Menstrual and Premenstrual Problems

Real Relief for Real Discomfort

It's not all in your head. You really do want to hang a do-not-disturb sign around your neck the week before your period. You really do get cramps that make you want to crawl pitifully into bed. Your cravings for chocolate are utterly overwhelming. And just where did that bag of potato chips go, anyway?

But you're resolved not to give in to menstrual or premenstrual discomfort. The job, the kids and life itself are just too demanding, and besides, you're not the type to hide under the covers for days on end. So what's a real woman, beset with the very real symptoms of premenstrual syndrome (PMS), cramps and other menstrual challenges to do? For the best advice that advocates of natural healing have to offer, read on.

PMS: HELP FOR THE SCREAMING MEANIES

PMS is so ubiquitous among women that one British doctor calls it the world's commonest disease. "Sixty to 80 percent of all women have premenstrual changes that are mildly annoying," says Kathleen Ulman, Ph.D., staff psychologist at Women's Health Associates at Massachusetts General Hospital and instructor in the Department of Psychiatry at Harvard Medical School, both in Boston. "About 3 to 5 percent of women have severely disruptive symptoms, like profound depression, flashes of rage and unremitting exhaustion."

What causes PMS? No one, not even the British physician Katharina Dalton, who coined the phrase "premenstrual syndrome" back in 1953, is entirely certain. What scientists do know, though, is that female reproductive hormones, specifically progesterone, probably play a significant role.

Dr. Dalton notes that there are more than 150 recognized symptoms of PMS and they affect teenage girls, menopausal women and everyone in between. The good news, she says, is that nearly 100 different treatment options exist to help relieve PMS.

Medical options include daily doses of synthetic hormones or drugs such as Prozac (an antidepressant) and Xanax (an anti-anxiety drug). For women looking for a natural, nondrug route, alternative practitioners offer the following advice, from herbs to yoga.

De-stress with Relaxation and Exercise

"We know that stress-management techniques can alleviate many PMS symptoms," says Dr. Ulman, who runs PMS stress-management groups. Here are the strategies that she has found to be the most successful.

Keep a menstrual journal. In small notebook, note your mood and physical symptoms for each day of your cycle. Many women with PMS find that stresses that they would otherwise tolerate well (or ignore) at other times of the month seem to make PMS worse.

"Keeping a record is the only way that you can connect your PMS symptoms to events in your life," says Dr. Ulman. "When you learn what triggers your symptoms and what your bad days may be, you'll learn when you have to take it easy, go home a little early and save the hard stuff for next week."

Learn a calming discipline. It doesn't matter which relaxation technique you choose, as long as it helps you to relax, says Dr. Ulman. "Deep breathing, meditation and yoga are all excellent for PMS," she says. (For details on deep breathing, meditation and yoga, see pages 67, 233 and 309.)

Take a walk. "I have some very exciting news for women with PMS," reports Mary Jane DeSouza, Ph.D., an exercise physiologist with the Center for Fertility and Reproductive Endocrinology at New Britain General Hospital in New Britain, Connecticut. Dr. DeSouza conducted a study on 45 sedentary women. Her findings? Women who took easy to moderately brisk half-hour walks three or four times a week experienced significant improvement in PMS symptoms. "This is the first study to document that low to moderate levels of exercise can improve PMS problems and symptoms," she says. "I'd much prefer to tell a woman to go on a low-intensity walking program than tell her to take an antidepressant drug."

Food and Vitamin Therapy to the Rescue

A few dietary changes can ease or even end premenstrual syndrome and other menstrual problems, says Loretta Mears, D.C., chiropractor and certified clinical nutritionist in private practice in New York City. "For many of the women that I work with, PMS problems are usually related, in one way or another, to nutritional problems."

Here's what she and other nutritional experts recommend.

Eat small meals--frequently. "I find that eating five small meals a day, with a good balance of complex carbohydrates and a moderate amount of protein, helps many women," says Dr. Ulman. (Half of a turkey sandwich on whole-wheat bread is a good example.)

The combination of carbohydrates and protein helps buffer mood swings, says Diana Taylor, R.N., Ph.D., director of the Perimenstrual Symptom Management Research Program at the University of California School of Nursing in San Francisco.

"What doesn't help is going for hours without eating and then grabbing a candy bar," she says. Simple sugars, like candy, soft drinks, juice drinks, cookies and ice cream, cause your body to release additional insulin, which can cause a low-blood-sugar rebound effect, sometimes resulting in fatigue and irritability, according to Dr. Taylor.

