Other possible menstrual irregularities, as discussed by Susan Lark, M.D., in the PMS Self Help Book (Celestial Arts, Berkeley, CA, 1984), have symptoms that may be related to low estrogen levels. Women with this problem often experience more of their symptoms after their period than before it. This low-estrogen state is far less common than the progesterone deficiency. Occasionally, tests to measure hormonal levels can be done at specific times of the month. However, these are expensive and not always easy to interpret (the range of normal is wide) unless done repeatedly. Generally though, as long as there are relatively regular menstrual periods, these ovarian and pituitary hormone levels will be within normal values. Other tests that may be abnormal include thyroid hormone levels, thyroid antibodies, or antiovarian antibodies, which may represent some autoimmune problems.

Another common symptom, not only of PMS but of most women’s premenstrual time, is a craving for sweets. This desire is often enhanced in those with PMS, which brings up another important point. Women with PMS often have other correlating conditions that may contribute to symptoms. These include hypoglycemia (low blood sugar), candidiasis (an overgrowth of and hypersensitivity to the common yeast Candida albicans), food and/or environmental allergies, moderate to severe stress, and vitamin and mineral deficiencies. Whether these problems contribute to or are a result of the premenstrual and hormonal problems is not clear, but it is important to evaluate women for these conditions when they either have significant PMS symptoms or do not respond well to treatment. PMS is definitely aggravated by low blood sugar generated by stress and an intake of refined flour and sugar products.

From a dietary point of view, it is important to avoid the food stressors, irritants, and stimulants that, if they do not contribute to the PMS problem in the first place, definitely make it worse. These include sugars and refined foods, caffeine, alcohol, and chemicals. A diet that helps in reducing symptoms is a balanced, wholesome, and high-nutrient one, with lots of whole grains, leafy greens and other vegetables, good protein foods, and some fruits, but a minimum of fruit juice. A hypoglycemic diet of regular meals and protein-oriented snacks is often helpful. If there are yeast or allergy problems, a diet to help with those conditions (see previous programs) would be beneficial. If these problems are not present, extra brewer’s yeast, with its high levels of B vitamins and minerals, can be a supportive food. Eating a variety of foods and a modified rotation diet (as is discussed in the Allergy program in this chapter) are also helpful in getting the wide range of important nutrients and maximizing food sensitivities. Some women also experience a reduction of symptoms through colon detoxification and a cleansing-type diet high in juices, soups, and salads. Intake of fiber as psyllium or bran started a week before symptoms usually begin will improve colon elimination, and an enema or colonic irrigation at the time symptoms begin might be helpful.

Premenstrual syndrome is more common in women in their 30s and 40s than in those in their 20s and teenage years. Dr. Lark points out a number of other factors associated with an increased likelihood of PMS problems—these include women who are or have been married, do not exercise, have had children, experience side effects from birth control pills, have had a pregnancy complicated by toxemia, have a significant amount of emotional stress in their lives, or those whose nutritional habits lead to certain deficiencies or excesses. Dietary factors that worsen PMS include foods high in refined sugars and fats, processed or chemical foods, caffeine drinks (coffee, tea, colas), alcohol (especially wine and beer with the higher carbohydrate level), chocolate products, eggs, cheese, red meats, and high-salt foods. A natural food diet, of course, will help alleviate the symptoms of PMS.