Introduction
PMS or premenstrual syndrome is a common condition that causes a great deal of distress to women 7 to 10 days prior to their period. There are symptoms of fluid retention, mood swings, stress and anxiety, premenstrual depression, headaches and painful swollen breasts.
With PMS progesterone seems to be metabolized in a subtle different way thus causing the above symptoms (Ref.1, p.1932). When the menstrual period starts, the premenstrual symptoms usually disappear within hours because of the hormonal switch. Some women are plagued by dysmenorrhea with painful menstrual periods. This is common in teenagers, but normalizes often in the early twenties. Dr. Lee et al. (Ref.24) explains that cortisol is often increased in patients with PMS due to increased stress. High cortisol levels reduce progesterone production and also compete with common hormone receptor sites between the two hormones (cortisol and progesterone). The end result is that higher than usual progesterone cream dosages are required for treatment of PMS.
PMS treatment
PMS is partially responding to a nutritional changes and nutritional counseling with a view of changing to the zone diet plan
(Ref. 2) would be a good first step. With well balanced intake of protein and a reduction or elimination of sugar hyperinsulinism is corrected, a hormone balance is achieved and many patients feel much improved. Otherwise the physician can order water pills for the few days before the period when fluid retention is a problem, but this is only symptomatic treatment. Dr. Lee (Ref. 24) recommends to treat with 40mg of progesterone cream in two divided doses (morning and night) from day 10 to 12 until day 26 to 30 of each cycle and this can be increased in a crescendo like pattern until symptoms are controlled. The least amount needed to control symptoms is suggested.
Treatment with bioidentical progesterone
Other treatments such as oral contraceptives, progesterone pills and pulsed gonadotropin-releasing hormone or an agonist (leuprolide) have been tried, but are not as well tolerated as Dr. Lee’s bioidentical progesterone cream treatment. Dr. Lee explains in chapter 10 of Ref. 25 that most symptoms of PMS are identical to the side-effects of estrogen excesses. PMS in his opinion is an estrogen dominance condition where at any time, particularly in the second half of the cycle too much estrogen is circulating. Many of these women have anovulatory cycles so that they do not have a corpus luteum in any of their ovaries that would produce progesterone to balance the estrogen effects. It follows from this that natural progesterone cream treatment once or twice daily in the second half of the cycle (day 13 to 26) would be the most logical approach for treatment. Dr. Lee has done this and had remarkable results with this simple natural therapy. The dosage is 30 to 40 mg initially for 2 to 3 cycles, then can be tapered to 20 mg to 25 mg daily from day 13 to 26 of each cycle. The treating physician should check thyroid levels (T3, T4 and TSH levels) to rule out borderline hypothyroidism, which, if present would also have to be treated with thyroid replacement.
Other beneficial treatment with supplement
Vitamin D3 (at least 400 IU or more) and calcium 1200 mg have been found to be very successful in minimizing PMS symptoms as was discussed in my blog.
Sometimes a specialist (gynecologist or endocrinologist) may be required in those cases that are more difficult to control. Each patient needs to be treated according to her unique underlying problem.
References:
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 256 and 257 Dr. Lee describes how progesterone can be used as a cream to treat PMS.
25. Dr. John R. Lee: “Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.
