Jackie McNamara, Nutrition Therapist (440) 552-8824 jackie@h4hnutrition.com

menstrual dysfunctionsAny condition resulting in changes of regular menstrual flow can lead to Dysfunctional Uterine Bleeding, or DUB. In most cases, the problem is related to changes in hormone levels. Regular menstrual flow occurs about every 28 days and lasts 4 to 7 days. Abnormal bleeding is bleeding that occurs more frequently than every 21 days, less frequently than every 35 days, lasts more than 7 days, is usually heavy or light, or occurs after menopause. Menstrual dysfunctions can include:

• D y s m e n o r r h e a ( m e n s t r u a l cramps)

• Amenorrhea (absence of periods)• Menorrhagia (heavy bleeding)• Metrorrhagia (irregular bleeding)• Menometror rhag ia ( longer

duration of bleeding)• Abnormal bleeding• endometriosis (endometrial cells

in uterine cavity) • Uterine fibroids (uterine tumors)• PMS

common medical treatmentsThere are many different medical t r e a t m e n t s t h a t a r e u s e d f o r Dysfunctional Uterine Bleeding. Some are meant to return the menstrual cycle to normal. Others are meant to stop monthly periods or reduce bleeding. Women respond different to each treatment. The below treatments are traditionally used in the medical community, but are not recommended by Hungry for Health without further discussion. Below are treatments that may be included:

Hormones, such as a progestin pill or daily birth control pill (progestin and estrogen) can be taken. These hormones are given to help control the menstrual cycle and reduce bleeding and cramping.

A short course of high-dose estrogen can be given. Estrogen is a hormone that is often used to stop dangerously heavy bleeding.

Use of the levonorgestrel IUD (device placed inside the uterus), which releases

a progesterone-like hormone in the uterus. This reduces bleeding while preventing pregnancy.

Rarely used medicine that stop estrogen production and menstruation, such as gonadotropin releasing hormones. These drugs can cause severe side effects but are used in special cases.

Surgery, such as endometrial ablation (laser beam, electricity or heat used to destroy inner lining of uterus) or hysterectomy (surgery removal of uterus) is often offered, when other treatments do not work.

Finally, ibuprofen or other anti-inflammatory drugs are often offered for menstrual pain or heavy bleeding.

In the most natural cases, women will decide to use watchful waiting, or a wait-and-see approach. Irregular bleeding can be normal in women that just recently got their period for the first time, and also in women nearing menopause.

The evaluation of abnormal uterine bleeding requires a complete physical examination, detailed medical history and laboratory testing.

80% of American women have PMS at some time in their life

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Jackie McNamara, Nutrition Therapist (440) 552-8824 jackie@h4hnutrition.com

Signs and Symptoms of PMSBEHAVIORAL• Nervousness, anxiety, irritability• Mood swings and personality change• Fatigue, lethargy and depressionGASTROINTESTINAL• Abdominal bloating• Diarrhea and/or constipation• Change in appetite (usually craving

sugar)FEMALE• Tender and enlarged breasts• Uterine cramping• Altered libidoGENERAL• Headache• Backache• Acne• Edema of fingers and ankles• Fainting

Signs and symptoms of PMS occur be tween 7 and 14 days be fore menstruation, and are recurrent. 30-40% of menstruating women experience symptoms of PMS, and about 10% of those women have severe symptoms. Because the symptoms affect women in s o m a n y d i f f e r e n t a s p e c t s , pharmaceutical companies have used PMS as an opportunity to use their drugs to mask symptoms, rather than treat the underlying condition. Examples include anti-depressant drugs and anti-anxiety drugs. Unfortunately, the risks almost always outweigh the benefits.

In women with PMS, there seems to be a common pattern of elevated estrogen levels and reduced plasma progesterone levels five to ten days before the menses. Reduced progesterone is often associated with corpus luteum insufficiency as well. In addition, hypothyroidism and/or elevated prolactin, FSH and aldosterone levels are common. Other underlying factors may include stress, depression and nutritional factors such as macronutrient deficiency or excesses.

Nutrition & Lifestyle Intervention that may help

The appropriate approach is to identify the factors causing PMS, and identifying the appropriate treatment using dietary therapy, nutrition supplementation and exercise. Women who suffer from PMS typically have a fairly unhealthy diet. Guy Abraham, M.D., reports that, compared to symptom-free women, PMS patients c o n s u m e : 6 2 % m o r e r e fi n e d carbohydrates, 275% more refined sugar, 79% more dairy products, 78% more sodium, 53% less iron, 77% less manganese, and 52% less zinc. PMS symptoms should be treated nutritionally w i t h t h e f o l l o w i n g d i e t a r y recommendations:• Follow a predominantly vegetarian diet-

vegetarian women have shown to excrete 2-3 times more estrogen in their feces and have 50% lower levels of free estrogen in their blood than omnivores.

• Reduce your intake of fat- Decreasing the percentage of calories consumed as saturated fat has a dramatic effect on reducing circulating estrogen levels, and on PMS symptoms.

• Eliminate sugar intake- A strain on blood sugar control has a detrimental effect on PMS symptoms and mood. The most significant symptom-producing food in PMS appears to be chocolate.

• Reduce dietary exposure to environmental estrogens- Environmental estrogens are found in toxic pesticides, which are hard to break down and are stored in fat cells. Minimizing exposure can contribute to lowered PMS symptoms.

