PMS Relief: Master Your Hormones
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Nutrients from broccoli, berries, and beyond deliver hormone-balancing action
What is PMS?
Whether it’s a sore back or shorter fuse, a lower energy level or a bigger bra size, a migraine or an upset belly, many women can tell when “that time of the month” is near. And those suffering from premenstrual syndrome (PMS) are not alone: almost half of all women are affected by any number of the 300 plus symptoms of PMS.[1]
As tempting as it may be to hide under the covers for a few days out of every month, there are fortunately other ways to endure (and thrive) through the monthly dip in hormones naturally seen in the menstrual cycle.
3,3′-diindolylmethane (DIM), the estrogen tamer
The healing power of Brassica vegetables like broccoli, cauliflower, Brussels sprouts, cabbage, and kale comes in large part from the phytochemical indole-3-carbinol (I3C), which naturally breaks down in the gut to a constituent known as 3,3′-diindolylmethane (DIM) (pronounced “dim”).[2] Consumption of cruciferous vegetables is associated with a reduction of inflammation,[3],[4] decreased risk of cardiovascular disease,[5],[6] and even lower risks of certain types of cancer.[7],[8],[9] DIM also supports healthy hormone metabolism and detoxification, and thus can be helpful in alleviating a number of hormonal issues in women.
DIM supports healthy hormone metabolism and detoxification, and thus can be helpful in alleviating a number of hormonal issues in women.
There are different estrogen metabolites in the body, some of which are more estrogenic and potentially harmful, while others are likely more protective.[10] DIM’s primary virtue with regard to women’s health comes from its role in helping the body strike a safer balance of the “good estrogen” (2-hydroxy-estrone) with the “bad estrogen” (16-alpha-hydroxy-estrone).[11],[12] DIM also has anti-estrogenic activity, competing with estrogen for binding sites on cells and reducing proliferation,[13] and may thus reduce the risk of certain hormone-sensitive cancers.[14],[15] (It is important to note, however, that DIM supplements should not be used by pregnant women.[16])
Balancing estrogen types and levels can be beneficial in alleviating the symptoms not only of PMS, but also of benign breast ailments such as fibrocystic breast disease.[17] DIM in particular supports this aim when synergized with chaste berry.
Vitex, the progesterone booster
The herb chaste berry (Vitex agnus-castus), or vitex, acts on the hypothalamic-pituitary-ovarian axis (the “axis” referring to these three main players that send out hormones dictating the female monthly hormonal cycle). Vitex increases the production of luteinizing hormone (LH), a hormone produced by the pituitary gland to trigger ovulation and raise progesterone levels.[18],[19]
Vitex shifts the body’s estrogen to progesterone ratio in favor of progesterone, thus combating PMS.
By supporting LH production, vitex shifts the body’s estrogen to progesterone ratio in favor of progesterone, thus combating PMS.[20],[21],[22] By directly binding to dopamine receptors, furthermore, vitex helps lower prolactin levels,[23],[24],[25] which in turn can help mitigate breast pain, irregular menstrual cycles, and infertility.
Pyridoxal-5-Phosphate (P5P), the serious relaxer
Vitamin B6 is a highly-studied nutritional intervention for the management of PMS. This is likely because vitamin B6 status has significant influence on the production of the calming neurotransmitters serotonin and gamma-aminobutyric acid (GABA), which mitigate depression, anxiety, and pain perception.[26] In fact, these neurotransmitters require pyridoxal-5-phosphate (P5P), the active form of vitamin B6, for their production.[27] It’s perhaps no surprise, then, that a review of nine clinical trails on P5P representing over 900 patients concludes that P5P is of benefit in treating the symptoms of PMS, including depression.[28]
When it comes to troubleshooting PMS, B6 appears to combine particularly well with magnesium.
Magnesium, the muscle soother
In a study exploring the combined effects of B6 and magnesium, participants were divided into three groups: one group received received placebo, the second received magnesium, and the third received a combination of magnesium with vitamin B6. The mean PMS scores decreased significantly in the magnesium group, but even more dramatically in the magnesium plus vitamin B6 group.[29]
Magnesium is perhaps best known for its effects on easing muscular tension.[30],[31] Because the pain associated with menstrual cramps is caused by the cramping of the muscle fibers in the uterus, magnesium has been a long-time friend to menstruating women, helping to ease this cramping.[32] Magnesium also has well-documented effects on mood, both in the context of PMS and in general,[33] and has been shown to help alleviate the emotional symptoms of PMS. As a substance that supports vasodilation, or relaxation, of the blood vessels, magnesium may even prevent menstrual migraines.[34] Magnesium has also anecdotally been said to decrease sugar and chocolate cravings.[35]
Chromium, the sugar balancer
Chromium is well known and celebrated in medicine for its effects on stabilizing blood glucose (sugar) levels.[36],[37] It has also been shown to have positive effects on improving insulin sensitivity and menstrual regularity in women with polycystic ovary syndrome (PCOS), a condition often associated with poor sensitivity to insulin.[38],[39]
In a small study done with women suffering from premenstrual dysphoric disorder (PMDD), a severe form of PMS, a short-term course of chromium supplementation was shown to improve menstrual cycle-related mood symptoms like depression.[40] Another study found significantly lower blood levels of chromium (as well as calcium, copper, and manganese) in women with PMS than non-PMS-experiencing healthy controls.[41]
Diet and lifestyle for PMS control
As with many (if not all) health conditions, PMS can be radically improved through simple changes in diet and lifestyle.
