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PMS treatment through the use of CAM.

A New Approach to PMS Treatment Through the Use of CAM

It is common knowledge that pre-menstrual syndrome (PMS) largely affects the daily life of many women; however not until recently has it been recognized as a medical condition. While official recognition is welcomed, women have intuitively known this real phenomenon for years and sought and shared information regarding relief of symptoms. Premenstrual symptoms are common in women of reproductive age with an estimated 30% of women bothered by premenstrually experienced symptoms (Tschudin, Bertea, & Zemp, 2010). Symptoms of PMS are reported to affect up to 90% of menstruating women, and two to five percent of women experience the most severe symptoms (Dog, 2009). Although symptoms of PMS vary from mild to severe, many women seek methods to alleviate them.

Childbirth educators, who have close contact with women, are ideally positioned to offer education to women regarding issues surrounding their reproductive systems. With the recognition of PMS as a medical condition, traditional medicine now offers more options; however, alternative methods remain of great interest to many. Typical traditional methods to alleviate PMS symptoms include non-steroidal anti-inflammatory drugs (e.g. ibuprofen or naproxen), antidepressants, diuretics, and medicines that stop ovulation (e.g. birth control pills) and stabilize hormonal swings (Mayo Clinic, 2012).

These traditional methods are widely known, however, there is increasing evidence to support the use of complementary and alternative medicine (CAM). Due to the varied symptoms associated with PMS, multiple treatment options are needed to meet individual needs. Effective methods of CAM include altering one's diet, and utilizing herbal supplements such as Cramp Bark, Ginkgo biloba, and Chaste Tree extract. As more women consider the use of CAM, it is important to provide information on the potential effectiveness and safety of these remedies. The purpose of this article is to familiarize health care providers and support persons on the various uses of complementary and alternative medicine (CAM) for the relief of symptoms associated with PMS.

Overview of PMS

As defined by Canning, Dye, and Waterman (2009) PMS is a cyclic condition occurring seven to ten days before the onset of menstruation and is relieved shortly after menstrual flow begins. There are over 150 symptoms associated with PMS (Loch, Selle, & Boblitz, 2000). Research conducted by Freeman et al., (2011) identified six core daily-recorded symptoms that were statistically significant predictors of PMS to include: changes in appetite and food cravings, decreased interest in activities, mood swings, cramps, aches, and increased anxiety/tension. The most severe symptoms may interrupt multiple areas of life, including work, school, family life and sexual relations.

Frequently Reported Symptoms of PMS:

Emotional disturbances:

* Irritability

* Crying spells

* Anxiety & stress

* Depression & confusion

* Frequent & unexplained anger

* Lack of focus and attention

* Sleep disturbance

* Food cravings and increased thirst

Physical symptoms:

* Pain in the breasts

* Itching of the breasts

* Headache

* Swelling of the hands

* Swelling of the feet

* Joint and muscle ache

* Bloating

* Weight gain

Complementary and Alternative Methods

Manipulating diet and routine exercise are the easiest and most inexpensive ways to treat PMS. Diet and exercise also allow individuals to actively participate in their treatment plan, which can lead to more positive results. Women suffering from PMS tend to have a diet high in refined sugars and carbohydrates and low in B vitamins and many minerals. Dietary changes can greatly improve some of the symptoms of PMS. Bussell (1998) points out that woman can help control bloating and breast tenderness by simply increasing fluid intake and decreasing sodium intake. In general, recommendations to offer include: to limit or avoid junk foods, sweets, cakes, chocolates, honey, sugar in tea and coffee and refined flour products. Alcohol, red meat, and foods fried in saturated fats have also been implicated and avoidance may improve symptoms in some women.

Caffeine is a known stimulant; and the use of caffeine has been associated with PMS symptoms of irritability, tension, and headaches. By decreasing caffeine consumption, PMS symptoms may be greatly reduced. Coffee, a highly caffeinated beverage, contributes to breast tenderness; this symptom will also benefit from limiting caffeine (Bussell, 1998).

