Archive for March, 2011

Under the Cloud of PMS

Many of my child-bearing age female patients suffer from PMS.  I’d like to take a few moments to discuss PMS but in order to understand PMS, it’s important to first understand a normal, healthy menstrual cycle.

You can think of the menstrual cycle as a dance or interplay between many different hormones.  Follicle stimulating hormone (FSH) and luteinizing hormone (LH) are both produced by the pituitary gland located in the brain while estrogen and progesterone are primarily produced by the ovaries.  The interaction between these four hormones creates the menstrual cycle.  Other hormones such as oxytocin and testosterone are involved but are less significant.

Day 1 of the menstrual cycle is the onset of bleeding and this continues generally for 3-7 days.  Upon completion of bleeding, FSH levels begin to rise.  This is necessary for ovarian follicles to mature as well for the ovaries to begin producing more estrogen.  Estrogen serves many purposes:  it sends signals to the uterus to develop its endometrial lining (for potential egg implantation) as well as suppressing FSH but also increases LH levels near ovulation.  Estrogen should be highest prior to ovulation and then should decrease until menstruation.

As LH rises in response to rising estrogen, body temperature increases and ovulation occurs within 12-48 hours.  Ovulation takes place when a mature follicle releases an egg.  The empty follicle then becomes the corpus luteum, which produces progesterone until the onset of menses 14 days later.

Between ovulation and menstruation, progesterone should be the dominant female hormone.  Progesterone has many functions including maturing the uterine lining for implantation and pregnancy, helping to calm and focus brain activity, relax muscles, increase sex drive and assist in fat burning.   If implantation of an embryo does not occur then progesterone and estrogen levels fall.   This signals the onset of menses and the cycle continues.

As you can see the hormones are intimately interrelated and dependent upon one another; if one hormone is imbalanced, the likelihood of other hormones becoming imbalanced increases.  When one cycle fails to function properly, the following cycle is affected and it becomes a downward spiral of dysfunction.  PMS is related to the cyclic dysfunction.

PMS is considered a “multifactoral” condition that can have different causes, and not every woman with PMS will have the same symptoms.  Emotional symptoms can be aggression, anxiety, confusion, depression, irritability, and emotional withdrawal.  Physical symptoms can be abdominal bloating/cramping, back pain, breast swelling/tenderness, fatigue, heart palpitations, nausea, food cravings, migraines, and insomnia.

One underlying cause of PMS that I see in my office is called Estrogen Dominance (ED).  ED is when estrogen, instead of progesterone, predominates in the second half of the cycle (between ovulation and menstruation).  Estrogen and progesterone are both necessary for a healthy cycle and they need to be in the correct proportion with one another.  Estrogen stimulates brain function so when it is not balanced by progesterone irritability, anxiety, and general moodiness can result.  Remember that progesterone calms and focuses the brain.  For many women, progesterone drops off too quickly prior to menstruation or isn’t produced at all because no ovulation occurred.  This results in inadequate levels of progesterone to balance the estrogen at the end of the cycle.  Emotional and physical symptoms can result.  And depending on when the progesterone drops off, symptoms could last 3 days of 10 days.  It may be different for each woman and each cycle.

In my next post, I will talk about how to correct Estrogen Dominance.  Stay tuned.