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 Herbal Medicine: Pre-Menstrual Tension 
A condition characterized by nervousness, irritability, emotional instability, depression and possibly headaches, edema and mastalgia; it occurs during the 7 to 10 days before menstruation and disappears a few hours after onset of menstrual flow.

In other words the name describes a broad range of symptoms that occur cyclically which are severe enough to disturb a woman's life patterns or cause her to seek help from a health practitioner. Most women experience some body change cyclically during the menstruating years corresponding to the pattern of cycling hormones. The subtle shift in mental and emotional focus as well as body response is observed and ritualized in many cultures. Women often express a positive attitude toward the conscious observance of these patterns within their own bodies, however when the hormonal and chemical changes result in debilitating symptoms they may disrupt functioning in virtually all body systems.

The symptom picture may include:
Behavioral Symptoms:
personality alteration in the form of nervousness, irritability, agitation, unreasonable temper, fatigue, depression. Violent crimes and suicide are often committed in the premenstruum. Symptoms that suggest clinical depression such as anxiety, palpitations, tightening in the chest, hyperventilation are common.
  • Neurological Symptoms: headache, vertigo, syncope, paresthesias of the hands or feet, aggravation of seizure disorders have all been recorded.
  • Respiratory Symptoms: asthma may be intensified.
  • Gastro-intestinal Symptoms: constipation, and increase or decrease in appetite, carbohydrate craving particularly sugar and chocolate.
  • Miscellaneous: edema, weight gain, backache, enuresis, oliguria, capillary fragility, exacerbations of dermatologic disease, breast changes, and eye complaints

Four categories of PMT have been identified corresponding to the major symptoms patterns :
  • PMT-A (80%): predominantly anxiety, associated with excess estrogen, and CNS stimulation resulting in anxiety. Excess estrogen can be caused by deficiency in progesterone (high estrogen/progesterone ratio), or by inability of the body to break down estrogen (poor liver function, or Vitamin B deficiency resulting in same).
  • PMT-H (60%): predominantly hyperhydration (bloating, edema), increased ACTH, water/salt saving by kidneys.
  • PMT-C (40%): carbohydrate craving, due to increased responsiveness to insulin.
  • PMT-D (5%): depression, due to excess progesterone, CNS depression PMS is diagnosed on the basis of when symptoms are present. There is (by definition) a period of time when symptoms are absent, usually just after the onset or end of menses. PMS occurs during the proliferative or luteal phase of the menstrual cycle when levels of estrogen and progesterone are relatively high. Estrogen is a central nervous system stimulant. Progesterone is a CNS depressant. What is important in the relationship of estrogen to progesterone during the luteal phase.

A number of etiological factors have been identified for primary PMT:
  • Estrogen excess.
  • Progesterone deficiency.
  • Fluid retention: it is believed that many of the symptoms of PMS relate to a shift in the fluid in the water compartments, intra and extracellular and intravascular with increased retention of water and water moving into the extracellular spaces. Mediated by increased ACTH and aldosterone.
  • Hypoglycemia: the cells are more receptive to insulin in the premenstruum, causing relative hypoglycemia resulting in carbohydrate craving.
  • Decreased production of Prostaglandin E1: researched by David Horrobin; advocates the use of Gamma-linolenic acid, which is found naturally in human milk and oil of evening primrose. Other nutrients encouraging the conversion of fatty acids to Prostaglandin E1 are: Magnesium, B6, Zinc, Niacin, and Vitamin C.
  • Increased production of other prostaglandins.
  • Magnesium deficiency leading to decreased dopamine in the brain resulting in increase levels of CNS stimulators (norepinephrine and serotonin).
  • Increased prolactin levels causing decreased progesterone.

NOTE: post partum depression is very similar to PMS both in symptoms, and in the hormonal picture of progesterone deficiency.

Actions indicated for the processes behind this disease :
Nervine herbs will usually remove the symptoms, but rarely clear the recurrent pattern.
Anti-spasmodic herbs will ease any dysmenorrhoea that accompanies the PMT.
Diuretic remedies would be indicated if water retention is part of the picture.
Hormonal Normalizers would be indicated if the diagnosis suggests a pivotal contribution by hormonal imbalance.

System Support :
In addition to the reproduction system, the nervous system usually needs aid. In some intransigent cases attention must be given to endocrine function.

