Women's Health Update

Eighty percent of women experience premenstrual emotional or physical changes, whereas only about 20-40% of these women have difficulties as a result. A much smaller number, about 2.5-5 percent,' feel it has a significantly negative impact on their lives, to the point where work, relationships and home life are jeopardized. It is difficult to identify the cause in a condition that overlaps so broadly with normal physiology, affects so many, and has such a wide array of symptoms. Many theories have been explored and none found completely satisfying. Most likely this is because it is such a complex interaction of factors both physiologic and social. While absolute levels of estrogen and progesterone are no different in PMS sufferers, we know that in women in whom both hormones are pharmaceutically blocked, PMS diminishes by 75%.̂ It is likely that ovarian hormones affect the neurotransmitter, neuroendocrine, and circadian systems that influence mood and behavior differently in each of us. One of the theories that may prove to be the most accurate, is that PMS is influenced by serotonin levels. Rapkin studied serotonin levels in women with PMS and those without, and found that serotonin levels fell after ovulation in women with PMS.̂ There is also evidence that estrogen levels affect the serotonin system. New therapies that have been successful include SSRIs which further supports this approach. Numerous nutritional supplements can also increase serotonin levels. These include tryptophan and 5 hydroxytryptophan, Sadenosylmethionine (SAMe), magnesium and B6. Only B6 has been studied for the treatment of PMS which is discussed in the nutritional supplement section of this article. Acute tryptophan depletion was shown to correlate with PMS and aggravation of premenstrual symptoms.* Excessive and incorrect prostaglandin (PG) synthesis has been implicated in the cause of PMS; a deficiency of prostaglandin El(PgEl) at the central nervous system has been proposed to be involved in PMS.'* There are many nutrients important for the synthesis of PgEl. These include magnesium, linoleic acid, vitamin B6, zinc, vitamin C, and vitamin B3. This theory is carried through as a basis for some of the nutritional therapies in the treatment of PMS. Numerous natural alternative therapies are appropriate for the treatment of PMS including lifestyle changes, vitamin and mineral supplementation, herbal medicines, and natural hormones. Many of these have demonstrated their effectiveness in scientific studies; these are a mixture of controlled randomized clinical trials and uncontrolled. But at least an equal number have either shown no effect or an effect that was not statistically significant. Herein lies one of the curiosities of medicine, elegantly portrayed with PMS: Why do conventional scientific studies fail to demonstrate success with many of these natural therapies that women consistently rely on for their monthly successful treatments? Perhaps the answer lies in the difficulty in determining what works for one person is different than what works for another. Double-blind, placebo-controlled, scientific studies attempt to find what works for as many people as possible, not what works best for an individual. The interaction between neurotransmitters, the body's steroids, circadian systems, mood, behavior, plus plants and nutrients from nature may remain scientifically elusive, but have often instinctually come upon safe and effective natural solutions. What follows is a guide to some of the natural approaches in the management and treatment of PMS that have been investigated.