Pre Menstrual Syndrome and Menstrual Cramps, how I eliminated them completely

This is my story of how I eliminated these two sometimes debilitating female issues, I hope this will give other women some tools to eliminate them also.

I always had pain and cramps with my monthly, in high school a couple of aspirins would usually keep it at bay. In my 20’s I got increasingly annoying Pre-Menstrual Syndrome (PMS), I was grumpy and irritable, but the worst was the sore, tender lumpy breasts, like a couple of massive bruises sitting of my chest getting progressively worse over the week before my period. This was then replaced by cramps for 2 or 3 days.

In my mid 20’s I improved my diet (or so I thought) by becoming a vegetarian, also motivated by wanting to help animals and the planet. I also stopped eating fish as I was worried about the impact of overfishing.

I left New Zealand on my OE (Overseas Experience) at 26, something every good Kiwi does as a rite of passage. After 3 months in the USA I arrived in England to settle down and earn some money. My menstrual pain was getting worse and worse. It got to the point where I’d have to take Panadeine every 4 hours or I’d be doubled up and vomiting with the pain. I went back to NZ at 29, still suffering terrible cramps and still semi-vegetarian (mostly vegetarian meals and infrequent meat), the trendy diet for the ‘80s. My doctor suggested I do more exercise, so I took up running, and surprisingly this helped. Interestingly studies show female athletes report less than normal pain with their periods.

However, when I reduced the exercise the terrible pain came back. I kept suffering and swallowing pain killers. It never occurred to me there was something I could do about it. The PMS continued as well.

Approximately 30% of the female population suffer from Pre Menstrual Syndrome (PMS), and for about a third of those it is severe. About 10 percent of women have severe dysmenorrhoea (period pain).

When I was about 35 my partner picked up a copy of Dr Barry Sears “Enter the Zone”. It looked interesting, I devoured the book.  A lot of issues Sears talked about rung true with me, blood sugar problems, hunger and cravings, weight gain. He looked at food in a new light, each meal sets off a hormonal cascade starting with insulin and glucagon and then eicosanoid hormones. By controlling blood sugar and consequently hormones you control of unstable blood sugar and cravings, and achieve easy weight loss.

Sears also had a section on PMS. (My interest picked up at this point!) He says PMS appears to be linked to a genetic defect in the normal synthesis of Gamma linolenic acid (GLA). This essential fatty acid is the building block of several groups of prostaglandin hormones. Research indicates that women with severe PMS have GLA levels 80% lower than women without PMS. Some studies show women taking a GLA supplement (found in evening primrose and borage oil) get relief, however other studies found that there was no benefit. (I was in the no benefit group – tried it, didn’t work)

Sears says the problem is you can’t resolve PMS with GLA supplementation alone – it has to be combined with a diet that controls the hormone insulin. Why is controlling insulin so important? GLA is the building block of both pro-inflammatory and anti-inflammatory prostaglandin hormones. If you have high levels of insulin, an enzyme called delta -5 desaturase is activated. This is responsible for converting GLA into arachidonic acid, a fatty acid that is then converted into inflammatory prostaglandins. These hormones are connected with PMS symptoms.

Sears stated that it is essential to combine activated fatty acids (GLA) with a Zone balanced diet. This is because the Zone diet keeps blood sugar and insulin levels low and stable. The Zone diet also increases Omega 3 levels, by including lots of oily fish and taking fish oil as a supplement. The result? The same GLA goes down another pathway and gets converted into anti-inflammatory hormones called PGE1.

Sears stated “That’s what I’ve done with hundreds of PMS patients, and it WORKS: these patients report significant reduction, if not eradication of PMS within 30 – 60 days”

What was I waiting for? It was worth a shot. I immediately changed my diet to eating Zone balanced meals. The next cycle I was stunned at the result – nothing, not the tiniest bit of breast tenderness, not a single black cloud. After 20 years of putting up with monthly discomfort – I’d finally found the answer to PMS. Unfortunately the cramps did not abate.

What about period pain: dysmenorrhoea? Dysmenorrhoea is characterised by severe uterine pain during menstruation. Primary dysmenorrhoea is not caused by any underlying medical issue such as endometriosis or fibroids (this is what I have).

One cause of dysmenorrhoea is thought to be an overproduction of pro-inflammatory eicosanoid (prostaglandin) hormones that cause pain and vascular constriction. There is also a lack of anti-inflammatory and vaso-dilating eicosanoid hormones.  In fact elevated levels of inflammatory prostaglandins have been measured in the menstrual fluid of women with severe dysmenorrhoea.

Fatty acids are the building blocks of these prostaglandin hormones – Omega 6 fats and arachidonic acid are the building blocks of the inflammatory, pain causing and vaso-constricting hormones, and Omega 3 fats are the building blocks of anti-inflammatory hormones. If your diet has an imbalance of too high levels Omega 6 and too low levels of Omega 3 you have lots of building blocks of hormones causing the pain and blood vessel constriction, and a lack of building blocks of anti-inflammatory prostaglandins.

Several studies have shown that taking omega-3 fatty acids can reverse the symptoms of dysmenorrhoea, by decreasing the amount of omega-6 FA in cell membranes and replacing it with Omega 3. High levels of omega 3 in cell membranes ensure the building blocks of anti-inflammatory hormones are available in abundance.

