Stabilising blood sugar will favour consistent energy levels and moods according to dietitian Melanie McGrice (melaniemcgrice.com.au). “Grains that have a low glycaemic index, which means that they provide longer-lasting energy, can also help to increase the hormone serotonin in the brain, so try some chickpeas, brown rice or quinoa,” says McGrice.
According to accredited practising dietitian Lisa Yates, some studies show that PMS may be exacerbated by too much caffeine, sugar and alcohol. To minimise symptoms, she suggests that you reduce your alcohol, caffeine and salt intake, and follow a low-GI diet.
Professor Kulkarni says supplements such as evening primrose oil can be effective for relieving PMS symptoms and favours these as a primary intervention before resorting to the contraceptive pill. “The two supplements I suggest are vitamin B6 and evening primrose oil, which has healthy essential fatty acids. Both supplements have been shown in studies to help alleviate some symptoms in women with PMS and many women benefit from them,” Prof Kulkarni says. A study published in 2010 found that the combination of magnesium and vitamin B6 was particularly helpful for decreasing PMS symptoms. “Nuts are rich in both magnesium and B6, so I’d recommend taking 30 g unsalted nuts daily in the week prior to your period,” says McGrice.
Correcting iron deficiency may also ease syptoms as women who consume insufficient iron are at higher risk of suffering PMS according to University of Massachusetts research. Women with higher non-heme iron, which comes from plant sources, are 30 to 40 per cent less likely to experience PMS. This is possibly because low iron affects levels of serotonin, the hormone that elevates mood. Good sources of non-heme iron include silverbeet and spinach, broccoli, bok choy, soybeans and lentils.
4. The Pill
Contraceptive pills can help ameliorate symptoms of severe PMS and PMDD, but not all pills are equally effective. “Women should not take older-style progesterone pills as these can actually contribute to emotions like anger and depression,” warns Prof Kulkarni. “Some of the newer varieties of pill such as Zoely, Diane and Juliet can be very beneficial.”
To establish a more stable hormonal pattern, women may take the pill with the active hormones for three cycles then go on to a sugar pill for one week only, so that within a three-month cycle they only have one week of bleeding.
5. Hormone therapy
The next line of defence is hormone therapy according to Prof Kulkarni. Oestrogen patches or oestradiol patches and progesterone can cause a kind of hormone detour. “For some women who are very sensitive to hormones, another alternative is to deliver the progesterone via the Mirena IUD, which is placed in the uterus. This allows the hormones to go directly into the surrounding organs rather than passing through the bloodstream first, where it may cause more side effects,” Prof Kulkarni says.
For women who feel their lives are hijacked by hormones every month, antidepressants can provide enormous relief. “The antidepressants stabilise the level of hormones like serotonin, so some women with PMS or PMDD no longer experience those huge mood swings from hormonal fluctuations,” says Davison.
A new approach to this treatment is to take the antidepressant intermittently. “It may be taken for one week or 10 days of each month when symptoms occur,” says Prof Kulkarni. “To ensure the dose and type of antidepressant suits your system, speak to your GP about having a blood test or swab to get background on your metabolic system and guide the choice of antidepressant.”
If antidepressants are not effective, women who suffer severe symptoms of PMS may then choose to undergo a ‘chemical menopause’, where strong hormones are used to stop ovulation and give women a break from the terrible hormonal and mood swings. “This approach sometimes needs to be permanent but can also have a kind of resetting effect on the brain,” Prof Kulkarni explains. “If women choose to come off the hormones, their impact is usually reversible and even when no longer on the therapy, the hormonal-related moods swings may be greatly reduced.”