A bit on Functional Medicine versus Conventional Medicine when it comes to PMS. Functional medicine addresses the underlying cause of a chronic illness, disease or acute finding. It serves a patient in that instead of healing isolated symptoms with medications as a ‘band aid’ approach, further testing is utilized to assess underlying conditions. FM looks at the whole body or ‘patient-centered approach’, listening to the history of a patient, lifestyle, diet and any interactions that could be causing the symptoms that are causing them harm. This can also include environmental, genetic and psychological stress factors that can induce and create long-term illness.

In a world of traditional conventional medicine where isolated symptoms are treated, it is refreshing to see how the shift in perspective is leaning in to a more personalized model that gives patients and practitioners the best model approach to achieve optimal health.¹

Premenstrual Syndrome or PMS affects millions of women at all ages after starting their menstrual cycle. Symptoms can be debilitating but range from weight gain, breast tenderness, mood swings, depression and anxiety, skin issues, food cravings, lack of sexual drive, migraines, brain fog, fatigue and irritability. PMS on a more serious level can be diagnosed as Premenstrual Dysphoric Disorder (PMDD). Both of these disorders can start 7-14 days before a woman’s menstrual cycle occurs and can range from mild to severe.^2,3

I find this topic rather interesting to me given I am a woman that has reached peri-menopause (after 35), does not have children and has a history of PMS. I have worked thoroughly on my own symptoms and underlying causes to soothe and ease monthly episodes naturally without using SSRI’s or birth control pills; both of which I have tried, but did not feel right for me. I found this article to be functional in it’s own right, because it does not only look at treating the symptoms of PMS/PMDD, but also underlying causes that are not obviously mentioned in so many articles or included in the advice given from a GYN or GP. Overall, the cause of PMS/PMDD is tough to assess. Most articles and doctors suggest this is a deficiency in B-vitamins, hormonal fluctuations, low serotonin levels and/or prostaglandins. Other causes that exacerbate PMS are high stress, alcohol and nicotine, sugar intake (causing inflammation) and a family history of PMS. While many of the points mentioned can inadvertently be true, what I liked about the article Premenstrual Disorders: An Expert Review that appeared in the American Journal of Obstetrics and Gynecology, was the effort to dig in a bit deeper. Although there is significance in Dr. Yonkers’ findings that oral contraceptives and serotonin reuptake inhibitors are the end point of treatment, there are numerous ways to start on a gentler path. Significance in early abuse and trauma is something you do not see most often as a possible cause and comorbidity between depressive and anxiety disorders as a potential risk, which Dr. Yonkers mentions and can be a crucial diagnostic tool. With that said, the one clinical cause that has been studied and proven is the fluctuation in hormone levels. A closer look shows that women can have a pathological expression to progesterone, withdrawal or exposure as well to GABA (gamma amino butyric acid) agonist, allopregnanolone. It shows that allopregnanolone, if blocked, can reduce symptoms of PMS.

Whether conventional or alternative treatment, the overall view is the effect on the serotonin system, specifically the serotonin transporter. If tryptophan, serotonin’s precursor is not functioning the way it should be, PMS disorders can become debilitating and affect a woman’s life on a month-to-month basis for up to two weeks each month. That is a significant amount of time in ones life. Further, if ones gut health is not intact, serotonin, amino acid transport systems can delay assimilation and slow down neurotransmitter metabolism.

There is a lot of detail regarding brain function and how the amygdala integrates emotional and physical input and the processing of emotional expression; but for the sake of the article/blog post  I will focus solely on functional medicine, it’s approach and what it can mean for those suffering from PMS/PMDD.

Dr. Yonkers speaks about four main categories of treatment: 1) an alternative approach including diet, exercise and psychotherapy, 2) vitamins and botanicals, 3) hormonal agonists and antagonists and 4) psychotropic treatment. In fact, Cognitive Behavioral Therapy compared to Prozac to manage emotional symptoms showed that CBT was better maintained and with a higher attrition rate (50%). This does not at all negate or interpret the possibility of needing Prozac or other SSRI’s as a form of treatment, since many women find a huge benefit to this route especially when dealing with severe PMDD and anxiety/depression that accompany this disorder; however, someone like myself that prefers a more alternative approach and that may not need pharmaceuticals, may appreciate psychotherapy and an alternative approach using vitamins, hormonal testing, and possibly nutraceuticals. I think the trouble with conventional medicine is the straight shooter approach to SSRI’s, oral contraception or HRT (Hormonal Replacement Therapy) without diagnostic testing for micronutrient deficiencies, hormonal levels or trying more beneficial methods that our bodies perhaps create on its own, but may be deficient or have a hard time assimilating.⁴

I would like to incorporate the points in this review in treating PMS using a functional medicine approach. I think the importance of using the four steps given in this article would be a great starting point in the treatment of PMS. For example, starting with an elimination diet theory as well as micronutrient testing to ensure that there aren’t any sensitivities/allergies to foods causing inflammation, which can exacerbate symptoms and potentially cause more harm could be useful. Micronutrient testing could give us a baseline to ensure that deficiencies are present or not and supplement accordingly. Scientific studies over and over indicate that exercise as well as meditation can boost endorphins and release serotonin transmitters across the board; a fitness plan as well as mindfulness should be included. Also, knowing that there is or isn’t past traumas and experiences can guide us as practitioners to ensure our clients have the professional help that they need. If these steps, (1 and 2) do not work alone, working with nutraceuticals to the best knowledge I have at this time such as Phenitropic (Biotics), work on the precursors to GABA and can have a great calming and healing effect before trying pharmaceuticals. Herbal treatments (St. John’s Wort, Vitex, etc.) can also be beneficial in combination with the other tools mentioned can be used 7-10 days before a woman’s cycle to see if cyclical symptoms dissipate over time. I think with any treatment of this kind, it is important to ensure a 2-3 month period to see if treatment is working or not. Of course, if a certain supplement or a restrictive diet does not resonate and feels intolerable, it is important to work together to ensure what works and what does not work. As a clinical nutritionist, I think it is also important to work with hormonal testing to establish a baseline. Specific testing of Thyroid levels, T3, T4, reverse T3 and TSH (Thyroid-stimulating hormone) are also a suggested baseline test. If SSRI’s or other pharmaceuticals are warranted, working in conjunction with a clients’ psychotherapist and/or psychiatrist to ensure any interactions should be supported.

References

1. The Institute for Functional Medicine. About Functional Medicine. 2017

https://www.functionalmedicine.org/what_is_functional_medicine/aboutfm/

Accessed June 13^th, 2017

2.  University of Maryland Medical Center. Premenstrual Syndrome. 2017.

http://www.umm.edu/health/medical/altmed/condition/premenstrual-syndrome

Accessed June 13^th, 2017

3. PubMed Health. National Library of Medicine. Premenstrual Dysphoric Disorder. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024721/

Accessed June 13^th, 2017

4. Yonkers KA, Simoni MK. Premenstrual Disorders: An Expert Review.

American Journal of Obstetrics and Gynecology. 2017.

Doi: 10.1016/j.ajog.2017.05.045