An Ounce Of Prevention Is Worth A Pound Of Cure!

Posts tagged ‘Premenstrual syndrome’

Period Pain and Low Pain Threshold

There are generally two types of pain associated with “dysmenorrhea” (difficult or painful periods). These are referred to as primary dysmenorrhea and secondary dysmenorrhea. The word “secondary” means symptoms are a consequence of an underlying disease such as endometriosis, ovarian cysts, fibroids, etc. Primary dysmenorrhea refers to symptoms that occur during menstruation without obvious associated disease states.

The causes of period painin primary dysmenorrhea remain somewhat clouded. However, recent research by University of Oxford researchers has shed new light on knowledge of the characteristics and potential significance of period pain (Dr. K. Vincent and colleagues).The research involved investigation of pain thresholds of otherwise healthy women, with or without period pain.

The causes of period pain in primary dysmenorrhea remain somewhat clouded. However, recent research by University of Oxford researchers has shed new light on knowledge of the characteristics and potential significance of period pain (Dr. K. Vincent and colleagues).The research involved investigation of pain thresholds of otherwise healthy women, with or without period pain.

In experiments, a heated plate was applied to skin to induce pain. Those who suffered from period pain experienced more pain and discomfort from lesser degrees of thermal (heat) application, compared to women who did not have period pain. In other words, women without period pain were more robust in terms of their lack of pain perception than those with period pain. Moreover, women with period pain were more sensitive to pain induction and had a lower pain threshold.

What do these findings mean? It was suggested that women with period pain have more “pain problems,” in general. Therefore, the management of period pain may reduce overall debility from “body pain.” I believe these studies demonstrate the power of “body-mind” functions.

Primary dysmenorrhea is often treated by pain killers (analgesics, e.g. ibuprofen) or low-dose contraceptive pills. However, addressing mind-body issues with behavioral interventions, such as the induction of relaxation responses, biofeedback training or positive visualization (modified hypnosis) seem to be an obvious, simple, gentle and natural approach to period pain and general pain management.

While studies on period pain seem to be revealing, the phenomena they probe are not new or novel issues in medicine. There have been studies on other conditions linked to mind-body functions. Perhaps the most common is irritable bowel syndrome (IBS), which affects as many as 25 million Americans and is more common in women than men.

With IBS, abdominal pain can be associated with altered bowel habits and other distressing symptoms. This classic mind-body (gut-mind) disorder has been shown to be related to an enhanced sensitivity to pain. Modified hypnosis, relaxation and behavioral treatments have been reported to be more effective than standard medical treatments for pain or colic in IBS.

The medical world is moving toward a better understanding of the harmonious functions of the body, especially mind-body connections. Disturbances of function (functional diseases) are primary targets for many alternative medical interventions (e.g. relaxation responses, yoga, music therapy, etc.). These approaches are emerging with an evidence base in the practice of Integrative Medicine.

Herbs and natural substances, such as black cohosh or soy isoflavones-which are used in traditional herbal medicine to address female-specific issues-may also offer benefits. Herbs are not actual pain killers (analgesics), but they may exert indirect benefits on period pain and premenstrual syndrome (PMS). Observations of pain control have also been noted with curcuminoids, derived from curcumin (turmeric).

There are many reasons to seek alternative strategies to manage chronic pain, and I raise these issues to make my readers aware of information that is often overlooked in practices of prescription or over-the-counter use of pain-killing medication. Many drugs are merely band-aids for pain, and a holistic approach is required.

This knowledge underscores the importance of the recent observations of difference in pain appreciation or pain thresholds that differ greatly among different people. Pain is part of the lack of harmony of body functions.

Be Healthy! Dr. Stephen Holt, M.D.

Nutrients for Women’s Wellness, Part 2

Ginkgo biloba in China

Image via Wikipedia

There are many areas of health that are important to women, including hormonal balance, mood, stress response and more. This newsletter is Part 2 of a two-part series covering specific nutrients that may be helpful for these critical areas of women’s wellness.

Ginkgo Biloba

It is surprising how often the benefits of ginkgo biloba have been underestimated. The potent and versatile health-giving properties of ginkgo have been demonstrated in many clinical trials, using different extracts of the leaves, fruit and seeds of the ginkgo tree. There are many benefits of ginkgo that are quite relevant to the management of PMS and menopause, including the promotion of healthy circulation, brain function and normal stress response.

