Naturopathy and Western herbal medicine may offer effective, nonpharmacological options

Women who experience Premenstrual Syndrome (PMS) often seek complementary treatment for their symptoms. Although conventional medicine can provide relief using oral contraceptives and antidepressants if necessary, naturopathy and Western herbal medicine may offer women with PMS effective, nonpharmacological options.

Women who experience Premenstrual Syndrome (PMS) often seek complementary treatment for their symptoms.

Although conventional medicine can provide relief using oral contraceptives and antidepressants if necessary, naturopathy and Western herbal medicine may offer women with PMS effective, nonpharmacological options.

A wholistic approach involves individual treatment plans encompassing a combination of lifestyle and dietary changes, specific herbal formulations and/or nutritional supplements.

PMS is a multifactorial condition, and presentations vary in individual women. Differing combinations of physical, mental and emotional symptoms can manifest and may vary from month to month.

The primary diagnostic indicator  is the cyclic nature of the symptoms.

PMS arises during the luteal phase and abates with, or shortly after, the onset of menstruation.

PMS affects approximately 75% of women of reproductive age.¹ Given most women experience at least mild PMS, a certain degree of discomfort in the premenstrual phase has been suggested to be normal.²

A clear understanding of the aetiology and exact pathophysiology of PMS remains elusive. Theories range from an imbalance in normal hormonal fluctuations, abnormal reactions to regular hormone fluctuations, nutrient deficiencies, blood glucose irregularities and neurotransmitter imbalances.

An analysis of Medline articles from 1950-2008 concluded that despite a lack of evidence, lifestyle modifications and exercise are first-line recommendations for all women with PMS.³ These include reducing caffeine, avoiding refined sugar and excessive salt, stopping smoking, reducing alcohol intake, cognitive behavioural therapy, relaxation and aerobic exercise.

With the exception of calcium supplementation, standard trials of herbal medicine and nutritional supplementation to treat PMS have produced unclear or conflicting results.⁵ The relevance of applying the gold standard randomised controlled trial (RCT) to non-pharmaceutical models of therapy involved with complex syndromes such as PMS is currently being debated.⁴ Additionally, the legitimacy of non-specific or contextual benefits, also known as placebo, and the creation of a therapeutic relationship between patient and practitioner, may play an important role in the treatment of PMS.⁵

Trained naturopaths and herbalists may formulate herbal medicine prescriptions after considering an individual's presentation. These could include herbal medicines such as Angelica polymorpha (dong quai), Dioscorea spp (wild yam), Hypericum perforatum (St John's wort), Passiflora incarnata (passionflower), Withania somnifera (withania), Zingiber officinale (ginger) and Achillea millefolium (yarrow).

Three leading complementary medicines for PMS that are supported in the scientific literature by RCTs are calcium, magnesium and Vitex agnus-castus.

Calcium

Calcium has demonstrated efficacy in PMS trials. Improvements in mood, concentration and behavioural symptoms and a general reduction in the symptoms of pain, food cravings and water retention have been verified in various trials using 1000-1200 mg/day of calcium carbonate.^6,7

Calcium supplementation must be taken for three months to achieve a treatment effect.⁷

Side-effects and interactions

Adverse reactions include constipation and gastrointestinal irritation. Caution is needed in people with hyperparathyroidism or chronic kidney disease.⁶ Calcium can compete with zinc and iron for uptake, so these supplements should be taken at different times.

Magnesium

Trials have shown magnesium is associated with an improvement in mood swings and fluid retention,⁸ while a Cochrane review showed it was more effective than placebo for pain relief in dysmenorrhea.⁹

Dosage for PMS ranges from 200-1000 mg/day, depending on the presentation and magnesium formulation. Clinical effects are shown to develop slowly, starting during the second cycle.¹⁰

Side-effects and interactions

The predominant adverse reaction is diarrhoea, which is associated with excesses of 350 mg/day. Magnesium supplementation is contraindicated in renal failure and heart block, and should be used with caution in conjunction with diuretics.

It may decrease efficacy of various antibiotics and should be administered at least two hours later.¹¹

Vitex agnus-castus

Chaste tree berry was subject to a pilot study of 170 women that demonstrated effective and well-tolerated treatment for the relief of PMS symptoms. Improvement in irritability, mood alteration, anger, headache, breast fullness and bloating were observed over three consecutive cycles.¹²

Side-effects and interactions

Interaction is seen with the oral contraceptive pill, progesterone or other hormone replacement therapy. Dosage should commence on day one of the menstrual cycle and be taken early morning. It should not be self-prescribed, but initiated by a trained herbalist or naturopath.

Summary

A wholistic approach to the management of PMS involves the formation of a personalised prescription of dietary and lifestyle modifications, and advice regarding nutritional and/or herbal supplements, which may include those supported in the scientific literature and fostering a therapeutic relationship.

The author reports no conflict of interest.        

 Alternative approaches to PMS  106.07 Kb  

References

See Medical Observer http://www.medicalobserver.com.au/

Content Updated October 14, 2009