Interesting to me was that my period pain had become increasingly worse during my years as a vegetarian. I ate virtually no food with any decent amount of omega 3 and my body must have become increasingly deficient. After learning about Omega 3, I started supplementing my diet with 2000mg EPA+DHA (6 purified fish oil capsules a day). Within a month the pain reduced to tolerable levels, although I still needed pain relief. Not only that, but joint inflammation (knees and neck) decreased by about 80% as well. Again this was a revelation to me. Even though I had started eating fish again and restricted my intake of omega 6 – it was not enough. Only taking the additional daily supplement of omega 3 was effective. I continued to eat along Zone diet guidelines for the next 12 years, the menstrual cramps continued but were never severe as long as I took the omega 3. The PMS came back from time to time, and I couldn’t figure out why.

About 18 months ago I was introduced to the Paleo diet though CrossFit Auckland (where I started working as a nutrition coach). After reading both Robb Wolf and Loren Cordain’s work, I was convinced that Paleo food choices were worth trying. This article was particularly convincing, Cereal Grains: Humanity’s Double-Edged Sword, as was this interesting testimonial on relief of PMS and cramps on the paleo diet. http://www.thepaleodiet.com/success_stories/#menstrual

I removed grains, legumes and dairy from my diet (Paleo diet). The menstrual cramps became almost non existent as did the PMS. It’s now been 16 months 100% PMS free, and since adding magnesium to my supplements 100% menstrual cramp free. This was the missing link, when I cut these foods out completely, I got complete relief. While the Zone diet reduced these foods considerably and fixed my blood sugar and weight issues, it was not the full picture. Food quality matters, a point Robb Wolf has noted again and again when I wrote to him of my experience. The Zone: Better with Paleo Foods

Even a gynecologist I spoke to found this almost unbelievable. However, I regularly find clients have similar results to me.

Just a note here – Sears noted that GLA (evening primrose oil) helps some people, my experience of it has always been negative. I feel worse when I supplement, and it tends to increase PMS symptoms and inflammation. It is a very individual requirement. I recommend first following trying out diet and supplements below and only try GLA after a couple of months if you are not getting as much relief as you hoped for.

My recommendations for both PMS and period pain, with supportive studies (note – these are what helped me, I hope they make a difference for you, women have individual differences, if you need to consult a medical specialist first, please do so):

• Paleo diet, i.e.  grain, legume and dairy free. This will control food quality, reducing gut irritant foods. This was effective for me as was a reduced carbohydrate diet, clinical studies need to be done – article is useful (here )
• Try eating a zone balanced, reduced carbohydrate diet. Focus on getting your carbs from fibrous colourful vegetables and fruit – they increase polyphenols and antioxidants which are anti-inflammatory. They also increase the alkalinity of your diet which helps you retain calcium. Higher calcium levels are linked with less PMS
• Take Omega 3 – use a high-quality fish oil supplement. 2000 – 3000mg EPA+DHA per day. (Vitamin B1 and fish oil study here , and fish oil more effective that iburofen here)
• Magnesium: Double-blind studies have found magnesium supplementation to be effective for treating primary dysmenorrhoea. It has vaso-dilatory and muscle relaxant effects, as well as inhibiting the synthesis of prostaglandin F2 alpha (a pro-inflammatory hormone).   (here  and here )
• Zinc: in one study 1 to 3 x 30mg doses were given daily for one to four days prior to onset of menses, and prevented virtually all menstrual cramping (here)
• Vitamin E, mixed tocopherols, 200iu per day, is shown to reduce cramps and bleeding. (here and Vitamin E and fennel here)
• Cut out or minimise oils that contain Omega 6, as these can convert to inflammatory prostaglandins. Use oils that are high in monounsaturated fat (Omega 9) such as olive oil, nuts, especially macadamia and avocado. (health implications of a diet high in omega 6 here)
• Minimise arachidonic acid – this fat is the building block of inflammatory prostaglandins and is found in fatty red grain fed meat and egg yolks from grain fed chickens. Eat grass fed meat.
• Make sure your vitamin D levels are at the top of the ideal range. Calcium and vitamin D are linked with a significantly reduced PMS risk. Vitamin D is crucial for calcium absorption, if you are deficient you only absorb about 10% of the calcium from your diet. Get sunlight on your arms and legs for 10 minutes a day (off peak) in the summer. In winter it pays to supplement with 2000iu per day. See article on Vitamin D for more information. (here and here
• Do regular high intensity exercise, it elevates mood and reduces menstrual pain.(Here) Female athletes report less than normal pain with their periods.
• Take a good quality vitamin, mineral and antioxidant supplement with iron. This will ensure that dietary deficiencies are reversed.
• Cinnamon taken 3 times a day reduced bleeding and pain severity (here  and here)
• Ginger (here )
• Phaleria macrocarpa extract (here)

See Zone online shop for the following products:

OmegaRx2 high concentrate Omega 3 fish oil capsules.

OmegaRx Sport: Omega 3 concentrate plus GLA, and toasted sesame oil extract to ensure GLA is converted to anti-inflammatory hormones.

Maryland Medical Centre article on menstrual pain: http://www.umm.edu/altmed/articles/menstrual-pain-000052.htm