Q & A: Severe Premenstrual Syndrome Treatment

Expert answers to your health questions

| January/February 2005

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.

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