Vitamin B also plays a key role in controlling PMS symptoms. Bussell (1998) identifies vitamin B6 as the central B vitamin needed, however, all of the B vitamins are recommended for inclusion in the diet. Bussell (1998) explains that the B vitamins affect the formation of dopamine and the use of magnesium in the body: Vitamin B6 helps is in the formation of dopamine, and when dopamine levels are adequate, mood swings related to PMS are reduced. In addition to mood swings, vitamin B6 is also known to reduce depression, irritability, breast tenderness, headaches, and bloating in some women. Adequate levels of vitamin B6 increase cell membrane transfer and the use of magnesium that may also improve mood swings and decrease menstrual migraines (Bussell, 1998). While increasing the intake of B vitamins is generally safe, patients taking more than 250 mg of B6 may experience adverse effects of paresthesia (burning, tingling or pin pricking) of hands and feet; should this occur the intake should be decreased (Cerrato, 1988).

Calcium intake has been linked to improvement in PMS symptoms, and when taken with vitamin D may provide significant relief. Similar to the reduction of the same symptoms as vitamin B6, calcium may also alleviate pain and further reduce water retention and bloating. An additional benefit of adding calcium and vitamin D to women's diet is the beneficial effect on bone and potential prevention of osteoporosis. While dietary changes are believed to be effective, they do require about three months to significantly decrease PMS symptoms; so tenacity on the patient's part is a must. Educating women about the health benefits as well as the potential relief of PMS symptoms through dietary changes and supplements may lead to improved overall health.

In addition to these dietary changes, it may be beneficial to incorporate herbal therapies into the patient's daily regimen. Herbal supplements may be attractive to users due to common perceptions that there are few or no side effects. A variety of herbs are available to treat multiple PMS symptoms. Individuals may choose from several herbs to tailor a personalized treatment plan. Three of the most promising herbal supplements trending currently are cramp bark, ginkgo biloba, and chaste tree berry.

Cramp Bark

Viburnum Opulus, commonly referred to as cramp bark, is a plant native to Europe, Northern Africa, and Northern Asia. The key elements in the bark are hydroquinones (arbutin), Coumarins (scopoletin), tannins, and resin (Think Natural Limited, 2011). As the name implies, the bark gathered from the plant has been used to relieve cramps associated with PMS (Locklear, 2008). The antispasmodic effects of cramp bark prevents the painful cramping which often accompanies PMS. Cramp bark relaxes smooth muscle in the uterus and ovaries. This relaxation prevents spasms of the pelvic area. This treatment is effective before and during menstruation (Hobbs, 1998). The spasms which typically occur during the premenstrual syndrome cause the muscles to become fatigued from the constant contraction, this results in pain.

The bark from the branches is gathered when the plant is flowering, usually during spring and summer (Think Natural Limited, 2011). Once gathered, the bark is made into a tincture or tea. These forms of the herb can typically be found at a local health food store. This mixture can be taken every few hours until the cramping is alleviated (Hobbs, 1998). As well as being taken internally, cramp bark can be used as a topical treatment for muscle cramps as well (Think Natural Limited, 2011).

Ginkgo Biloba

Among several herbal remedies is ginkgo biloba which is an indigenous plant of China and used in Traditional Chinese Medicine for over 1000 years. The seeds and leaves are more commonly utilized and the effective ingredients are flavonoid glycoside and terpene lactone. Ginkgo biloba has been commonly used for impaired memory and age-related dementia. However, in recent years ginkgo biloba has been linked to reducing premenstrual syndrome symptoms. Ginkgo has been tested and proven to reduce the severity of physical and psychological symptoms of PMS. For example, in a recent study in Tehran the overall symptoms of PMS decreased from 34.80% to 11.11% (Ozgoli, Selselei, Mojab, & Majd, 2009). In a study by Tamborini and Taurelle, it was found that gingko biloba benefits congestive PMS symptoms, in particular breast tenderness (Canning, Waterman, & Dye, 2008). In the Tehran study side effects were extremely minimal. One out of 40 participants experienced nausea and two experienced an increased desire for sleep. Education should include that ginkgo biloba may increase the anticoagulant effects of aspirin and anticoagulant medications and present a risk for abnormal or excessive bleeding. This herb also hinders monoamine oxidase inhibitors, therefore this should not be used by persons taking antidepressants. Ginkgo biloba is not recommended for women who are pregnant.

