Lehua, my 30-year-old patient from Honolulu, came to see me because, for one week each month before her menstrual period started, she experienced dramatic mood swings, bloating and fatigue. Her symptoms were so severe that she was unable to cope with her demanding schedule. The birth control pills and Prozac that had been prescribed for her had not helped. I explained to Lehua that when pre-menstrual syndrome (PMS) is viewed as a symptom of an underlying physiological imbalance, it can quite often be successfully treated.

Many women experience PMS symptoms severe enough to seek professional help. However, not every woman experiences the same symptoms or the same degree of discomfort. The causes of PMS are many; female hormones, neurotransmitters, nutrients, and stress levels all play a role. PMS occurs anywhere from one to two weeks prior to a period; the symptoms abate once the menstrual flow starts. Typical symptoms include irritability, anxiety, insomnia, breast tenderness, water retention, weight gain, cravings for sweets, fatigue, trembling, mood swings, depression, and headaches.

What can you do to treat your PMS?

Balance your hormones. Numerous studies have indicated that balancing hormones seems to be the key to resolving the symptoms of PMS. Some women respond very well to supplementing with the hormone progesterone. The Journal of Reproductive Medicine has reported that “dietary and supplement programs which have successfully treated PMS often result in a decrease in serum estradiol (estrogen) and an increase in progesterone.” However, a small percentage of women who suffer from PMS have the reverse problem; too much progesterone and too little estrogen. It is important to test hormone levels, preferably on the 21st day of your menstrual cycle, to evaluate whether your PMS is from imbalanced estrogen, progesterone or both.

Exercise. Many studies report that women who exercise regularly have decreased PMS symptoms. Exercise increases circulation, increases endorphins, decreases depression, and decreases circulating estrogens. What constitutes regular exercise? Twenty minutes of aerobic exercise at least three times a week.

Eat healthy food. In the Journal of Reproductive Medicine, Guy Abraham, a leading researcher in the field, said that “PMS patients consume 27.5% more refined sugar, 62% more refined carbohydrates, 78% more sodium, 79% more dairy products, 52% less zinc, 77% less magnesium, and 53% less iron than women without PMS.” It is important for PMS sufferers to have an adequate intake of vitamin B6, vitamin D, vitamin E, magnesium, calcium, manganese, zinc, and essential fatty acids. These nutrients are found in a diet consisting of fruits, vegetables, fish and whole grains.

Decrease caffeine. The American Journal of Public Health states that women who consume large amounts of caffeine are more likely to suffer from PMS. How much caffeine does a cup of coffee contain? Anywhere from 40 to 100 mgs. Beware, chocolate lovers – chocolate has caffeine in it.

Consider your brain chemistry. Serotonin is a neurotransmitter that can significantly affect mood and behavior. Since the early 1990s, a number of studies have suggested the use of antidepressants such as Prozac in the treatment of PMS. However, numerous side effects of the drugs prevent many women from using them. Alternatively, the herb St. John’s Wort has been reported in over 25 double blind studies to have demonstrated positive effects in the treatment of depression; it may aid in the treatment of PMS when low serotonin levels are thought to be the causative factor.

It has been four years since I first treated Lehua for her PMS, and she is still without symptoms. She exercises regularly, eats well and continues to

Article was originally printed in the Honolulu Advertiser, honoluluadvertiser.com.