Is it that time of the month again? Elizabeth Pavka explores natural approaches to PMS.

Is it that time of the month again?" Have you heard that question asked of you? Have you asked that question of another woman? If so, you know that many women--estimates range from 30%-70%--experience symptoms that cycle with their menstrual cycle. PMS is defined as those symptoms that occur only between ovulation and menstruation, between day fourteen and the onset of the menstrual flow. The problems usually get worse with age, high levels of stress, after starting birth control pills, after having children, and after having a tubal ligation. In her book Dr. Susan Larks' PMS Self-Help Book, Dr. Lark lists more than 150 symptoms of PMS. Lark places 25 of the most common symptoms into the following six categories:

PMS-Type A: anxiety, nervous tension, mood swings, irritability.

PMS-Type C: craving for sweets, increased appetite, headaches, pounding heart, fatigue, tremulousness (internal or external shakiness).

PMS-Type D: depression, forgetfulness, crying, sleeplessness.

PMS-Type H: weight gain (heavy), swelling of extremities, breast tenderness, abdominal bloating.

PMS-S: skin changes such as oily skin, oily hair, pimples.

Dysmenorrhea: low abdominal cramps, general backache, general aches and pains, nausea and vomiting 

Charting your symptoms for a month or two--according to presence, severity, and duration--will help you see if they are directly related to your menstrual cycle. (To receive a PMS symptom calendar, see bio at end of article.)

Complex interrelationships among the pituitary, ovaries, adrenals, thyroid, parathyroid, and pancreas glands orchestrate the truly amazing series of events that produces the female menstrual cycle. Small changes or shifts in balances can create many problems, including PMS. The primary imbalance in women with PMS is elevated estrogen and reduced progesterone during the 5-10 days before the menstrual flow begins. In addition, some women have lowered thyroid hormone levels and elevated prolactin levels which add to the problem.

The ability to rebalance your body into a better level of functioning and feeling rests squarely in your own hands. Here are some of the changes you can make to feel better all month long.

First, make changes in your eating pattern. This is essential to any long-term improvement. Reduce sugar and carbohydrate consumption. If, during PMS time, you know that you will crave sweets or chocolate at 4 PM (that's related to an unstable blood sugar), then snack on a cut up apple with almond butter at 3:30PM. By the way, chocolate cravings often indicates a need for more magnesium (more information below).

Eat more whole foods, more fruits and vegetables, at least five servings a day. Fruits and vegetables provide essential vitamins and minerals to feed and nourish the endocrine system. They provide dietary fiber, which improves bowel function, and that, in turn, increases the speed at which the liver breaks down more estrogen for elimination. Improving liver function is another key approach to rebalancing PMS.

Eat fewer PMS-promoting fats like French fries, potato chips, and ice cream. Eat more anti-PMS fats including olive oil, flax seed oil, as well as walnuts, pecans, and almonds. If you tolerate diary products, eat yogurt containing active cultures to maintain a health-promoting balance of the "good" bacteria in the bowel. "If you don't handle dairy well (it can be a factor in PMS-Type H), then supplement with a non-dairy based probiotic containing 1-10 billion viable bacteria per capsule. Ample levels of these bacteria are essential for optimal functioning of the bowel.

Various nutrients are essential to reduce PMS complaints. General recommendations are: 1) 50 mg of B-6 daily in addition to a full B-complex; 2) 200-400 mg of magnesium daily; (3) 400 IU of vitamin E as d-alpha tocopherol, not dl-alpha tocopherol; and 4) 1-2 tablespoons flax seed, preferably fresh ground, or as an oil. These recommendations are a one-size-fits-all pattern. Supplements customized for the individual, based on testing you can do in the privacy of your own home or the advice of a health practitioner, are the best way to support a healthier body.

Several herbs also help rebalance the female endocrine system, including angelica (dong quai), licorice root, black cohosh, and chasteberries. For more information, read Encyclopedia of Natural Medicine by Michael Murray and Joseph Pizzorno, 1998.

Regular exercise is key to reducing PMS. Exercise reduces stress, which is a big piece of PMS, raises endorphin levels (the "feel-good" hormone), and increases circulation all over the body. Develop a better coping style for stress, perhaps with the aid of a psychotherapist. Take time for yourself during those two weeks. Many women experience heightened creativity and receptivity, which is nurtured by quiet and solitude.

In closing, here are two additional observations. At a recent health fair, two high school students asked me whether they could have PMS. Their physician told them that they were too young. I said, "Of course you can. Some young women experience cramps with their first cycle. Many teens experience PMS. Start now to make changes, and you don't have to experience PMS anymore."

Some women assume that, if they can just "hang in there" until they start menopause, then their PMS symptoms will disappear. On the contrary, I believe that unresolved PMS problems flow right into menopause and create problems at that phase of a woman's life. So take the necessary steps now to reduce PMS. You'll have an easier mid-life transition through menopause as well.

You, personally, control your experience with PMS. By making changes, you can rebalance yourself into better health. Real power resides there.

Elizabeth Pavka, PhD, LN, wellness consultant, offers individual counseling, writes, and teaches lay and professional audiences. Her office is located at the Asheville Wellness Center, 25 Orange Street, Asheville, NC 28801; phone [phone]. To receive a PMS symptom calendar, send a stamped, self-addressed envelope to the address given.