PMS Powwow
A candid conversation between a natural health expert and four premenstrual syndrome sufferers

By Brooke Foster

The PMS sufferers:
Kim Brooks, 26, novelist and adjunct professor at the University of Dubuque in Iowa. Married.
Alison Sieloff, 27, arts and events editor of an alternative weekly paper in St. Louis. Single.
Shelley Smithson, 32, investigative journalist in St. Louis. Married, with one daughter, age 2.
Laura Lane, 39, 4th-grade teacher in Lewisville, Texas. Married, with two daughters, ages 8 and 14.
The natural health expert: Diana Taylor, RN, PhD

No matter how healthy your lifestyle, chances are PMS has affected you at some time or another. Maybe cramps keep you away from the gym for a few days each month. Or maybe that cute black skirt suddenly seems a little snug. And what about your coworkers, significant other, and children: Are they trying to get on your nerves?

For most women, premenstrual syndrome is as mysterious as it is prevalent. To help remedy your most common PMS pains and problems, we asked natural health expert Diana Taylor, RN, PhD, professor emeritus of nursing at the University of California, San Francisco, and coauthor of Taking Back the Month (Perigee/Penguin Putnam, 2002), to sit down and chat with four self-avowed PMS sufferers. Her advice may help ease your symptoms or even turn PMS into a thing of the past.

Kim: OK, I’ll start: Honestly, my husband is afraid of the extreme mood swings I undergo when I’m premenstrual. What can he or I do to fortify our relationship during that time?

Diana Taylor, RN, PhD: You definitely need to educate your husband about PMS—but make sure to do so after your period! Guys cannot instinctively understand PMS, so we have to explain it to them. Ask your husband to think of a time when he felt at the mercy of his emotions, particularly times when he was angry or stressed out. Then tell him that feeling, combined with the flu, is how you feel at this time of the month. Reassure him that he’s not to blame for your emotions, but let him know he can help. For example, he can prepare dinner, make you a cup of tea, or do something that lets you relax and take care of yourself.

Alison: I get pretty emotional when I have PMS, too. And I have a really hard time getting motivated to do anything. How can I combat that feeling of lethargy?

Dr. Taylor: A feeling of being bone-tired strikes many women for a few days before their period. One culprit could be your diet. If you feel lethargic after a meal that is high in starchy carbohydrates—pancakes or pasta, for instance—balance out the carbohydrate load with some energy-boosting, low-fat protein, such as cottage cheese, low-fat yogurt, tuna, beans, or lentils. Good carbohydrate/protein combos include toast with peanut butter, whole-wheat pita with hummus, tacos with ground turkey, and Spanish rice with beans. Also, if you aren’t already, start exercising aerobically for at least 15-minute sessions three to four times per week to help boost endorphins in your bloodstream, which can enhance your overall feeling of well-being.

Shelley: I’ve been doing yoga to help PMS, but I also rely on coffee to get me past the feelings of fatigue. Without caffeine, I feel like I’d have to call in sick to work because I’d be so tired! Is drinking coffee OK? Are there other options?

Dr. Taylor: First of all, definitely keep up the yoga, which can help ease muscle tension and relieve stress, irritability, and fatigue. I recommend 20-Minute Yoga Workouts (Ballantine, 1995) and The American Yoga Association’s Beginner’s Manual by Alice Christensen (Fireside, 1987).

As for the caffeine, this is really individual. For some women, even a small amount of caffeine can increase feelings of irritability, so you should be careful. One solution is to start gradually decreasing your daily intake of caffeine—perhaps by having half-caffeinated and half- decaffeinated coffee. And try eating a little protein at each meal; this will aid blood-sugar control because protein takes longer to digest, providing your body with a continual supply of energy. Keep track of how your symptoms change based on what you eat, and share the results with your husband—engage him in helping you, too.

The amino acid tyrosine can also help your energy level and improve concentration. Tyrosine is a precursor to the energizing biochemicals adrenaline and dopamine, so tyrosine-rich foods, such as low-fat cottage cheese, almonds, soy milk, and beans, can pave the way for increased energy and feelings of well-being.

Kim: My doctor also recommends yoga and other exercise, but ever since I was 16, my period has been preceded by 24 to 48 hours of excruciating cramps. I try to exercise as much as I can during the month, but I can barely get out of bed when my cramps are at their peak, let alone exercise. How else can I manage the pain?

Dr. Taylor: You might want to consider taking one of the nonsteroidal anti-inflammatory drugs (NSAIDs), which inhibit the production of prostaglandins, hormones that stimulate contractions of the uterus and cause cramps. It may be that your prostaglandins are produced in excess or that you’re particularly sensitive to them. Other strategies include using heat, such as a hot water bottle or a heating pad on your abdomen, or immersing yourself in a hot bath, which relaxes the muscles and decreases pain perception.

Omega-3 fatty acids can also help ease cramps by inhibiting the formation of arachidonic acid, which is present at the beginning of the prostaglandin cascade. Good sources of omega-3 fatty acids include flaxseed, walnuts, and “fatty” fish, such as herring, salmon, or tuna. You can also take fish-oil supplements to get omega-3s. (For more on helpful supplements, see “6 Herbs and Supplements to Help Ease PMS.”)

Alison: I’ve always had problems with cramps, too, both in my abdomen and my back, and with bloating. My physician put me on a triphasic birth-control pill, which has helped with the cramps, but it hasn’t really helped with the bloating. What do you think?

Dr. Taylor: Any low-dose birth-control pill should be effective in suppressing ovulation and reducing PMS symptoms, but it sounds like you may do better with a monophasic pill. All birth-control pills have two types of hormones, estradiol and progestin, but here’s the big difference: In the triphasic pill, the progestin amount varies to mimic a menstrual cycle. With the monophasic, every pill has a constant amount of both hormones, so you’re not taking pills that imitate the physical and emotional ups and downs of the menstrual cycle. Any monophasic pill should help ease your symptoms, but you might want to find one that has a mild diuretic effect since you also have problems with bloating.

Laura: Can certain supplements or foods help with bloating, too?

Evening primrose oil helps regulate hormones and reduces breast tenderness and fluid retention.

Dr. Taylor: You may feel bloated in your belly because a surge of hormones that occurs just before your period can cause your kidneys to retain salt and water. A supplement that may help reduce this fluid retention is evening primrose oil. This oil is high in the essential fatty acid gamma linolenic acid (GLA), a precursor to prostaglandin, which helps regulate hormones and reduce PMS symptoms, including breast tenderness and fluid retention.

Also try eating foods that stimulate the kidneys to flush excess body fluid; these include steamed asparagus, alfalfa sprouts, apple-cider vinegar, and dandelion greens. And definitely avoid salty snacks, canned soup, and deli meats—anything high in salt that can make you feel like a beached whale. Moderate to vigorous exercise will also make you sweat and hasten the transport of water through your body.

Brooke Foster, a freelance writer and editor living in St. Louis, has implemented much of the advice in this article and feels happier and healthier already.