Specific Remedies :
Different remedies may act as specifics for specific women, so generalizations are problematic. From my clinical experience I would suggest Scutellaria spp. in the short term is as close to a specific for relief of symptoms as possible. Longer term `specific' herbs would be the hormonally focused ones such as Vitex agnus-castis.

One possible prescription :
Scutellaria spp. 2 parts
Valeriana officinalis
1 part
Taraxacum officinalis
fol. 1 part 5ml of tincture taken as needed to alleviate symptoms.
Vitex agnus-castis 2 parts
Cimicifuga racemosa 1 part 5ml of tincture taken once a day throughout cycle.

The dosage of the symptomatic medication may be increased until the desired relief is experienced. The dosage regime may be altered as necessary, varying time of day and quantity of dose to suit individual needs. For example this may be the whole dose first thing in the morning, or smaller amounts at frequent intervals throughout the day. The womens' experience is the guiding principle here. Always treat the human being and not the theory about the `disease'!

This supplies the following actions :
Nervine (Scutellaria spp., Valeriana officinalis, Cimicifuga racemosa)
Anti-spasmodic (Scutellaria spp., Valeriana officinalis, Cimicifuga racemosa)
Diuretic (Taraxacum officinalis fol.)
Uterine Tonic (Cimicifuga racemosa, Vitex agnus-castis)
Hormonal normalizer (Vitex agnus-castis)

If water retention predominates symptomatically, then more focus should be given to diuretics. Palpitations would suggest Leonurus cardiaca as a relevant herb. As an example of how this basic approach can be modified to address specific symptoms consider the following.

One possible prescription : PMT associated with transitory skin problems
Scutellaria spp. 2 parts
Anemone pulsatilla
1 part
Galium aparine 1 part
Taraxacum officinalis
fol. 1 part 5ml of tincture taken as needed to alleviate symptoms.
Vitex agnus-castis 2 parts
Cimicifuga racemosa 1 part 5ml of tincture taken once a day throughout cycle.

This supplies the following actions :
Nervine (Scutellaria spp., Anemone pulsatilla, Cimicifuga racemosa)
Anti-spasmodic (Scutellaria spp., Anemone pulsatilla, Cimicifuga racemosa)
Diuretic (Taraxacum officinalis fol., Galium aparine)
Alterative (Galium aparine, Anemone pulsatilla)
Uterine Tonic
(Cimicifuga racemosa, Vitex agnus-castis)
Hormonal normalizer (Vitex agnus-castis)

Broader Context of Treatment :
The whole gamut of issues that the holistic practitioner can address must be focussed upon. The herbal treatment can be exceptionally effective, but will benefit from appropriate stress management techniques and possibly dietary support. The following dietary guidelines have been suggested by Dr. Karen Bilgrai Cohen D.C. in Clinical Management of Women In the Childbearing years.
  • Limit refined sugar as it increases excretion of B Vitamins, Magnesium, and Chromium, and contributes to increased insulin secretion resulting in hypoglycemia.
  • Limit salt to under 3 grams per day.
  • Limit red meat because of high sodium & high fat content, to 3 oz. per day. Some evidence shows that the hormones in red meat contribute to fibrocystic disease & menstrual cramps.
  • Limit alcohol to I oz. per day. Alcohol destroys B Vitamins, Magnesium and Chromium, and may be a potent depressant in some people.
  • Limit Caffeine: it intensifies anxiety and contributes to fibrocystic disease.
  • Limit dairy products. They are high in fat, interfere with magnesium absorption, & may constipate.
  • Limit fats to 30% of total calories. * Limit cold foods.
  • Limit protein to 1 gram per kilogram of body weight.
  • Avoid licorice: it stimulates the production of aldosterone.
  • Minimize spinach, beet greens and other oxalates as they interfere with mineral absorption.
  • Increase complex carbohydrates to 40% of diet, with whole grains, green leafy vegetables and legumes. They are high in fiber, B Vitamins and release sugar slowly.
  • Increase potassium rich foods, which are beneficial against water retention: sunflower seeds, dates, figs, peaches, bananas, tomatoes.
  • Increase intake of natural diuretics: artichokes, asparagus, parsley, watercress.
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 About The Author
David Hoffmann BSc (Hons), MNIMHWhilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it......more
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