It’s likely no surprise that smoking increases the likelihood of PMS, especially in adolescents,[42] making PMS yet another reason (in the list of many) to quit smoking. Alcohol consumption has also been associated with an increased risk of PMS.[43]
Nutrition plays an essential role in easing the hormonal imbalance of PMS and its associated symptoms. Reducing or eliminating processed foods, sugars, refined carbohydrates, and dairy products is a great place to start in managing PMS.[44] Watching salt intake prior to and during menstruation can also help ease water retention and bloating.[45] Eating plenty of vegetables and high fiber foods also helps support the body’s ability to conjugate and eliminate toxins and excess estrogen.[46]
Finally, exercise is a must for just about any woman suffering from PMS, and has been shown to alleviate many of the symptoms.[47],[48]
Through nutritional support, herbal medicines, and simple lifestyle changes, PMS doesn’t have to be a monthly prison sentence. It is possible to heal and enjoy steadier hormonal and emotional health.
Click here to see References
[1] Ashraf Direkvand-Moghadam, et al. Epidemiology of premenstrual syndrome (PMS)-a systematic review and meta-analysis. J Clin Diagn Res. 2014 Feb; 8(2): 106-109. [2] Bradlow HL, Zeligs MA. Diindolylmethane (DIM) spontaneously forms from indole-3-carbinol (I3C) during cell culture experiments. In Vivo. 2010 Jul-Aug;24(4):387-91. [3] Navarro SL, et al. Cruciferous vegetables have variable effects on biomarkers of systemic inflammation in a randomized controlled trial in healthy young adults. J Nutr. 2014 Nov;144(11):1850-7. [4] Jiang Y, et al. Cruciferous vegetable intake is inversely correlated with circulating levels of proinflammatory markers in women. J Acad Nutr Diet. 2014 May;114(5):700-8.e2. [5] Lockheart MS, et al. Dietary patterns, food groups and myocardial infarction: a case-control study. Br J Nutr. 2007 Aug;98(2):380-7. [6] Zhang X, et al. Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality. Am J Clin Nutr. 2011 Jul;94(1):240-6. [7] Higdon JV, et al. Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacol Res. 2007 Mar;55(3):224-36. [8] Tse G, Eslick GD. Cruciferous vegetables and risk of colorectal neoplasms: a systematic review and meta-analysis. Nutr Cancer. 2014;66(1):128-39. [9] Lam TK, et al. Cruciferous vegetable consumption and lung cancer risk: a systematic review. Cancer Epidemiol Biomarkers Prev. 2009 Jan;18(1):184-95. [10] Telang NT, et al. Induction by estrogen metabolite 16 alpha-hydroxyestrone of genotoxic damage and aberrant proliferation in mouse mammary epithelial cells. J Natl Cancer Inst. 1992 Apr 15;84(8):634-8. [11] Reed GA, et al. A phase I study of indole-3-carbinol in women: tolerability and effects. Cancer Epidemiol Biomarkers Prev 2005;14:1953-60. [12] Niwa T, et al. Alterations in estradiol metabolism in MCF-7 cells induced by treatment with indole-3-carbinol and related compounds. Steroids 1994;59:523-7. [13] Riby JE, et al. Ligand-independent activation of estrogen receptor function by 3,3′-diindolylmethane in human breast cancer cells. Biochem Pharmacol 2000;60:167-77. [14] Hong C, et al. Bcl-2 family-mediated apoptotic effects of 3,3′-diindolylmethane (DIM) in human breast cancer cells. Biochem Pharmacol 2002;63:1085-197. [15] Bell MC, et al. Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecol Oncol 2000;78:123-9. [16] Furukawa S, et al. Indole-3-acetic acid induces microencephaly in rat fetuses. Toxicol Pathol. 2004;32(6):659-67. [17] Vorherr H. Fibrocystic breast disease: pathophysiology, pathomorphology, clinical picture, and management. Am J Obstet Gynecol. 1986 Jan;154(1):161-79. [18] Brown D, Murray T. Vitex agnus castus (Chaste Tree). Pharmacology of Natural Medicines. 2013 Jan;1135-9. [19] Jarry H, et al. In vitro prolactin but not LH and FSH release is inhibited by compounds in extracts of Agnus castus: direct evidence for a dopaminergic principle by the dopamine receptor assay. Exp Clin Endocrinol. 