Ginkgo biloba is not recommended for women who are pregnant.

So how does ginkgo biloba reduce PMS symptoms? Ginkgo biloba is thought to decrease PMS symptoms by controlling the balance of prostacyclines; which is connected to the relief of congestive symptoms such as breast tenderness, abdominal bloating, and edema. Ginkgo improves mood and symptoms of depression by increasing the release of catecholamines and other neurotransmitters, and also by inhibiting the re-uptake of these substances. Ginkgo is known as a stress modulator and an anxiolytic. It is reported to effectively decrease PMS symptoms such as labile mood, tension, irritability, and anxiety (Ozgoli, Selselei, Mojab, & Majd, 2009). Ginkgo biloba may be very effective for some women who desire to reduce the severity of PMS symptoms and generally has a low occurrence of side effects. Education is needed particularly regarding ginkgo biloba because most individuals associate it with improving memory, not with PMS relief.

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Chaste Tree Berry

Chaste tree berries are becoming increasingly popular for the treatment of PMS symptoms, in addition to other ailments. For consumers who are not familiar with Chaste Tree, it is a deciduous shrub with slender leaves and purple-black berries. Chaste trees grow natively in Europe, Central Asia, and the Mediterranean. It is within the berries where the medicinal value lies. The berries contain many healthful components, but specifically, it is the flavonoids (casticin, quercetagerin, isovitexin) that target estrogen receptors. In addition, diterpenes and glycosides are found within the berries, and in vitro they have been shown to exhibit dopaminergic activity and have an indirect effect on hormones ("Vitex agnus-castus", 2009).

Some research indicates that patients receiving 20 mg chaste berry extract daily showed significant improvement in irritability, mood alteration, breast fullness, headache, and anger. Chaste tree is believed to produce these positive effects by reducing prolactin, increasing progesterone, and binding opioid receptors. The binding effect on opioid receptors and its relationship with endorphin levels minimizes the typical symptoms of PMS, such as anxiety, food cravings, and physical discomfort (Dog, 2009). According to Abascal and Yarnell (2008), Chaste tree improves mood in PMS and in one study, was as effective as fluoxetine in patients with premenstrual dysphoric disorder

Perhaps the greatest therapeutic benefit is that symptoms can be treated with little or no side effects. Nausea, acne, and gastrointestinal complaints are the only identified adverse effects experienced while on a chaste tree regimen for longer than five months ("Vitex agnus-castus", 2009). At recommended dosages, Chaste tree extract remains moderately to highly effective and is considered safe. So safe in fact, that the German Commission E has approved the use of Chaste tree extract in their country, for the treatment of PMS, cyclical mastalgia, and menstrual irregularity. There is still a great need for more research and investigation into the safety and effectiveness of this or any herbal regimen. It is recommended that any female who is pregnant or is thinking about becoming pregnant, should avoid chaste tree until more studies can be done.

There are a number of ways to incorporate chaste tree into a PMS treatment plan. The German Commission E recommends 30-40 mg of dried fruit extract daily or 40 drops of tincture. Dried berries can be found at health food stores and the extract can also be found in a convenient pill form. Another recommended preparation is one teaspoon of berries steeped in one cup of water three times daily (Dog, 2009). Most studies suggest that the most promising results are yielded after five to six months use and longer.

