IRREGULAR PMS & ESTROGEN DOMIANCE?

Q. Over the past 5 years, I've gone from never having had PMS to having almost unbearable symptoms. I have been reading that PMS can be caused by estrogen dominance? Can you explain this to me? How do I decrease estrogen and will this help to calm my PMS symptoms?

A. Estrogen dominance is a recently coined term that does not necessarily mean that estrogen levels are higher than normal, but simply that they are unopposed, meaning there is a relative lack of progesterone to counteract primarily estrogen dependent processes. It can also be used to describe an excess of estrogen, not because of an excess production, but more likely a compromised liver detoxification pathway. Basically, if the liver is not functioning optimally (often described as 'sluggish') then estrogen metabolism and excretion is is inadequate.

The role of estrogen dominance has been indicated in a number of female pathologies, including painful menstruation, excessive menstruation (dysmenorrhea and menorrhagia, respectively), endometriosis, as well as being associated with symptoms of peri- and early menopause, fibrocystic breasts and fibroids. There is still debate as to whether women who experience PMS are more likely to have a higher than normal estrogen to progesterone ratio. Treating PMS using a protocol aimed solely at correcting estrogen dominance has not been confirmed in research and does not work for all patients. There is no disputing that PMS is associated with a dysfunctional inflammatory process within the body, prior to menses, although the reasoning behind this is still unclear. Obesity is considered an independent risk factor for PMS. Those with a body mass of greater than 30 are 3 times more likely to suffer from PMS. Women in this category have found that weight loss was correlated with a significant reduction in symptoms.

So, if we don't focus on estrogen dominance, how do we go about treating PMS. Keep in mind that, similar to menopause related complaints, every woman who experiences PMS has a slightly different symptom picture. The suggestions that follow may not work for all women the same way and may require months before any significant changes are noticed.

Magnesium status is the first issue I am going to address. Magnesium is depleted by changes in female sex hormones in the luteal phase, which also corresponds to the time which most PMS symptoms are experienced. Some studies have also shown a pattern of lowered red blood cell magnesium levels in women who experience PMS versus women who don't. Magnesium is essential for both fatty acid metabolism, as well as the metabolism of B6, which as you will see have both been indicated in PMS symptoms. Perhaps it is the benefit that magnesium has on these other nutrient levels in the body that is at the root, but either way, it's use has been been shown to significantly decrease PMS associated symptoms of bloating, breast distention, edema and mood fluctuations. Consider combining your magnesium with 1000-1500 mg calcium for added benefit.

B6 has been shown to be responsible for the increase of several neurotransmitters in the brain, including serotonin, dopamine, norepinephrine and epinephrine. Decreased levels of serotonin and dopamine have been implicated in PMS symptoms of irritability, fatigue and depression. 100-200 mg/day in divided dosages is considered safe, but this amount should not be exceeded unless under the supervision of a healthcare practitioner.

Dysfunctional synthesis of prostaglandins (mediators of our inflammatory processes) has also been a proposed commonality between most women who experience PMS. It is possible that some are produced in excess (pro-inflammatory), while others, like Prostaglandin E1 are deficient. Essential fatty acids like evening primrose and fish oils, have been found to increase these levels, while also alleviating PMS symptoms. More recent research suggests that the use of Krill oil, an omega 3 fatty acid, was found to be even more effective than fish oil in terms of managing PMS symptoms, including breast tenderness, dysmenorrhea (pain at the onset or during menses) and mood fluctuations.

Vitex, or Chaste tree, is also an extremely effective herb for the relief of a wide array of PMS symptoms. It has long been considered a balancing herb, meant to balance out any overt excess or deficiency. In practice, it does slightly favour progesterone, as well as increasing the secretion of luteinizing hormone (LH). Some studies have shown it to be as useful, if not more useful, than Prozac in decreasing psychological symptoms associated with PMS.

As far as diet and lifestyle go, there is a lot we can do to decrease cyclical symptoms, either in combination with supplementation or as stand along interventions. Several studies have shown a correlation between high intake of dairy products and high incidence of PMS. Dairy and calcium products can decrease magnesium absorption, as well as stimulate inflammatory processes. Decreasing dairy intake has led to the complete resolution of PMS in women with dairy sensitivities. Refined sugars can also wreak havoc on the body, again, promoting inflammation, causing blood sugar imbalance, which can directly affect mood, as well as increasing the urinary excretion of magnesium. A diet high in refined sugar also leads to further cravings for sweet and salty foods. Decreasing intake of refined sugar, at all times, or at least throughout the luteal phase of the cycle, may help to decrease the severity of PMS symptoms. Although the mechanism of action is unclear, reducing or cutting out caffeine intake leading up menses has also been significantly correlated with decreased breast tenderness.
Regular exercise, yoga, meditation and deep breathing exercises have all been shown to decrease both incidence and intensity of PMS symptoms.

Back to all Dr. Jody Q&A

All articles copyright National Nutrition 2001 - 2012.  For educational purposes only.  Please note that while National Nutrition supports your right to use natural health care products for any therapeutic purpose that you see fit, that the information on this website should not be considered as a claim or as a substitute for medical advice.