1994;102(6):448-54. [20] Boon H, Smith M. The Botanical Pharmacy: The Pharmacology of 47 Common Herbs. Kingston, ON: Quarry Press, Inc.; 1999;76-81. [21] Vitex agnus-castus. Alt Med Rev. 2009:14(1)67-70. [22] Weiss RF. Herbal medicine. Gothenburg, Sweden: Ab Arcanum; 1988. [23] Wuttke W, et al. Chaste tree (Vitex agnus-castus) – pharmacology and clinical indications. Phytomedicine 2003;10:348-57. [24] Sliutz G, et al. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res. 1993;25:253-5. [25] Jarry H, et al. Agnus castus as dopaminergous effective principle in mastodynon N. Zeitschrift Phytother. 1991;12:77-82. [26] McCarty MF. High-dose pyridoxine as an ‘anti-stress’ strategy. Med Hypotheses. 2000;54:803-7. [27] Head KA. Premenstrual syndrome: nutritional and alternative approaches. Altern Med Rev. 1997;2:12-25. [28] Wyatt KM, et al. Efficacy of vitamin B6 in the treatment of premenstrual syndrome: systematic review. BMJ 1999;318:1375-81. [29] Fathizadeh N, et al. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. [30] Scahill SL. Magnesium for muscle cramps. J Prim Health Care. 2013 Sep 1;5(3):253. [31] Young G. Leg cramps. BMJ Clin Evid. 2015 May 13;2015:1113. [32] Parazzini F, et al. Magnesium in the gynecological practice: a literature review. Magnes Res. 2017 Feb 1;30(1):1-7. [33] Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67(2):362-70. [34] Quaranta S, et al. Pilot study of the efficacy and safety of a modified-release magnesium 250 mg tablet (Sincromag) for the treatment of premenstrual syndrome. Clin Drug Investig. 2007;27(1):51-8. [35] Marz R. Magnesium. Clinical Nutrition from Marz. 2nd Ed. Portland, OR: Omni-Press; 2002;106-7. [36] Hoffman NJ, et al. Chromium enhances insulin responsiveness via AMPK. J Nutr Biochem. 2014 May;25(5):565-72. [37] Feng W, et al. Chromium malate alleviates high-glucose and insulin resistance in L6 skeletal muscle cells by regulating glucose uptake and insulin sensitivity signaling pathways. Biometals. 2018 Oct;31(5):891-908. [38] Amr N, Abdel-Rahim HE. The effect of chromium supplementation on polycystic ovary syndrome in adolescents. J Pediatr Adolesc Gynecol. 2015 Apr;28(2):114-8. [39] Jamilian M, Asemi Z. Chromium supplementation and the effects on metabolic status in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Ann Nutr Metab. 2015;67(1):42-8. [40] Brownley KA, et al. Chromium supplementation for menstrual cycle-related mood symptoms. J Diet Suppl. 2013 Dec;10(4):345-56. [41] Shamberger RJ. Calcium, magnesium, and other elements in the red blood cells and hair of normals and patients with premenstrual syndrome. Biol Trace Elem Res. 2003 Aug;94(2):123-9. [42] Bertone-Johnson ER, et al. Cigarette smoking and the development of premenstrual syndrome. Am J Epidemiol. 2008 Oct 15;168(8):938-45. [43] Fernández MDM, et al. Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis. BMJ Open. 2018 Apr 16;8(3):e019490. [44] Mohebbi M, et al. Comparison between the lifestyles of university students with and without premenstrual syndromes. Electron Physician. 2017 Jun 25;9(6):4489-96. [45] Farasati N, et al. Western dietary pattern is related to premenstrual syndrome: a case-control study. Br J Nutr. 2015 Dec 28;114(12):2016-21. [46] Houghton SC, et al. Carbohydrate and fiber intake and the risk of premenstrual syndrome. Eur J Clin Nutr. 2018 Jun;72(6):861-70. [47] El-Lithy A, et al. Effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women. J Obstet Gynaecol. 2015 May;35(4):389-92. [48] Mohebbi Dehnavi Z, et al. The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome: a clinical trial study. BMC Women’s Health. 2018 May 31;18(1):80.
The information provided is for educational purposes only. Consult your physician or healthcare provider if you have specific questions before instituting any changes in your daily lifestyle including changes in diet, exercise, and supplement use.
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Dr. Erica Zelfand
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