Mother Earth Living

Q & A: Severe Premenstrual Syndrome Treatment

Expert answers to your health questions
By Kathi Keville and Karta Purkh Singh Khalsa
January/February 2005
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Evening primrose is one of the best herbs for pms symptoms.


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I suffer from extreme PMS. My doctor has placed me on 100 mg of Zoloft for the past two to three years. My symptoms start at least two weeks before I start my period and include depression, emotional upset, inability to sleep or rest well, weight gain, constant sweet and salt cravings, mood swings and PMS migraines, for which I have Imitrex injections and inhalers. I’d love to get off of Zoloft, but if I miss a dose I have heart palpitations, get head rushes and numbness and tingling in different areas of my body. I have tried feverfew, evening primrose oil, omega-3 fatty acids and vitamin B6. I am open to any suggestions.
—K.S., Campobello, South Carolina 

Keville responds: Because your symptoms are cyclic, it seems that you experience classic premenstrual syndrome. Due to the seriousness of the symptoms you describe, my first suggestion is to seek out a natural practitioner with whom you can work. It sounds like missing doses of the antidepressant is giving you withdrawal symptoms. I hear complaints about this from many people who try to get off antidepressant drugs. A skilled practitioner who has experience with antidepressants can help you choose which herbs, such as St. John’s wort (Hypericum perforatum), to take and help you regulate the dosage as you wean off Zoloft. Because of the depression and heart palpitations you experience, you should not attempt this on your own. Acupuncture and exercise would be good adjunct therapies. Here are a few suggestions to get you started.

You were on the right track with the herbs and vitamin B6 you selected, but you may not have been taking enough. Some women need to start with at least six of the 500-mg capsules a day of evening primrose oil (Oenothera biennis). You also may not have taken it long enough. It typically takes three menstrual cycles for herbs to have much of an effect on PMS. Try not to eat fried foods — and this includes “health foods” — because they hinder the body’s metabolism of essential fatty acids.

Vitex (Vitex agnus-castus), also known as chaste tree, is one of my favorite herbs to treat PMS. It helps relieve the symptoms, apparently by rebalancing hormones. It is especially useful for treating fluid retention, breast tenderness, mood swings and food cravings. A number of new clinical trials support the herbal extract as an effective remedy for reducing the woes of PMS.

Asian ginseng (Panax ginseng) can adjust blood sugar levels and reduce food cravings, and also seems to help regulate the brain chemistry that is tied in with depression. The herbal sweetener stevia (Stevia rebaudiana) is another blood sugar regulator that can be used in place of sweeteners like sugar and honey, which disrupt blood sugar levels. Stevia is available in powder and liquid forms, or you can buy the dried leaf to sweeten your herbal teas.

Two relaxing herbs for promoting sleep and calming heart palpitations are hops (Humulus lupulus) and valerian root (Valeriana officinalis). A pleasant tea to drink throughout the day can be made with equal parts of linden flower (Tilia europaea), passionflower (Passiflora incarnata) and chamomile flower (Matricaria recutita). It won’t make you too sleepy but will quiet down the anxiety and jitters that often accompany PMS.

I prefer taking herbs rather than nutritional supplements, but for more severe PMS like yours, supplements can really help. Vitamins B6 and E team up with magnesium to lower the levels of the hormone prolactin, which seems to be the source of many PMS-related problems. In several studies, in which PMS sufferers took vitamin E alone for two to three months, their depression, irritability, headaches, bloating and sweet cravings all decreased. A well-balanced B-complex may be better for long-term use than taking vitamin B6 alone.

Also, if you live in a northern climate or spend a lot of time indoors, you might try getting out more and see if that helps lessen the migraines. Despite all the warnings to avoid sunlight, getting mild sun exposure is a natural way to boost vitamin D.

Khalsa responds: There’s no doubt that PMS can be very miserable, and it sounds like you know firsthand! There are as many varieties of PMS as there are women, so it’s best to follow an individualized treatment. That said, many natural medicines can work wonders.

I’m concerned about your comments about getting off Zoloft. While I applaud your interest, use appropriate caution. This antidepressant drug is a Selective Serotonin Reuptake Inhibitor (SSRI). SSRIs are not thought to be addictive, per se; however, discontinuing their use is known to produce physical and psychological withdrawal symptoms, a condition known as SSRI discontinuation syndrome.

This syndrome is a real concern for people taking SSRIs. Symptoms may include anxiety, numbness and tingling, strange dreams, agitation, depression and flu-like symptoms. The symptoms are ultimately not dangerous — they eventually go away on their own, but they are uncomfortable while they are happening. I have spoken with patients who found it difficult to discontinue an SSRI due to the unpleasant symptoms, and who had to decrease the dose extremely slowly. Consult your physician.

Chinese herbal formulas designed to regulate the menstrual cycle or treat PMS almost always center on bupleurum (Bupleurum chinense), which is said to relieve blood stagnation in the liver. In women, liver stagnation can cause menstrual cramps, breast swelling, irregular menstrual flow, irritability and food cravings. Bupleurum is relaxing, so it can be helpful for PMS with anxiety and irritability. Its liver-supportive qualities also help reduce sugar cravings, a common PMS symptom. Start taking the herb in capsules as soon as the symptoms begin. The dose immediately before your period begins might be around 8 grams per day.

My personal favorite herb for PMS is blue cohosh root (Caulophyllum thalictroides), which gets results in many cases. Increase the dose gradually as needed, to a high of perhaps 5 grams per day, if necessary. Use caution, because it can make you queasy if you increase the dose too fast. I like to use it in combination with wild yam root (Dioscorea villosa) for inflammation and fo-ti (Polygonum multiflorum) for long-term hormonal balancing.

Many of your symptoms hint at magnesium deficiency. In my experience, upping magnesium is about the best thing you can do for chronic migraine, and it is excellent for PMS in general. Take the mineral at just less than the dose that loosens the bowels (about 1,200 mg daily for most people).


Kathi Keville is the director of the American Herb Association and author of 11 herb and aromatherapy books, including Herbs for Health and Healing (Rodale, 1996). She teaches seminars throughout the United States.

Karta Purkh Singh Khalsa has more than 25 years of experience with medicinal herbs. A licensed dietitian/nutritionist, massage therapist and board member of the American Herbalists Guild, he specializes in Ayurvedic, Chinese and North American healing traditions.

The information offered in “Q & A” is not intended to be a substitute for advice from your health-care provider.


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