Are premenstrual mood symptoms caused by progesterone or helped by progesterone? And why do antihistamines give such relief?
In this episode, Lara discusses premenstrual mood symptoms including:
Are premenstrual mood symptoms caused by progesterone or helped by progesterone? And why do antihistamines give such relief? Join me today for some new treatment ideas for the irritability, sensitivity, sleep disturbance, and even rage you might experience leading up to your period.
Welcome back to the podcast. I’m your host Lara Briden, a naturopathic doctor and author of the books Period Repair Manual and Hormone Repair Manual.
I’m currently still in Christchurch, New Zealand where I live but I’m gearing up to go over to Canada where I’m from and one of my first stops will be Vancouver where I hope to give a little public presentation and book signing. For more info, make sure you’re on my mailing list, which you can join from the link in the show notes.
Okay. Onto the topic of premenstrual mood symptoms. I’ll start by saying that premenstrual mood is my favourite thing to treat because in most cases, it responds so well and so quickly to some pretty basic strategies. And if that has not been your experience with the conventional treatments of SSRIs and hormonal birth control, I encourage you to keep listening because there are other options.
Some of the treatments I’ll discuss today have been clinically trialled but some have not and that’s largely because of the rather startling lack of research on this topic. For example, there is still no clear understanding of what causes premenstrual mood symptoms. What little science there is points to an abnormal response of the brain to the normal fluctuations in estrogen and progesterone. Probably because of inflammation.
And, importantly, what little science there is suggests there is not one single mechanism to explain premenstrual mood symptoms in all women. Instead, there are probably at least several different things going on with different women. Which means that different treatments work for different people and I’ve definitely found that to be true with my patients. So, you might just need to just try a few treatments, or combination of treatments, until you find the one that works for you. In my 25 years with patients, I’ve had a chance to try a lot of premenstrual treatments. And today, I’ll share the six treatments I’ve found to be most effective. Before I do that, however, I want to get a few things out of the way.
First, these are treatments for mood symptoms that occur in the second half of a natural menstrual cycle. Mood symptoms on hormonal birth control are side effects of hormonal birth control and a separate topic.
Second, the same treatments can relieve physical premenstrual symptoms such as headaches and breast pain.
Third, these six treatments are by no means the only natural treatments. Like so many aspects of the menstrual cycle, premenstrual mood symptoms are an expression of general health, so anything you do to improve general health will also improve premenstrual mood. That includes moving the body, getting outside and getting more rest, fixing the gut, reducing inflammation, avoiding alcohol, and being fully nourished in every way including protein, B-vitamins, zinc, essential fatty acids, and more.
Finally, I just want to acknowledge the existence of severe premenstrual mood symptoms, which may be diagnosed as premenstrual dysphoric disorder or PMDD. Natural treatment can relieve PMDD, especially the antihistamine treatment, but not necessarily in every case. So, please check with your doctor.
Okay. Let’s go.
Treatment #1 is an antihistamine approach, which can mean first trying an over-the-counter antihistamine medication to see if that gives relief. Talk to your pharmacist about non-drowsy vs drowsy medication depending on what time of day you’re planning to take it. If that works, you could then try natural antihistamine treatments such as quercetin, SAM-e, vitamin B6, which we’ll come to, and a dairy-free diet. By which I mean specifically avoiding A1 casein, which is the protein found in milk from Holstein or Friesian cows. Goat, sheep and A2 dairy are usually fine. And interestingly, there is a study currently underway at Deakin University in Australia to assess how A1 versus A2 casein might cause inflammation and psychological distress in women.
You probably know histamine as the amine that causes allergies and inflammation—but it’s also a stimulating neurotransmitter that affects the brain. And histamine goes up and down with the menstrual cycle because it’s influenced by estrogen and progesterone. Signs of high histamine or mast cell activation include irritability, anxiety, insomnia, brain fog, headaches, and breast pain—all classic premenstrual symptoms. Other signs of high histamine include hives, nasal congestion, joint pain, fluid retention, and nausea. So, if you have those symptoms as well as premenstrual mood symptoms, you probably want to start with an antihistamine approach.
Treatment #2 is magnesium, wonderful magnesium. Which reduces inflammation and calms the brain and according to a 2017 literature review, is evidence-based treatment for premenstrual mood symptoms. I’ll put a link to that paper in the show notes. Some researchers think that the mechanism for magnesium giving such relief is that it “normalizes the action of progesterone on the central nervous system.” I usually prescribe 300 mg of magnesium glycinate to be taken during the week or two leading up to the period. And I sometimes give it in combination with the amino acid taurine which also calms the brain. For more about how to take and troubleshoot magnesium and taurine, see my magnesium and taurine blog posts. Links in the show notes.