Ginkgo biloba is a complex mixture of organic acids, plant fiber, phytosterols, flavonoids, terpenoids and carotenoids. The chemistry of the contents of ginkgo is quite complex, and this makes its biologic actions quite varied. While recent studies have evaluated specific extracts of ginkgo, many herbalists believe the benefits of ginkgo are a result of the interaction of the various natural components of the whole herb.

Of major relevance to the management of PMS and menopause is the ability of ginkgo to promote beneficial changes in memory, fatigue, concentration and mood. Other benefits include its ability to manage certain causes of dizziness, especially those related to problems with the balance mechanism within the ears. One published study of special relevance shows the demonstrated ability of ginkgo to reduce “breast congestion” and other troublesome symptoms in PMS (Tamborini A, et al, Rev Fr Gynecol Obstet; 88:447-457, 1993). Gingko may also have a beneficial effect on libido.

I believe that ginkgo biloba is a very important component of any natural, dietary supplement formula for menopause and PMS.



Image via Wikipedia

Ginseng comes in several forms, and it has a long history of use as a general tonic in Eastern medicine.

Ginseng may have some benefits for mood and energy. In one carefully conducted study of the use of Panax ginseng in more than 300 women with menopausal symptoms, improvements in mood were noted. In a separate study, Korean ginseng was found to improve symptoms of sleeplessness, moodiness and fatigue when used in a relatively high dose of 6 grams per day.

In excessive amounts, ginseng can cause insomnia, anxiety, diarrhea and breast pain. The use of Panax ginseng has been associated with vaginal bleeding following menopause, but it is not entirely clear that this reported effect is actually due to ginseng itself. It’s important to note that the quality of ginseng may vary depending on the source, and it is available in extracted forms that have not yet been fully evaluated.

Flower Essence Therapy, Vervain and Golden Root


Image by hjw223 via Flickr

Flower essence therapy is associated with the English physician, Bach, who wandered the hills of Wales in his search of remedies to restore balance in life. Flower essence therapy is a form of homeopathy. It is stated that flower essence therapy can relieve stress, and it is believed that it can be used with other herbal or botanical supplements for health. Extracts from the flowering parts of plants are used in flower essence remedies, and although these are not considered direct treatments for menopause symptoms, they may help balance underlying emotions.

The flower essence remedies are given as tinctures that are often diluted in a base of alcohol. There seems to be no limit to how long flower essence treatments can be used, but there is not much scientific evidence of their effectiveness for the management of discomforts associated with menopause or PMS.

Two other herbs have been used variably to assist with symptoms of menopause and PMS, but the evidence for their effectiveness remains questionable. One is vervain (Verbena officianalis), which is said to support function of the adrenal glands, thereby promoting normal stress response. The second is golden root (Rhodiola rosea), which is often used in a standardized extract. This herb may have stress-relieving and immune-supporting properties, with some positive effects on mood and mental balance. The evidence for the use of golden root for menopausal relief is somewhat anecdotal, and it is probably better reserved for the specific management of stress disorders.

Miscellaneous Nutrients

Other dietary supplements of emerging interest for PMS and menopause include flaxseed, diindolylmethane (DIM) and DHEA (oral or topical). DHEA is a universal hormone precursor with emerging evidence to support anti-aging benefits, but it is best used under medical supervision. The substance DIM is found in certain vegetables and it may increase certain forms of “friendly” types of estrogen in the body, including hydroxy and methoxyestrogen.

In addition to support from nutrients and herbs, women can also benefit greatly from restful sleep, which is a key factor in well-being for individuals of all ages.

Be Healthy!
Stephen Holt, MD

Nutrients for Women’s Wellness, Part 1

Vitex agnus-castus: Habitus

Image via Wikipedia

There are many areas of health that are important to women, including hormonal balance, skin health, breast health, libido and more. This newsletter is Part 1 of a two-part series covering specific nutrients that may be helpful for these critical areas of women’s wellness.

Antioxidants for Anti-Aging

While most women have heard of antioxidants, many are still unaware of how they work or how to take them. Basically, antioxidants work against the unwanted oxidation of body tissues. While oxygen can be the body’s best friend, it can occur in a reactive form that damages tissues through the process of oxidation. Reactive forms of oxygen are called free radicals.