Focus on vitamin B₆. "I recommend that women take 500 milligrams of vitamin B₆ once a day for three days before their PMS symptoms usually start," says Dr. Mears. (Vitamin B₆ is toxic in high doses. Since this is several hundred times the daily requirement for this vitamin, you should take it for brief time periods only, and only under the supervision of your doctor.)

Other women find that far lower amounts of B₆--50 milligrams--are adequate. But even then, its use should be limited.

Nix the wake-up juice. Studies have shown that as little as one cup of coffee a day can increase the tension and anxiety symptoms of PMS. Even decaffeinated beverages can contain enough caffeine to stimulate symptoms in sensitive women.

To avoid withdrawal headaches (not unusual in coffee drinkers who try to quit), gradually replace caffeine by substituting decaffeinated versions of your favorite beverages--coffee, tea and cola--over a couple of weeks, recommends Dr. Taylor. Then, try to meet your fluid needs of 48 ounces a day with noncaffeinated beverages such as herbal teas, seltzer water or iced water with a slice of orange or lemon.

Light Therapy for Winter PMS

Do you find that your PMS symptoms seem to worsen in the winter? If so, a type of depression known as seasonal affective disorder (SAD) may be a problem for you, says Brenda Byrne, Ph.D., director of the Seasonal Affective Disorder Clinic at Jefferson Medical College of Thomas Jefferson University in Philadelphia.

"It's been said that over one-half of all menstruating women who have SAD have PMS-type symptoms," says Dr. Byrne. "Those affected may feel that their PMS symptoms become worse during the darker, shorter days of winter. If you have seasonal affective disorder and your symptoms respond to light therapy, there's a good chance that it will improve your PMS symptoms, too."

Using light therapy for PMS may be as easy as sitting in front of a light source for a few minutes every morning. (To learn more about light therapy for seasonal affective disorder and related problems, see page 210.)

Traditional Chinese Medicine Claims Success

"Premenstrual syndrome is easily treated with Chinese herbal formulas and acupuncture," says Christina Stemmler, M.D., a Houston physician who uses acupuncture and Traditional Chinese Medicine (TCM) in her practice and previously headed the American Academy of Medical Acupuncture. In fact, PMS is one of the easiest conditions to treat with Traditional Chinese Medicine, she says.

According to Dr. Stemmler, each woman's condition needs a different approach, which might combine acupuncture, Chinese herbs, dietary changes and massage. Other practitioners say that TCM is also excellent for menstrual cramps and excessive menstrual bleeding.

"There is no standard recipe for curing PMS because PMS is a very complex problem with hundreds of subtly different nuances," says Dr. Stemmler. (For details on finding a practitioner of Traditional Chinese Medicine, see page 284.)

CRAMPS: K.O. PERIODIC PAIN

Almost half of us feel some kind of monthly pain, and 5 to 10 percent of us have pain that downs us for anywhere from an hour to three days. "What happens during a painful period is like a mini­heart attack of the uterus, where blood to the uterine muscle gets cut off," says Veronica A. Ravnikar, M.D., director of the Reproductive, Endocrine and Infertility Unit and professor of obstetrics and gynecology in the Department of Obstetrics and Gynecology at the University of Massachusetts Medical Center in Worcester.

When hormones called prostaglandins are released during your period, the uterine blood vessels constrict and cause decreased blood flow to the area. As a result, the uterine muscle clenches tightly and is felt as a cramp. Happily, cramps may lessen after you're 30, and motherhood sometimes ends them, too.

Many of the world's natural-healing systems treat cramps successfully. Read on.

Hydrotherapy: Made-to-Order for Cramps

Therapeutic use of water is a simple time-tested treatment that works especially well for menstrual cramps. "The soothing effect of lying in a tub of hot water helps relax tense uterine muscles, so that's why it helps your cramps," says Irene von Estorff, M.D., assistant professor of rehabilitation medicine at New York Hospital­Cornell University Medical Center in New York City.

Make your own heating pad. "Instead of a nice hot tub, however, you could use another, more portable variation on hydrotherapy when you have cramps--a moist hot pack."

Making your own moist heating pad is simple, explains Dr. von Estorff: Dampen a terry cloth towel in hot (not boiling) water. Wring out the towel so that it's not dripping and place it over your crampy lower abdomen. Then lie still, relax and let the towel cool naturally. Repeat as necessary.

