The 90 Minute Checkup

The case of mind-body medicine.

Premenstrual Syndrome—the Storm Before the Storm

PMS! Is it all in your head?

What does a man know about PMS? Let me tell you, being surrounded by women in my office, all day long, I have learned to become the expert spectator; this is by far the best position for a man.

All joking aside, Premenstrual Syndrome (PMS) or the more politically correct Premenstrual Dysphoric Disorder (PMDD), can interfere with many social, family, and work activities.

In looking at the disorder from a physiologic perspective, many women have been found to have high levels of estrogen with low levels of progesterone (Dhar et al. 1991). Other causes or factors associated with PMDD are obesity, diet and nutrition, and lifestyle issues.

CLASSIFICATION AND DIAGNOSIS
PMS-A - Anxiety
PMS-H - Hyperhydration
PMS-C - Cravings
PMS-D - Depression

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Obviously, most women will have a combination of these four classifications. As many women are also aware, many of the symptoms in PMS are related to changes in their hormonal levels; specifically the estrogen to progesterone ratio. A physiologically normal woman will have a Progesterone to Estrogen ration of 120:1. In PMS-A it has been shown to be 48:1 and in PMS-D it elevates to 274:1. It should also be noted that diet plays an essential role and the specific type of fat consumptions is important. Women consuming a majority of Omega-6 fatty acids (American Diets) tend to have more issues with PMS than those women with diets higher in Omega-3 fatty acids (Mediterranean diets).

Treatments:

PMS-A (Anxiety) can be treated with diet, mineral supplementation, and a more natural addition of progesterone. With all PMS, I would highly recommend meditation and some other form of mind-body techniques that can provide control and regulation.

PMS-D (Depression) there tends to be higher than normal levels of progesterone. Progesterone has a calming effect on the neurological system and it can be helpful in insomnia. Obviously, there can be many issues surrounding depression and women with this type of PMS should seek the help of a health professional.

PMS-C (Cravings) or issues with glucose intolerance. Even though these women tend to have cravings surrounding sugars due to volatile sugar levels in their bloodstreams, they should strive to eliminate simple sugars from their diets. Diets rich in unsaturated fats such as the Anti-Inflammatory or Mediterranean Diets should be considered.

NUTRITION AND SUPPLEMENTATION:
The following supplements may be helpful in reducing the symptoms of PMS.

Calcium and Vitamin D (PMS and Calcium)

Magnesium (Quaranta, S. 2007)

Zinc ( Postgrad Med. 1985 May 15;77(7):32-7)

Vitamin B6 (J Womens Health Gend Based Med. 2000 Mar;9(2):131-9)

Vitamin E (J Reprod Med. 1987 Jun;32(6):400-4.)

GLA (Am J Obstet Gynecol. 1984 Oct 15;150(4):363-6)
Chasteberry (Vitex) (J Pharm Pharmacol. 2007 Sep;59(9):1307-12)

MIND-BODY MEDICINE AND PRACTICES
Personally, I prefer to combine and therapies with a mind-body connection. PMS and many female disorders have such a strong, and unfortunately, negative psychiatric component. In many cases, this disorder, listed in the psychiatric diagnosis bible DSM-IV and there are physicians that do not feel PMDD is even a legitimate disease process. (See article)

Donna Eden in her book, Energy Medicine, makes a reference to PMS as a gift. "PMS drops you deep into your own being, and your own truth explodes forth. Whatever you have been successful at burying or denying to yourself bursts forth at this time of the month. It is a truth serum from which you cannot escape, and if you carve out space for it, PMS makes you wiser" (Eden, 1998).

I have come up with a simple ceremony geared towards reclaiming your control and to help in establishing ritual. I find it fascinating in our society that we are very ritualistic when it comes to ingesting medications and when we undertake surgical procedures, but we have eliminated daily ritual in our lives. Let us look at a simple ritual for PMDD or PMS that could possibly help a woman regain superiority over her second chakra.

Find a sacred space. That place where you feel the most comfortable and where you will uninterrupted.

Set the stage by filling the room with the scent of bergamot or neroli; fennel, rose, geranium, or citrus fruits will work as well. If you do not have incense or oils you can try filling the bathtub will bath salts.

On the floor of your sacred space, create a sacred geometric shape such as a circle or triangle; whatever appeals to you at the time. It is also important that you create this circle or shape with whatever is pulling you. If you are outside and wish to surround yourself with river rock or are inside and have potpourri it only matters that you create a space for "you."

Before stepping into your space, set an intention. It may be something simple like "Give me the freedom to control my fears and anxieties." With the intention, breath deeply and step into the circle.

Sit or lie down in your space, comfortably, but not so that you will fall asleep. Sleep can be a wonderful part of your ceremony, but save that for after the ritual.
Meditate on your intention. Meditate on the word control and only the word control. Feel the colors of control and the smells of control.

Open the top of your head (figuratively) to the archetype of the Benevolent Queen. Allow the healing powers of other women to enter your spirit. Claim it as your own. I would recommend this type of contemplative meditation for 15 minutes to start; increase your time as you desire.
When you have truly brought the word control to the point where you feel as though you own it, then bring your focus back to your breathing. Listen to your breath and calm your mind.

Ease yourself out of your meditation and step out of the circle.

Close your ceremony by thanking the sisters that were present with you in your quest and to the power of the moon that influences the cycles of the earth and water. If your practice becomes more advanced, I have recommended that women try a moonlight stroll in a safe area where they can bathe in the moonlight and focus their meditation while they walk. With every slow step, think the word "control."

In conclusion, there are many different therapies for help with PMDD or PMS. The goal is to try and find the one that is right for you. For many women, they will start with medications like Prozac and other SSRIs. These may be helpful, but so can chamomile tea and and a nice hot bath with bergamot. Be open to the change that is going on in your body and keep a journal to record the journey. Look back at your journal and see if certain practices help more than others. Share the journey, you're not alone.

Shawn Tassone, M.D., is a board certified OB-GYN, Ph.D. candidate in mind-body medicine, and author of two books.

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