian function, so a woman does not ovulate in the first place. This will eliminate most of the ups and downs of pre-menstrual hormone level changes. But birth control pills aren’t without side effects of their own. Women on birth control pills run the risk of blood clots, significant weight gain, low sex drive, and long-term users are at risk of more serious side effects (possibly breast cancer, cervical cancer, and liver tumors). And of course, birth control isn’t a good strategy for alleviating PMS if a woman wants to get pregnant!
Bio-identical Progesterone: a natural solution treating the underlying cause of PMS
When a woman comes to me experiencing PMS, rather than prescribing birth control pills or anti-depressants, I typically treat her with bio-identical progesterone. It’s extremely effective for treating PMS symptoms because it addresses the underlying problem, the drop in progesterone levels leading up to a woman’s period.
Unlike antidepressants or birth control pills, progesterone has few side effects and many benefits. Bio-identical progesterone significantly decreases a woman’s risk of breast cancer (it lowers breast tissue proliferation by 400%!), ovarian cancer, helps combat endometriosis, and lowers a woman’s chances for developing heart disease, partly by increasing good cholesterol (also known as high-density lipoprotein or HDL). One of the first things women notice after they start taking progesterone is dramatically improved sleep, and an almost immediate and drastic reduction in PMS symptoms and their severity.
Oral progesterone is the only form I use. Progesterone creams don’t penetrate the tissues enough to reap all the benefits of it; so while women on progesterone creams may have adequate levels in the blood, they may not have adequate levels in their tissues, which is where the progesterone needs to be in order to be truly beneficial.
The progesterone dose needed varies from woman to woman. The good news is, it’s virtually impossible to overdose on bio-identical progesterone. So if you’re still having PMS after starting it, you’re simply not taking enough. Just continue to increase your dose until your symptoms resolve. You can stop taking it as soon as your period begins – but many of my patients like it so much they take it every day of the month – which is OK too! I also recommend taking progesterone at night, as it promotes sleep. If it’s taken during the day, it may cause drowsiness.
A critical note on progesterone!
Not all progesterone is created equal. It’s essential that women take bio-identical progesterone; that is, progesterone with a molecular structure identical to that produced by the body. It should be made by a compounding pharmacy, or taken in the form of the commercially produced medication called Prometrium. The benefit of compounded progesterone is that a your dosage can be customized to the precise amount that works for you. Also, be sure your progesterone is micronized. Micronized progesterone is specially formulated to be absorbed maximally in a capsule form.
Don’t ever take synthetic progesterone (of which the most common brand name is Provera), patented by a pharmaceutical company. It’s been shown to significantly increase breast cancer risk and to have several other adverse side effects. Steer clear!
If you’re experiencing PMS, don’t suffer through another month. You shouldn’t have to, nor do you need to!