Chiropractic: An Eclectic Approach That Works

Some chiropractors find that spinal manipulation can help relieve menstrual cramps in much the same way that chiropractic relieves back pain. "Because the spinal nerves that go to the uterus and ovaries come from the lumbar spine, any untreated back problems can exacerbate cramping," says Dr. Mears.

Dr. Mears offers additional clues and solutions.

Keep a food diary. When a woman comes into Dr. Mears's office complaining of menstrual difficulties, she will probably be advised to start keeping a food diary.

"Menstrual difficulties are complex and can be associated with food allergies," asserts Dr. Mears. "I ask women to keep track of what they eat, the timing, frequency and social situation and how they feel after they've eaten. I also ask them to keep track of their bowel movements because constipation can contribute to cramps."

Stretch, walk, massage. One woman who consulted Dr. Mears complained of severe menstrual cramps that had not responded to heavier-than-recommended doses of ibuprofen, which the woman had been taking on her own.

"I gave her a new daily regimen consisting of daily stretching exercises and a brisk 20-minute walk in the park every day, and I started her on a special soup that I use to relieve constipation," says Dr. Mears. "I also saw her twice a week for chiropractic manipulations for her lower-back pain, and I taught her how to do self-massage for her abdomen and thigh muscles. It wasn't long before she was cramp-free for the first time in her life."

For the thigh, stroke along the inner thigh muscle for a few minutes. Do not press the muscle. Use your left hand to stroke your left thigh and your right hand to stroke your right thigh.

For the abdomen, lie on your back. Beginning on your right side, in the lower groin area, press in with the fingertips of both hands. Hold for two seconds and release. Follow this pressing and releasing pattern up your right side, across the top of your abdomen under the ribs and down your left side into the lower groin area. You are pressing in the form of an upside-down letter U. Continue this U pattern spiraling into smaller and smaller U's until you reach the center.

According to Dr. Mears, if you drink plenty of water and engage in physical activity, you'll banish your constipation--and your cramps.

Exercise to Exorcise Cramps

Add menstrual cramps to the long list of ailments alleviated by exercise. "If you can relax the pelvic area and increase the blood flow to the muscles, you'll decrease pain and cramping," says Dr. Ravnikar.

And, since exercise boosts endorphins, your body's natural painkillers, working out (or just walking) might ease your cramps, suggests Christine Wells, Ph.D., professor of exercise science and physical education at Arizona State University in Tempe and author of Women, Sport and Performance.

Start out easy. For the first 15 minutes of your workout, take it easy, says Dr. Wells. Then, if you're up to it, pick up the pace. When you're crampy, don't add unfamiliar exercises or heavier-than-normal weights to your routine and avoid heavy lifting that stresses your abs, she says. Save crunches and other belly-buster activities till later in the week.

Stretch Like a Yogi

Your lower back and thighs may ache when cramps stimulate nerves that supply these areas, says Dr. Ravnikar. Stretching yoga-style can help.

Sit up straight with both of your legs touching and stretched out in front of you. Bend your right leg, bringing your foot to your inner left thigh. Place a folded blanket on top of your extended leg. Inhale. Push into the floor with your hands to lift your chest and lengthen your spine upward as you twist your torso so that your breastbone comes directly over your extended leg. As you exhale, bend forward from the hips, keeping your back straight. Do not hunch your spine. Rest your chest forward on the blanket. Stay stretched like this for two to three minutes. Repeat the stretch on the other side.

Herbal Remedies for Cramps

According to herbalists, Mother Nature's own remedies are ideally suited to easing the pain of menstrual cramps. Herbalists often recommend the following three herbs.

Raspberry leaves. "Raspberry leaves contain fragrine, a specific constituent that tones the uterus and helps ease cramping," says Kathleen Maier, a physician's assistant, herbalist and director of Dreamtime Center for Herbal Studies in Flint Hill, Virginia, and former adviser on botanical medicine to the National Institutes of Health in Bethesda, Maryland. Maier recommends brewing a strong cup or two of raspberry-leaf tea (Rubus idaeus), available at most health food stores, for cramp relief.

Motherwort. "When you want a good mother herb, motherwort's wonderful," says Maier. "I use 10 to 15 drops of motherwort (Leonurus cardiaca) tincture for menstrual cramps at midcycle, or ovulation time, taken daily till bleeding starts. Some women may notice that their periods are heavier during the first month they use it because motherwort relaxes the uterine muscle and thereby releases more of the uterine lining. But with consistent use, bleeding levels off. Most women see a noticeable improvement in their cramps after one month, but I'd say that, generally, it takes three to four cycles to establish a difference."

