720 North Tustin Avenue
Suite 104
Santa Ana, CA 92705-3606
Phone: (714) 565-1032
Fax: (714) 565-1035

Jeremy E. Kaslow, MD, FACP, FACAAI Physician and Surgeon
Board Certified Internal Medicine

NOTICE TO CONSUMERS
Medical Doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov

There are several types of premenstrual symptoms, each has a specific underlying cause. No one treatment will correct all types. As you read through the profiles described, one will match most of your symptoms. Focus on that profile for a better understanding. At the bottom of the weboage are more information about the particular effects of estrogen and progesterone.

PREMENSTRUAL SYNDROME SUB-TYPE A: Nervous tension, mood swings, irritability, anxiety, and insomnia

  • Estrogen stress (with secondary brain dopamine depletion due to estrogen’s stimulation of MAO-2 activity causing lack of "relaxing" neurotransmitters and inhibition of MAO-1 activity causing excess norepinephrine/epinephrine excitatory brain transmitters. As a drug, MAO-inhibitors are used to treat depression…)
    1. Low progesterone production causes anterior pituitary stimulation leading to increased ovarian estrogen production
    2. Ovarian cysts or tumors
    3. Adipose tissue aromatization of androgens into estrogen
    4. Insufficient liver clearance of estrogens (see #8)
    5. Inadequate biliary flow
    6. Low fiber reducing intestinal clearance of conjugated estrogens
    7. High fat diets promote hydrolysis of intestinal conjugated estrogens into free estrogens that are reabsorbed.
    8. Enzymatic conjugation of estrogen in the liver is magnesium-dependent, if magnesium deficient there may be difficulty in metabolizing estrogen properly.
    9. Low B6 impairs estrogen utilization and removal by deactivation of the hormone itself. It may also be due to vitamin B6 antagonism by yellow dyes and hydrazine
    10. Excessive vitamin E elevates estrogen levels
  • Progesterone insufficiency (a CNS depressant by inhibiting MAO-2 leading to increased brain dopamine and stimulates MAO-1 leading to decreased excitatory neurotransmitters)
    1. Elevated estrogen inactivates the corpus luteum, where progesterone is produced
    2. Low LDL cholesterol bioavailable for progesterone production
    3. Excessive vitamin E (>600IU) lowers LDL cholesterol (lower doses stimulate progesterone production)
    4. Excessive animal fats/arachidonic acid lead to excessive PGF, which directly inhibits progesterone synthesis
    5. Insufficient vitamin E inhibition of arachidonic acid release (and thus PGF formation)
    6. Insufficient vitamin E effect as luteotrophin
    7. Excessive hepatic clearance of progesterone by synthetic progestin use or barbiturates
    8. Adrenal fatigue with insufficient progesterone production
    9. Hyperadrenia with resultant suppression of ovarian function via anterior pituitary response to the rapid oxidation
  • Dopamine depletion
    1. Chronic physical or psychological stress
    2. Depletion from magnesium deficiency
    3. Insufficient vitamin B6-dependent conversion of tyrosine to dopamine
    4. Vitamin B6 deficiency blocks dopamine synthesis at renal levels
  • Excess excitatory neurotransmitters
    1. Estrogen > Progesterone effect
    2. Refined sugar favors conversion of tryptophan to serotonin causing a relative dopamine deficiency and acetylcholine deficiency, which causes disturbances in movement and memory

Diet considerations for subtype A PMS: Tend to have excessive dairy product (Ca++>Mg++), high fat and/or refined sugar intake.

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PREMENSTRUAL SYNDROME SUB-TYPE C: (relative hypoglycemia with craving for sweets, increased appetite, heart pounding, dizziness or fainting, fatigue, headache, etc.)

  • Estrogen excess with symptoms primarily due to relative hypoglycemia. Often with low magnesium and prostaglandin E1 with increased carbohydrate tolerance

Management considerations for sub-type C PMS: Avoid alcohol since it impairs the release of glucose from liver glycogen. Eat small meals regularly.

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PREMENSTRUAL SYNDROME SUB-TYPE D: Is uncommon. (Depression, forgetfulness, crying, and confusion). May see high progesterone levels and, in some with excess hair growth, adrenal androgens. Others have lead intoxication.

  • Estrogen deficiency
    1. Ovarian fatigue from adrenal suppression
    2. Ovarian failure, ablation, or surgery
    3. Estrogen antagonism
    4. Reduced estrogen binding by lead
  • Relative Progesterone excess
  • Deficiency of norepinephrine in the central nervous system
    1. Decreased synthesis from insufficient dietary tyrosine
    2. Chronic stress-induced tyrosine depletion
    3. Increased metabolism of norepinephrine due to increased MAO-1 activity (Estrogen > Progesterone)

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PREMENSTRUAL SYNDROME SUB-TYPE H: (Weight gain, swelling of extremities, breast tenderness, and abdominal bloating)

  • Excess estrogen
  • Intake of too much refined sugar leads to sodium and water retention by hypoglycemic and acidotic stimulation of adrenals
  • Excess aldosterone with resultant water and salt retention
    1. Chronic stress leads to ACTH release from Anterior Pituitary
    2. Elevated serotonin causes ACTH secretion
    3. Acidosis stimulates the adrenals
    4. Elevated estrogen leads to angiotensin II release, which in turns leads to ACTH secretion

Management considerations for this subtype H PMS: Caffeine and other methylxanthines and nicotine exacerbate so eliminate these. Eliminate refined carbohydrates.