Treatment #3 is vitamin B6, which was actually my personal eureka moment for PMS when I first tried it thirty years ago. I was in naturopathic college at the time and thought it was normal to feel a little edgy or irritable leading up to my period. And then I tried vitamin B6 and the symptoms just evaporated and I thought “Oh, my goodness. This stuff really works.” I also realized: “Okay…So It’s possible for the period to just arrive with no symptoms.” Possible for me and possible for many, many of my patients since then.
Vitamin B6 has done well in at least one clinical trial and probably works via several mechanisms including boosting serotonin and GABA, as well as lowering histamine and prolactin. There are some safety considerations around the dose of vitamin B6, which I discuss on my blog. I’ll just say here that I usually prescribe B6 in the range of 30 to 60 mg but only during the luteal phase. Taking B6 for only part of the month is one way to reduce the potential but rare risk of nerve damage; another way is to use the form pyridoxal-5-phosphate or P5P rather than pyridoxine. Check with your clinician or pharmacist.
Treatment #4 is iodine, preferably molecular iodine, at the dose of 1 to 3 mg, which can be an absolute game-changer, not just for premenstrual mood symptoms but also for endometriosis and especially for breast pain. In fact, if you have breast pain, iodine is the first PMS treatment to try.
Like vitamin B6, there are some safety considerations. Mainly that if you have existing thyroid disease, especially autoimmune thyroid disease then you cannot use 1 to 3 mg of iodine but must stay at a lower dose of 300 mcg. That thyroid safety issue is why I always screen my patients for thyroid antibodies or TPO antibodies before prescribing iodine. A negative result for thyroid antibodies means it’s probably safe to try higher dose iodine. And please don’t let that precaution put you off. When iodine is the right treatment, it can make a dramatic difference to premenstrual mood symptoms.
Treatment #5 is the oh-so-popular vitex or chaste tree, which is the herbal medicine most people try first for premenstrual mood. And it can be helpful. In fact, vitex is one of the better researched natural treatments and works by a few mechanisms including directly calming the brain, increasing progesterone, and most importantly, lowering prolactin. With my patients, I sometimes test prolactin to try to determine if vitex is going to be the right treatment. If you have very high prolactin, of course, speak to your doctor. But if your prolactin is just on the high end of normal then vitex could be helpful for premenstrual mood, headaches, and breast pain.
I generally avoid vitex for PCOS because I find it can sometimes worsen androgen symptoms.
And as an aside, the other great herbal medicine for premenstrual mood is bupleurum.
Finally, treatment #6 is natural progesterone or body-identical progesterone. Which is entirely different from the progestins of hormonal birth control as I explain in episode 5. Progesterone can be calming and soothing because it has a natural antihistamine effect and because it converts to a tranquilising neurosteroid called allopregnanolone, which is usually calming to the GABA receptors in the brain. I say “usually” because about 1 in 20 women seem to experience a paradoxical anxiety effect from allopregnanolone probably because of something unusual going on with their GABA receptors—something that might involve inflammation and histamine.
If you have that kind of progesterone sensitivity, you might find your premenstrual mood symptoms kick in early, just a few days after ovulation when progesterone starts to climb. In other words, premenstrual mood symptoms potentially caused or triggered by progesterone. For most women, however, premenstrual mood symptoms typically kick in a little later about eight or nine days after ovulation when progesterone starts to drop. So, for most women, premenstrual mood symptoms are, at least in part, the result of withdrawal from progesterone. And can therefore be relieved by taking progesterone either a cream or an oral capsule as I describe in my books. If you take a body-identical progesterone capsule, be sure to take it at bedtime because it can make you very sleepy.
And yes, conceptually, there is quite a big difference between
Thankfully, the research is starting to look a little more closely at the withdrawal theory and I’ll just finish by saying that natural progesterone capsules can be worth trying even if you think you have progesterone sensitivity. Sometimes, it just requires a higher dose to calm and stabilize the GABA receptors. And possibly over a few cycles before things start to improve.
As always, there’s a section in my forum at LaraBriden.com to discuss the episode. Please chime in there with your experience.
I hope that’s been helpful and thanks so much for listening. Please share and leave a review. And I’ll see you next time when I’ll discuss how to prevent and treat post-pill acne.