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Conclusion

This paper has reviewed some alternatives to traditional medicine for the relief of symptoms associated with premenstrual syndrome. Pre-menstrual syndrome has been recognized as a legitimate health concern and CAM treatment options are increasingly being explored, researched, and used for PMS. While traditional medicine offers some effective strategies, many women may be interested in alternatives methods that offer few side effects. Healthcare providers and support persons should be familiar with a variety of treatments and be able to provide basic education on the different alternative treatments as well as the traditional ones. Considering the benefits associated with utilizing CAM in PMS treatment, an increasing number of women may seek advice on what to use and how to use it safely. Women often make health care decisions for themselves, and their families and it is important to provide them with accurate information. Current trends support a growing interest in CAM because it offers a holistic approach to their treatment plan, while allowing them to maintain control. Further research is needed but CAM can potentially provide safe, effective, and holistic approaches to treating PMS.

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References

Abascal, K., & Yarnell, E. (2008). Botanical galactagogues. Alternative & Complementary Therapies, '4(6), 288-294.

Bussell, G. (1998). Pre-menstrual syndrome and diet. Journal of Nutritional & Environmental Medicine, 8(1), 65-75.

Canning, S., Waterman, M., & Dye, L. (2006). Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy. Journal of Reproductive & Infant Psychology, 24(4), 363-378.

Cerrato, P. (1988). Dietary help for PMS patients. RN, 51(1), 69-70.

Dog, T. (2009). Chaste tree extract in women's health: a critical review. Alternative & Complementary Therapies, '5(3), 119-125.

Freeman, E., Halberstadt, S., Rickels, K., Legler, J., Lin, H., & Sammel, M. (2011). Core symptoms that discriminate premenstrual syndrome. Journal of Women's Health (15409996), 20(1), 29-35. doi:10.1089/jwh.2010.2161

Hobbs, C. (1998). Herbs for PMS. The Virtual Herbal. Retrieved from http:// www.christopherhobbs.com/index.html

Locklear, T. D. (2008). Biologically active compounds from justicia pectoralis: Significance for the treatment of dysmenorrhea. University of Illinois at Chicago, Health Sciences Center. ProQuest Dissertations and Theses, Retrieved from http://ezproxy.mtsu.edu/login?url=http://search.proquest.com/docvie w/304334677?accountid=4886

Mayo Clinic. (2012). Premenstrual Syndrome (PMS). Retrieved from http://www.mayoclinic.com/health/premenstrual-syndrome/DS00134/ DSECTION=treatments-and-drugs#

Ozgoli, G., Selselei, E., Mojab, F., & Majd, H. (2009). A randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of premenstrual syndrome. Journal of Alternative & Complementary Medicine, '5(8), 845-851. doi:10.1089/acm.2008.0493

Think Natural Limited. (2011). Key Medicinal Plants: Cramp Bark. Retrieved from http://www.thinknatural.com/articles.php?id=10120

Tschudin, S., Bertea, P., & Zemp, E. (2010). Prevalence and predictors of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample. Archives of Women's Mental Health, '3(6), 485-494. doi:10.1007/s00737-010-0165-3

Vitex agnus-castus--monograph. (2009). Alternative Medicine Review, 14(1), 67-71.

by Beth A. Kloss, Lisa A. Marcom, Ann M. Odom, Courtney L. Tuggle, and Deborah Weatherspoon, MSN RN CRNA

Beth A. Kloss is a senior BSN student attending Middle Tennessee State University. Her work experience includes patient care and she is a lactation technician.

Lisa Marcrom is a senior nursing student pursing her BSN at Middle Tennessee State University. Her work experience includes direct patient care in a rehabilitation facility.

McCain Odom a senior nursing student pursing her BSN at Middle Tennessee State University.

Courtney Tuggle is a senior nursing student pursing her BSN at Middle Tennessee State University. She currently works as a medical assistant.

Deborah Weatherspoon is a RN and a CRNA with 35 years of nursing experience in a variety of clinical settings and specialties. She is an assistant professor and teaches nursing courses at Middle TN State University.
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Title Annotation:pre-menstrual syndrome
Author:Kloss, Beth A.; Marcom, Lisa A.; Odom, Ann M.; Tuggle, Courtney L.; Weatherspoon, Deborah
Publication:International Journal of Childbirth Education
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2012
Words:2683
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