Premenstrual syndrome

Citation

Bussell, G. (1999), "Premenstrual syndrome", Nutrition & Food Science, Vol. 99 No. 4. https://doi.org/10.1108/nfs.1999.01799daf.001

Premenstrual syndrome

Premenstrual syndrome

One definition of premenstrual syndrome (PMS) is, ‘‘The cyclical recurrence, in the luteal phase of the menstrual cycle, of a combination of distressing physical, psychogical and/or behavioural changes of sufficient severity to result in deterioration of interpersonal relationships and/or interference with normal activities’’. It appears that one in three women suffer PMS to some degree and one in 20 suffer so severely that their lives are seriously affected. An average GP will see two new cases of PMS every week but by the time a doctor, a consultant in a specialist PMS clinic or even a PMS charity helpline sees or hears from a sufferer, the PMS victim will probably have been suffering quite severely for some time.

Symptoms of PMS include anger, panic attacks, tension, anxiety, aching joints, bloating, depression, food cravings, breast tenderness, skin problems, headaches, irritability, mood swings, poor concentration and fatigue. There is no blood test for PMS. The only way of diagnosing it is for sufferers to keep a symptom chart for three months. Symptoms of PMS will occur in the luteal phase of the menstrual cycle, the phase after the egg is released up to when the period starts, and should disappear after the period has reached its heaviest flow. The PMS chart can also be used to monitor improvements in symptoms with treatment.

Although PMS is believed to be triggered by the changes in hormone status in the luteal phase, its true cause remains a mystery. Modifications in lifestyle can alleviate some of the symptoms. Improvements in nutrition are a good starting point. This is safe, relatively cheap, effective and puts the sufferer in control of her own treatment. Furthermore it has been shown that if the sufferer needs to have further treatment, this is more likely to be successful if her diet is good. As a result of reviewing over 70 recent references on PMS and diet and from experience from many years of working with PMS sufferers, Gaynor Bussell has devised a dietary approach which is logical, scientific and effective.

It must be emphasised that each patient is unique and different and requires tailored advice. But all dietary changes are thought to have an effect on one or several of the following processes:

• •

  Glucogenesis.

• •

  Neurotransmitter production, especially serotonin or dopamine.

• •

  Oestrogen metabolism.

• •

  Prostaglandin production, especially prostoglandin E1.

• •

  Aldosterone levels which affect fluid balance.

Dietary advice is given in four phases. Phase one ensures that the sufferer is following basic healthy eating guidelines which are the same as those suggested for reducing cancers and heart disease.

Cutting down on fat, particularly trans and saturated fat, may help with prostoglandin production. Prostoglandins have many actions on the body. For example, they can affect neurotransmitter sensitivity and alter cerebral blood flow and may play a role in lessening PMS symptoms. Increasing starch may help with serotonin production. Increasing fruit and vegetable consumption may help to increase essential mineral and vitamin intakes which are essential cofactors in neurotransmitter production. They may also help to alleviate the problem of premenstrual constipation. PMS sufferers also seem to be short of magnesium which the fruit and vegetables would supply.

Increasing fibre may also help to bring down the oestrogen levels in the body by preventing its re-absorption from the gut. Decreasing salt may help to offest bloating and fluid retention. Excess refined sugar consumption may increase insulin production which may also aggravate bloating. It can also lead to a lowering of blood chromium levels and increase urinary excretion of magnesium. Decreasing the consumption of caffeinated beverages may also help alleviate breast tenderness. Caffeine is a known aggravate of sleep and tension both of which may be already upset by PMS and may also lower the level of minerals such as calcium in the body. Alcoholics are known to suffer more from PMS and alcohol seems to aggravate the condition by causing hypoglycaemia which is a symptom many PMS sufferers complain of. However there seems to be no evidence that true hypoglycaemia occurs in PMS subjects.

In phase two of the programme sufferers are advised to increase their consumption of complex carbohydrates to reduce symptoms such as dizziness, irritability and shakiness. It is thought that regular intakes of carbohydrate have an effect on serotonin levels which are thought to be deficient in PMS sufferers. If weight gain is a problem, advice on suitable low-fat, low-sugar snacks is given.

Except for magnesium there has been a failure to relate peripheral measures of vitamins and minerals to clinical manifestations of PMS. Gamma linoleic acid (GLA) provides the precursor for prostoglandins which allow various tissues to be less senstive to female hormones such as prolactin. There is little evidence that GLA is effective in treating symptoms of PMS other than breast tenderness but for this it appears to be very effective. Magnesium plays an important role in many processes in the body several of which may aggravate PMS symptoms. Magnesium also works closely with vitamin B6 and when taken with this vitamin will lessen the chance of nerve damage.

Vitamin B6 is involved with the production of serotonin and dopamine and is also involved in prostaglandin production. There is much evidence that vitamin B6 can alleviate many psychological symptoms of PMS. However, a 100mg dose should not be exceeded due to the risk of peripheral neuropathy. Further developments in this field and possible legislation is awaited.

If there is underlying disease, this can aggrevate PMS. Diabetes, anaemia and other similar conditions can be controlled and alleviated with diet. Allergy sufferers commonly suffer with PMS and so the easing of PMS misery in their case includes the avoidance of foods which cause the symptoms.

The charity, The National Association for PMS, offers help and advice based on current evidence to PMS sufferers. This autumn the Association will be running a workshop which will look at how PMS research can be carried out using randomised, placebo-controlled, double- blind, cross-over trials so that future research can be meaningful.

Gaynor BussellPublic Relations Advisor, British Dietetic Association