Premenstrual Syndrome

By Ron Hunninghake, M.D.

PMS is now a common household abbreviation. It refers to that time of the female cycle from ovulation leading up to menstrual flow. While it is commonly known to be a difficult time for many women, many underestimate the physical and emotional havoc it brings to these women and their families. Indeed, in Unmasking PMS, Dr. Joseph Martorano persuasively argues that the condition is often overlooked or misdiagnosed. Because over 140 different symptoms have been linked to PMS, the general tendency is to diagnose on a psychiatric basis, such as depression or panic disorder. Or, much worse, the woman’s symptoms are simply dismissed as “over -concern” about her body and her health.

Properly recognized and treated, 90% of PMS cases will resolve successfully.

In 1931, Dr. Robert T. Frank wrote a paper entitled “The Hormonal Causes of Premenstrual Tension.” He surmised that an imbalance between estrogen and progesterone was the physiologic culprit for the condition. Six years previous to this report, Okey and Robb reported abnormal glucose tolerance curves during a woman’s menstruation, with tendencies toward hypoglycemia (low blood sugar). Dr. Seale Harris corroborated these observations in the 1944 Southern Medical Journal, pointing out the frequent occurrence of hunger, fatigue, nervousness, and sweating just prior to menstruation.

Despite these findings, the typical medical response for decades to PMS was: “you’ll get over it” … “take a vacation” … “get a job outside the home” … “have another baby” … “drink a glass of wine” … “take this tranquilizer” … and, the most contemporary recommendation, “take Prozac.” The PMS epidemic grew, largely unaddressed.

Dr. Katharina Dalton, an English physician, took a deep interest in this symptom complex in the early 50’s. Her own premenstrual experiences, including menstrual migraine, led her to the conclusion that PMS was hormonal in its genesis. Her trip to America in 1979 to publicize the reality of this condition was fraught with controversy. Medical indifference changed to hostility. The term “PMS” became a political “hot potato,” suffering quite the similar fate of the term “hypoglycemia.” The AMA had earlier so much as decreed that hypoglycemia did not exist as a medical condition. Even factions of women were reluctant to acknowledge that “raging hormones” might impair their ability to function in the workplace. They were afraid that legitimizing PMS medically might heighten an unwarranted stereotype of women. Ironically, it was the lack of proper scientific recognition and treatment that probably created the severe and exaggerated cases of PMS that provided this stereotype in the first place!

Properly recognized and treated, 90% of PMS cases will resolve successfully. Excessive estrogen and inadequate progesterone post-ovulation creates a marked propensity for hypoglycemia. Most PMS sufferers crave simple sugars, including alcohol. This results in a physiological roller coaster ride with severe ramifications in the woman’s neurologic and hormonal orchestration of daily life. The first order  of treatment is to markedly curtail simple sugars of all sorts, switching instead to a high protein, frequent feeding dietary regime. This protocol alone handles up to 70% of PMS cases.

Because progesterone, B6, and magnesium further support more stable blood sugar levels, these modalities can be added in the more difficult cases. Natural micronized progesterone is far more effective than synthetic progestins, which compete for receptor sites in the brain. Yam derived progesterone can also be effective used topically. Recent findings suggest that the fat cells of the dermis can become saturated such that the treatment may stop working after so many months’ duration. Please consult with an informed physician to sort out which form of progesterone therapy might be best for your own situation.

Given the complexity of modern life, other environmental, relational, biochemical, or infectious factors may also enter the PMS picture. This brief overview of the condition and its treatment do not take into account these  other factors, including candida overgrowth, unsuspected hypothyroidism, heavy metal toxicity, sick building syndrome, micronutrient deficiencies, chronic bacterial or chlamydial infections, ~ential fatty acid and amino acid defiqienbes, and a host of other causative factors that might further complicate the PMS condition. So please be open to the need for a more thorough evaluation and treatment program.

PMS is very common. So much so that it is easy to be blinded to its significance in a woman’s life. If symptoms occur recurrently in the premenstrual time frame, this diagnosis should be seriously entertained and systematically treated. There is no blood test that diagnoses it.  Only alert, compassionate medical care will give it the credence needed to see it to a successful resolution.