Black cohosh. "Black cohosh is an antispasmodic--it quells muscle spasms, especially in the uterus," says Maier. "It relaxes the uterus and decreases cramps. But I use it in general relaxation formulas when there's also shoulder tension." The botanical name is Cimicifuga racemosa.

HEAVY BLEEDING: VITAMINS THAT HELP

An occasional change in your monthly flow is perfectly normal, say experts, and may be due to a lifestyle change. If you're bleeding more heavily than normal, ask yourself what's new or different: Have you started a new exercise program? Taken a new job? Moved into a new home?

Age could be a factor: Your uterus keeps growing until you're around age 35, so there's more uterine lining to bleed. Approaching menopause can also mean having unpredictable, heavy periods. Experts say that you should pay attention to your cycle and know what's normal for you and be certain to get examined annually. Recording when your period stops and starts and whether you bleed heavily or lightly is also smart.

If bleeding or pain seem unusually heavy for you, or if you miss a period, consult your physician, advises Margaret M. Polaneczky, M.D., medical director of women's health and assistant professor of obstetrics and gynecology at New York Hospital­Cornell University Medical Center.

If your physician has ruled out possible underlying medical causes for your heavy bleeding, these suggestions may ease the problem.

Pump some iron. Inadequate iron intake may cause excessive bleeding, according to Linda Ojeda, Ph.D., author of Menopause without Medicine. And excessive bleeding, in turn, can lead to iron-deficiency anemia, which can cause fatigue. So Dr. Ojeda and others recommend that women with heavy periods eat iron-rich foods to prevent iron deficiency.

The most efficiently absorbed iron, called heme iron, is supplied by foods such as red meat, liver, egg yolks and fish. If you're watching your intake of fat and cholesterol, a multivitamin/ mineral supplement with iron is a sound alternative, she says. Vegetarians who get nonheme iron from grains, beans and dried fruit must also take vitamin C to enhance absorption, says Dr. Ojeda.

Bolster your bioflavonoid intake. What's a bioflavonoid? This nutrient, also called vitamin P, is found in grape skins, cherries, blackberries and blueberries as well as in citrus fruits, especially in the pulp and white rind. Both bioflavonoids and vitamin C can reduce excessive bleeding by strengthening capillary walls. Since it's not easy to get the 500 milligrams a day of bioflavonoids that experts recommend, some suggest taking supplements. You might also add 1,000 milligrams of vitamin C in divided doses, says Susan Lark, M.D., in her book The Estrogen Decision Self-Help Book. (Note, however, that excess vitamin C may cause diarrhea in some people.) In her book, Dr. Lark recommends both vitamin C and bioflavonoid supplements for heavy menstrual bleeding. Take the supplements at the same time. They are available at drugstores and health food stores.

Look to the Garden

Your herb garden (or your health food store) has a number of options for treating irregular periods. Try these, all recommended by Susun S. Weed, herbalist and teacher from Woodstock, New York, and author of the Wise Woman herbal series.

Raspberry-leaf infusion. A cup a day (or more) acts as a tonic for the ovaries and the uterus, according to herbal medical lore. To make the infusion, add dried raspberry leaves to a quart of boiling water, then remove it from the heat and let it sit overnight.

Vitex tincture. Vitex (Vitex agnus-castus) has long been used in European herbal medicine. It is believed to inhibit the secretion of the peptide hormone prolactin by the pituitary gland. For irregular menstrual periods, take a dropperful two to three times a day in a small glass of water for six to eight weeks, after every irregular period. For heavy bleeding or flooding, take 25 drops several times daily for several months.

Lady's-mantle. In tincture form, clinical tests show that lady's-mantle (Alchemilla vulgaris) can control heavy menstrual bleeding or flooding in virtually all of the 300 or so women who participated in a study, says Weed. When taken after heavy bleeding began, lady's-mantle took three to five days to be effective. When taken one to two weeks before menstruation, lady's-mantle prevented heavy bleeding. Weed recommends taking five to ten drops of the fresh plant tincture three times daily for up to two weeks out of the month.

Cramp bark and valerian. "Heavy bleeding accompanied by nasty cramps responds well to a blend of two parts cramp bark tincture mixed with one part valerian tincture," says Rosemary Gladstar, herbalist and author of Herbal Healing for Women. The botanical name for cramp bark is Viburnum opulus, and for valerian, Valeriana officinalis.