PMS - Solutions

Author: Craig Coghlin, B.A., CPT, CSCS, ART Provider, D.C. (candidate)
Premenstrual Syndrome (PMS) is a group of symptoms related to the woman’s menstrual cycle. These symptoms will typically appear one or two weeks before the onset of menses. PMS is a troublesome combination of physical and emotional distresses and typically occurs during the luteal phase of menstruation.

Prevalence is estimated at 10% up to 90% depending on the type of survey employed. Of this percentile, 10% to 20% are classified as having severe PMS.

Surveys have shown up to 42% of women to rely on over-the-counter medications to deal with their pain. But due to the many side effects and complications associated with many of these drugs, it is not surprising that many women are now turning to complementary and alternative health practices to deal with their PMS.

Symptoms are typically classified under the following subsections:
Behavioural: nervousness, irritability, mood swings, depression, and lethargy
Gastrointestinal: bloating, diarrhea, constipation, cravings
Reproductive: breast tenderness, cramping, altered libido

Complementary Options
There have been several case reports on the efficacy of some homeopathic options, but few clinical trials have supported these findings.

Vitamin and Mineral Supplementation
One study examined the effect of Calcium supplementation on PMS symptoms. Another study looked at Magnesium supplementation. Both studies found positive effects, or were better than placebo in treating PMS symptoms. Similar results were found using Vitamin E. The does used in all the above trials was significantly higher than what is commonly accepted.

Dietary Changes
A low fat, high fibre diet has been found to help reduce the amount of unconjugated estrogen levels. Increased estrogen levels (or an altered estrogen to progesterone ratio) has been found to alter endorphin levels in the body, and is a likely culprit for some symptoms encountered in PMS. Women on a vegetarian diet excrete more estrogen than omnivorous women. A low fat diet alone has also been found to be beneficial.

Women who engage in higher levels of physical activity report lower incidence of PMS symptoms on average. This is due to the effect of exercise on the important clearance of estrogen from the body in order to maintain a proper estrogen: progesterone balance. Exercise is also well known to increase the level of endorphins within the body which will subsequently affect behavioural symptoms.

Black Cohosh
Black Cohosh is the only known naturally occurring substance that can increase blood progesterone levels. Also, it has been found to selectively block the excess estrogen levels from affecting breast tissue, thus decreasing breast tenderness.

There are other known substances that are purported to have similar effects on the body (dong quai, clover, licorice root), but they also have many side effects and contraindications.

Soy is a phytoestrogen. These are natural compounds which can bind to estrogen receptors and block xenoestrogens (bad) and estrogen from binding. Phytoestrogens are beneficial because they have a s

smaller estrogenic effect on the body than the other two aforementioned compounds. Thus they can decrease PMS symptoms such as breast and uterine tenderness.

Vitamin B6
Vitamin B6 helps the liver detoxify estrogen, and is also an aid to the body’s synthesis of neurotransmitters. B6 is known to work synergistically with other B vitamins, thus it would be beneficial to take as a complex.

The Role of the Chiropractor
The chiropractor’s role in the management of PMS symptoms is diverse. The doctor is well able to prescribe exercise changes that will aid as mentioned above. Dietary recommendations can also be made. By working with other practitioners, such as naturopaths and nutritionists, a chiropractor is able to effectively manage the whole patient and treat any related musculoskeletal problems.

Some studies have supported the anecdotal reports that chiropractic manipulation and soft tissue therapy can have a positive effect on symptom level in women with PMS.

In many of these studies, manipulation was compared to placebo treatments. It was found that women reported improvement no matter which intervention they received first. Unfortunately these studies had very small sample sizes, which make drawing statistical conclusions difficult.

Another group of clinical trials studied the effect of chiropractic treatments on the relief of associated back pain symptoms. In these studies and statistical improvement in these symptoms was noted in a group receiving a combination of manipulation and soft tissue therapy three times per week.

Several small studies have found the effectiveness of acupuncture in the treatment of PMS related disorders (headache, breast tenderness, muscle soreness) to be superior to that of a placebo group. They hypothesize this result to be related to acupuncture’s effects on serotonin and opioid pathways within the body.

In Conclusion

The management of PMS is a multidisciplinary one. The chiropractor has a range of options available for treatment of the premenstrual female, from manipulation, acupuncture and soft tissue therapy, to dietary advice and exercise prescription. There are many options available to a woman suffering from PMS symptoms, and complementary therapies offer effective and safe management options.


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Walsh, MJ. The frequency of positive common spinal clinical examination findings in a sample of premenstrual syndrome sufferers. Journal of Manipulative and Physiological Therapeutics, May 1, 1999; 22(4): 216-20.