I believe that antioxidant usage is a key anti-aging tactic. Oxidative damage to tissues has been associated with almost every known chronic disease. Moreover, oxidative damage to genetic material and other cell structures is believed to be a principal cause of abnormal tissue changes that may lead to poor health and premature aging.

There are two specific antioxidants that may be especially beneficial for women. The first is green tea, which is brimming with antioxidant polyphenols, and offers versatile, well-documented health benefits. Second, I am impressed with scientific data showing the powerful effects of ellagic acid, found in raspberries and pomegranates.

Many skin care products today contain antioxidants intended to produce anti-aging effects on the skin, yet the topical application of antioxidants may be only marginally effective at improving skin health and appearance. Instead, I recommend women take antioxidants orally.

L-Theanine: Relaxation from Green Tea

While many of green tea’s benefits have been attributed to its antioxidant polyphenol and related catechin (e.g., epigallocatechingallate, EGCG) content, the use of green tea and other herbal teas, such as German chamomile, can also cause feelings of relaxation.

The compound in green tea believed to be responsible for its soothing properties is the amino acid L-theanine. This amino acid has shown an ability to cause muscle relaxation and contribute to restful sleep, without a direct sedative or hypnotic effect. It’s believed that L-theanine may support the balance of various brain chemicals that serve as messenger molecules (neurotransmitters). Following the oral ingestion of L-theanine, brain activity shows measurable changes toward relaxation.

The frequent presence of anxiety or stress in PMS and perimenopause makes L-theanine an ideal addition to supplement formulas for women. In addition, L-theanine may help support healthy blood pressure.

Chasteberry (Vitex agnus castus) for PMS, Menopause & Libido

Vitex agnus castus (Chasteberry) is an herb that has been grossly underestimated as valuable for women’s health. Laboratory studies show that extracts of chasteberry can both bind to estrogen receptors in the body and may stimulate progesterone receptors. In other words, chasteberry is a hormonal biological response modifier with several potential actions (Table 1).

Multiple hormonal actions

May raise progesterone levels in blood

May increase levels of luteinizing hormone

May help correct consequences of progesterone deficiency

Inhibits the stress hormone prolactin

Has an antiandrogenic hormone effect 

Approved by German E commission for management of menstrual irregularities and mastodynia (breast pain)

Table 1. Vitex (chasteberry): Characteristics and actions of an underestimated herb for menopause and PMS.

It has been argued that the major benefit of chasteberry is related to its ability to enhance the actions of progesterone. When taken in low doses, Chasteberry may decrease follicle-stimulating hormone and increase lutenizing hormone levels in the blood. These changes in the blood levels of pituitary hormones can result in increases in blood levels of progesterone. This helps to explain why chasteberry may reduce hot flashes, help with vaginal dryness and contribute to better mood.

Chasteberry has also been used to promote libido in women, and it seems to have a clear effect on inhibiting the actions of the stress hormone, prolactin. Prolactin is a hormone secreted by the pituitary gland. These actions on prolactin make the use of chasteberry unwise in pregnancy and for people taking medications that promote dopamine responses (e.g. L-Dopa).

It could be noted that chasteberry is an herb that acts quite slowly in the body, and it may take as long as three months of continuous use before it exerts its beneficial effects for menopause and PMS.

Evening Primrose Oil for Breast Health, PMS & Menopause

It’s believed that evening primrose oil is beneficial for breast health, PMS, breast pain (mastalgia) and menopausal discomforts. Its beneficial effects may be due to its gamma-linolenic acid (GLA) content. This fatty acid is a precursor of a group of molecules called prostaglandins. Prostaglandins are considered, in simple terms, to be friendly types of hormones or messengers that support the body’s inflammatory response. GLA is known to be a precursor of prostaglandin E1.

Some studies have indicated that women with PMS may be unable to readily convert precursor molecules into GLA. It’s proposed that a deficiency of GLA may aggravate PMS.

Some of the desirable effects of GLA can also be achieved by omega-3 fatty acids, including DHA (docosahexanoic acid) and EPA (eicosapentanoic acid). Omega-3 fatty acids offer benefits for breast health, cardiovascular health, brain function and immunity. Every woman should consider taking a fish oil or other omega-3 supplement containing DHA and EPA, in enteric coated or targeted delivery forms, for health.

Be Healthy!
Stephen Holt, MD

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