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CRAMPS:    If there is pain and cramping during but not before menses, this pattern suggests an imbalance of prostaglandins, calcium loss in anaerobic metabolism or thyroid stress, estrogen insufficiency, progesterone excess, or sympathetic nervous system stress.

EXCESSIVE BLEEDING: If the menstrual flow lasts only 2-3 days, the pattern suggests relative estrogen excess. If the menstrual flow last for more than 3 days, the pattern suggests progesterone insufficiency. Other factors that lead to excess menstrual flow are low blood clotting factors due to deficiency of vitamin K, lack of ionized calcium, parathyroid insufficiency, liver insufficiency, fibroids, and malignancy.

PAINFUL OVULATION: May be due to pelvic congestion due to progesterone insufficiency or estrogen stress

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ESTROGEN

Estrogen is produced by the ovarian follicle under the influence of FSH, which is produced in the anterior pituitary. Production is stimulated by vitamin E, which also reduces breast symptoms. Vitamin B6 reduces blood estrogen and aldosterone, and may increase intra-cellular magnesium levels. Estrogen is mildly anabolic with an anti-dysaerobic effect. These metabolic states are discussed in more detail under aerobic metabolism. High fiber vegetarian diet binds estrogen in the gut and prevents its reabsorption during enterohepatic re-circulation. Estrogen decreases the cycle length and causes fat deposition in the breasts.

Estrogen Insufficiency: Causative factors include ovarian or pituitary insufficiency, intestinal bacteria destroyed so there is no de-conjugation in the intestine and re-circulation back into the body. The effects of low estrogen may include:

1.         Increased diastolic blood pressure

2.         Ulcers

3.         Sterility

4.         Pain, cramping, & tension DURING but not before menstruation

5.         Decreased menstrual blood flow

6.         Menstrual cycle longer than 28 days

7.         Hypoplastic weak uterus and senile vaginitis

8.         Menopausal hot flashes

9.         Anemia

10.       Poor retention of sodium, chloride, potassium and calcium.

11.        Poor calcium assimilation

12.       Excess retention of phosphorus

Estrogen excess: Can be due to adrenal insufficiency with ovarian overcompensation, liver overload preventing estrogen breakdown, parasympathetic dominance, excess fat or fiber intakes effect on enterohepatic circulation, excess coffee, tea, chocolate, or vitamin E. Features of a relative estrogen excess may include:

1.         Reduced diastolic blood pressure

2.         Pre-menstrual tension, nervousness, headaches, nausea, & fluid retention

3.         Menstrual cramps due to increased extracellular K+ and decreased Ca++ = smooth muscle spasm

4.         Watery vaginal discharge

5.         Excess menstrual flow lasting only 2-3 days

6.         Decreased thyroid effect with reduced temperature

7.         Tendency to vein problems

8.         Tendency to schizophrenia

9.         Increased incidence of breast, lung, liver, and GI cancer

10.       Gynic qualities

11.        Increased calcium & phosphorus retention

12.       Poor absorption of phosphorus

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PROGESTERONE

Progesterone is produced by the corpus luteum under the influence of LH. Low progesterone may be the result of thyroid insufficiency (which may be secondary to adrenal, anterior pituitary, or estrogen stress). Progesterone is mildly catabolic, is anti-dysaerobic, and opposes estrogen. Placental and mammary concentrates have progesterone activity. Progesterone decreases bleeding.

Progesterone Insufficiency: May be due to thyroid insufficiency. Also see webpage devoted to progesterone

1.         Menstrual cycle shorter than 28 days

2.         Heavy menstrual bleeding

3.         Fluid retention during menses

4.         Premenstrual tension, nervousness, headache, nausea, and fluid retention

5.         Menstrual bleeding longer than 3 days

6.         Menstrual cramps

7.         Uterine fibroids

8.         Breast lumps

9.         Breast swelling with increased subcutaneous fluid

10.       Decreased systolic blood pressure and pulse pressure

11.        Pulse and temperature decreased

12.       Poor retention of sodium and chloride

13.       Vomiting and toxemia of pregnancy

14.       Uterine contractions during early pregnancy

15.       Habitual miscarriage

Progesterone Stress: May be due to incomplete breakdown by liver, anaerobic, sympathetic, or glucogenic imbalances. Features of relative progesterone excess may include:

1.         Menstrual cycle longer than 28 days

2.         Scanty menstrual flow

3.         Acne during menses and/or acne, greasy hair and skin

4.         Breast tenderness during menses

5.         Premenstrual depression

6.         Increased temperature

7.         Dry vagina and/or thick discharge

8.         Excess retention of sodium, chloride, phosphorus and sulfur

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