Premenstrual Syndrome: Nutritional and Alternative Approaches

Since it was first identified in the 1930s, premenstrual syndrome (PMS) has presented the clinician with challenges from an etiological as well as treatment perspective. To know the cause is to know the cure. The cause of PMS appears to be a complicated interplay among hormones, neurotransmitters, nutrients and psychosocial factors. To complicate the picture further, the same imbalances are not present in every person suffering from PMS. This article is a review of the literature, citing numerous studies, sometimes with conflicting views, of the etiology and non-drug treatment for premenstrual syndrome. Specific nutrients and botanicals are discussed as they relate to particular neuroendocrine imbalances. In view of the fact that there appears not to be one particular deficiency or excess which can be identified in each case of PMS, the most reliable method of treatment involves a comprehensive approach which includes dietary changes, supplementation of specific nutrients and botanicals, and when indicated, use of identical to natural hormones such as progesterone. (Alt Med Rev 1997;2(1):12-25) Historical Perspective Premenstrual syndrome (PMS) is a complex of physical and psychological symptoms appearing in the luteal phase of a woman’s cycle, generally beginning seven to ten days prior to the onset of menses, increasing in severity as the menses approaches and ceasing with or slightly after the onset of menses. Hippocratic physicians made reference to physical and psychological symptoms in their writings1 as early as the fourth century BC. It wasn’t until 1931, however, that Robert Frank, an American physician, brought it to the attention of the New York Academy of Medicine and suggested that the cause was faulty ovarian function.1 That same year, a psychoanalyst, Karen Horney, postulated that the syndrome was the result of suppressed sexual desire and power.1 Difficulties of Defining and Diagnosing PMS The absence of any clear diagnostic criteria has made evaluation of this syndrome somewhat difficult. Much of the reporting has been dependent upon analysis of retrospective surveys which depend upon the patient’s recall of symptoms and are not the most reliable means of evaluation. Studies employing both retrospective and prospective data indicate that retrospetive studies overestimate the prevalence of symptoms.2 Whether a retrospective survey is used or a prospective symptom diary is kept, the subjectivity of the data is still an issue. The extent to