"One day she is all smiles and gladness ... but the next she is dangerous to look at or approach."

- Simonides, Greek poet, 400 BC

Pain and other problems associated with menstruation are well known. Another period problem, PMS, is not so well known. The term PMS or premenstrual syndrome refers to both the physical and mental symptoms which occur before a woman's menstruation. Recently, another term, premenstrual tension (PMT) has been used in reference to just the emotional changes.

Up to one-third of women have some symptoms of PMS, and in about five per cent of these, the problem is severe or even incapacitating.

SYMPTOMS of PMS

By definition PMS symptoms occur within the two weeks before menstruation each month. Some women have PMS from the time they begin having periods, but for most, PMS begins around the mid-30s, and becomes increasingly severe as the menopause approaches.

Although it's possible to list dozens of PMS symptoms, the most common are bloating, water retention (and the resulting weight gain), breast tenderness and lumpiness, headaches, cramps, fatigue, irritability, mood swings, anxiety and craving for sweet or salty food. In women with severe PMS, irritability and mood swings can become outbursts of anger and rage. Existing conditions such as depression, asthma, allergies, and epilepsycan also become worse. Pain during the period itself is not included as a symptom of PMS.

PMS lumps together a collection of symptoms - a mixed bag of individual responses to a natural event: the menstrual cycle. Women typically experience these symptoms from up to 14 days before the start of menstruation.

CAUSES OF PMS

Many factors contribute to PMS: stress, negative social attitudes towards menstruation, nutrition and lifestyle all influence hormonal changes and other bodily processes.

I, along with many complementary medicine doctors, believe that a hormonal imbalance called oestrogen dominance is one of the major factors causing not only PMS, but also a long list of common female disorders like menopausal symptoms, uterine fibroids, breast lumps and endometriosis.

OESTROGEN DOMINANCE

Oestrogen is one of the main female hormones. In addition to the oestrogen produced by a woman's ovaries, in today's world, we live in a sea of oestrogens. These other oestrogens used to be the phyto-oestrogens, compounds in plants that have mild oestrogenic effects. Women who live in parts of the world where they customarily eat these plants will pass through menopause with hardly any symptoms whatsoever.

However, in modern times we now have very potent chemicals called xeno-oestrogens that we are exposed to on a daily basis. They can be found in the food we eat, the water we drink, the air we breathe and in the personal care products we put on our skin and hair. These are petrochemicals that act like oestrogen. They are extremely potent even in very tiny amounts.

The other major female hormone is progesterone, which acts to balance the actions of oestrogen. In the latter half of each menstrual cycle, normally there are hundreds of times more progesterone than there is oestrogen. So if progesterone is low or missing, the woman will have a whole month of mostly oestrogen, and this is described as oestrogen dominance.

Women with PMS are low in progesterone. The ovaries should be making the progesterone and they are not. These women are oestrogen dominant. To further complicate things, high levels of the stress hormone cortisol make oestrogen dominance even worse.

TREATMENT OF PMS

1. Correct oestrogen dominance

Avoid foods and drinks that contain oestrogens: commercial meats and poultry, household chemicals and personal care items with xeno-oestrogens. A diet high in fresh vegetables and fruit, high-quality soy products and green tea helps in hormone balancing. Use organic produce if possible.

Detoxify your body to remove offending chemicals. Far infrared sauna therapy, colon cleansing and detoxifying herbs are very useful.

Natural progesterone cream safely helps correct oestrogen dominance. It is best used under the direction of an experienced health-care provider. It contains the exact substance that is deficient in your body and is not a chemical imitation. The popularly prescribed Progestin drugs are not the same as the bio-identical progesterone in this cream and do not give the same results. The quality, the dosage and the timing of application of the cream are important for success of the treatment. The label on the brand you choose should read: 'Natural Progesterone Cream, USP 2 per cent'.

2. Stress management

This is critical as poor stress management will result in high levels of the stress hormone cortisol that worsens oestrogen dominance. Stress commonly disturbs thyroid function and this should be looked out for and addressed.

Exercise, adequate rest, relaxation techniques, massage, reflexology, Reiki, emotional release therapy and hypnosis are all useful tools.

3. Identify and avoid triggers

Activities or habits that trigger your symptoms are called PMS triggers. Examples include cigarette smoking, coffee, stress and overwork, sugar, salty foods and some drugs. Keeping a diary of your symptoms can help in identifying these triggers.

4.Supplements

The Chinese herb tang kuei helps in avariety of hormone-related female disorders like PMS. Vitamins C and E, the minerals calcium and magnesium, the omega-3 fatty acids, B vitamins, chamomile and St. John's Wort are all recommended.

As with so many conditions, I strongly recommend that we seek to deal with the underlying cause of PMS and not just be content with managing the symptoms with drugs.