Physical symptoms during the premenstrual period are referred to as premenstrual syndrome (PMS) and mental symptoms in the premenstrual period are referred to as premenstrual dysphoric disorder (PMDD). The symptoms alter the person’s daily activities. The American College of Obstretics and Gynecology says that the diagnosis of PMS is made “if at least one mental and one somatic symptom occurs with moderate or intense severity.”
Physical symptoms of PMS include breast tenderness, abdominal bloating, headache, and swelling extremities. Mental symptoms of PMDD include depression, angry outburst, anxiety, irritability, social withdrawal, and confusion. The symptoms are relieved within four days of menses and don’t begin until cycle day thirteen.
The cause of PMS is not known, but the breakdown of progesterone has been shown to have some relationship to PMS. The progesterone hormones produced by the corpus luteum of the ovary may be the cause of PMS. Painful breasts could be the result of elevated levels of prolactin (hyperprolactinemia or hyperprolactinaemia,) a hormone produced by the pituitary gland.
PMS is relieved by medications that reduce the production of prolactin, reduce the re-uptake of serotonin (a neurotransmitter), and the inhibition of ovulation. Prolactin plays a role in painful, swollen breasts. Bromocriptine is a medication that reduces prolactin and a dose of 5 mg. has been shown to relieve painful breasts. Bromocriptine has the side effect of nausea and vomiting in 12.5% of women.
Many of the symptoms of PMS seem to be due to decreased serotonin neurotransmission. The symptoms of PMS/PMDD are similar to the symptoms of reduced serotonin activity. Pharmaceuticals called “selective serotonin re-uptake inhibitors,” or SSRIs, such as fluoxetine and sertraline, have been shown to be of benefit in PMS because they increase serotonin activity.
“Functional hyperprolactinemia” can be diagnosed by a doctor through the use of a metoclopramide test. Hyperprolactinemia refers to a high blood level of prolactin. An oral dose of 10 mg. of metoclopramide will result in a two- to six-fold increase in prolactin levels within 60 minutes. A stronger response is abnormal and indicates hyperprolactinemia.
Elevated prolactin levels can be seen with thyroid disease. The TSH (thyroid stimulating hormone) level should be tested if there are questions about thyroid function.
Obesity, insulin resistance, low vitamin D, and low dietary calcium are risk factors for PMS.
PMS is altered by dietary changes and diet modification should include limited salt, reduced caffeine, reduced chocolate, reduced alcohol, and reduced fat. Dietary supplements should include 1200 mg. calcium, 400 mg. magnesium, 400 units vitamin E, 50-100 mg. vitamin B-6, daily. L-tryptophan can be given 6,000 mg./day from the day of ovulation to the third day of menses.
Relaxation techniques sould be done to relieve stress.
Exercise should include walking for 30 minutes daily or aerobic excercise.
The herb Vitex agnus castus (VAC) is beneficial and deserves further study. A dose of 20 mg./day in the evening relieved PMS symptoms in functional hyperprolactinemia. The VAC berries are the most popular. Use during pregnancy and breast-feeding is not recommended.
A relationship between alcohol and GABA receptors has been theorized. PMS symptoms are affected by gamma-aminobutyric acid (GABA) in the central nervous system.
CONCLUSION: PMS and PMDD are menstrual symptoms for which the cause has been poorly defined. The symptoms are related to hyperprolactinemia and reduced serotonin activity. Various treatments are suggested. Dopamine agonists relieve elevated prolactin levels. Elevating serotonin activity has also been shown to be of benefit. Vitex is an herb that shows benefit and should be further studied.
NOTE: Boswellia serrata is an herb which has been shown to be a 5-lipoxygenase inhibitor. Boswellia is used to reduce prolactin levels. Whether Boswellia can relieve PMS symptoms has not been shown clinically.
Tryptophan is an amino acid necessary for the production of serotonin.
Hyperprolactinemia can be caused by a deficiency of dopamine. Tyrosine is an amino acid necessary for the production of dopamine. Vitex agnus casti is useful in treating high prolactin levels.
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