• Increase your intake of soy foods- Soy foods contain phytoestrogens, which have a balancing action on estrogen effects. If estrogen levels are low, estrogenic activity in phytoestrogens will cause an increase in estrogen effects. If estrogen levels are high (as in PMS), phytoestrogens bind to estrogen-receptor sites, competing with estrogen and decreasing estrogen effects. Soy products should be consumed whole, not processed.

• Eliminate caffeine consumption- Caffeine consumption is strongly related to the severity of PMS, and in psychological symptoms associated with PMS.

• Keep your salt intake low- Excessive salt consumption contributes to kidney stress, high blood pressure, water retention and PMS symptoms. This should be accompanied with increased potassium intake. Daily sodium intake should be below 1,800 milligrams.

• Weight Management- Consult your nutrition therapist about appropriate weight management for you. Weight fluctuation can have a significant impact on hormone levels and both physical and emotional symptoms of PMS.

• Exercise- Exercise significantly improves mood and physical symptoms during PMS. In addition, exercise elevates endorphin levels, lowering cortisol levels. 30 minutes of cardiovascular exercise each day is recommended.

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The nature of PMSCauses & Risk Factors

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• Herbs for PMS symptom relief- Angelica of Dong Quai, Licorice root, Black Cohosh and Chasteberries. Consult your nutrition therapist for appropriate dosage recommendations.

• Supplementation that helps relieve PMS symptoms- 50-100 mg vitamin B6/day, 300-500 mg Magnesium/day, 1,000 mg calcium if mood and water retention are symptoms, 15-20 mg. Zinc/day. Consult your nutrition therapist before supplementing.

Jackie McNamara, Nutrition Therapist (440) 552-8824 jackie@h4hnutrition.com

Like many other conditions in our society today, stress definitely does play a part in PMS. Stress triggers biological changes in our brain which result in adrenal gland function and endorphin secretion or action. When stress is extreme, unusual or long-lasting, symptoms can be worse. These changes produce a domino effect that leads to alterations in normal physiology. Effective treatment of PMS must include stress management.

When it comes to stress, there are many aspects to be addressed, including negative coping patterns, time management and relationship issues. Ginseng is an herb that can improve the ability to deal with stress. In addition to managing coping patterns, dietary recommendations include the following: Eliminate or restrict the intake of caffeine, eliminate or restrict the intake of alcohol, eliminate refined carbohydrates from the diet, increase the potassium-to-sodium ratio in the diet, eat regular planned meals in a relaxed environment, and control food allergies. Many of these recommendations follow those of controlling PMS symptoms.

So what is the connection between stress and PMS? Well, stress increases cortisol levels. Cortisol, a hormone released primarily by the adrenal glands in response to feelings of anger,

fear or danger, is also released to help you push through a stressful day. It is essentially a backup energy system. Unfortunately, cortisol competes with progesterone for common receptor sites in our cells. This means the elevated cortisol impairs progesterone activity, setting the stage for estrogen dominance. And what does estrogen dominance mean for menstruating women? PMS. In addition, high cortisol levels also affect blood sugar. Cortisol sends blood sugar flooding into the cells. The initial rush of glucose into the cells may feel great, but twenty or so minutes later your body will be working overtime to produce more glucose and you’ll be running to the vending machine for candy bars, cookies and potato chips to get your blood sugar and your energy back up. What does this mean for you long-term? It means that these empty calories will eventually be converted to fat, leaving you struggling to keep your weight down and your energy up.

Control your stress with stress exercises including journaling, yoga, exercising, meditation, talking with a friend, or taking time to do the things you enjoy. There’s no harm in simplifying your life. Put yourself first for once and forget about being involved in too many things to handle.

Does stress play a part? pms and the stress connection

39 percent of students suffer from mild to severe depression. Stress is characterized by feelings of tension, frustration, worry, sadness and withdrawal that commonly last from a few hours to a few days. Depression is both more severe and longer lasting, and is characterized by more extreme feelings of hopelessness, sadness, isolation, worry, withdrawal and worthlessness that last for two weeks or more. Depression is the most important risk factor for suicide.

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Jackie McNamara, Nutrition Therapist (440) 552-8824 jackie@h4hnutrition.com

3-day menu planfor PMS relief

Day 1

BREAKFAST1 egg 1/4 avocado1 slide sprouted bread1/3 cup mixed berries2 glasses of water

LUNCHRoast chicken with onion & garlicCruciferous vegetablesBrown rice with seasoningsAppleAlmond butter

DINNERSalmon (sauteed in olive oil)Spinach salad with oil based dressing Avocado & any other vegetablesQuinoa

Day 2BREAKFAST1/4 cup carrots1/2 cup whole grain granola1 TBSP flax seed1/3 cup greek yogurt1 banana

LUNCHTuna salad with olive oil (no mayo)Bed of spinach greensBean of choice (on salad)1 pear1/3 cup macadamia nuts

DINNERGrilled halibutStir fry broccoli & carrotsBrown riceTop with ghee if desired

Day 3BREAKFASTProtein shake1/4 cup grapesAlmond milk (in shake)1 TBSP flax seed (in shake)

LUNCH1 KiwifruitLentil soupSide salad with oil & vinegar dressingTop with ground flax seed

DINNERTurkey burger with lettuce and tomatoWhole wheat bunSide green beans with sea salt1 sweet potatoTop with ghee if desired

SnacksNuts of choiceFruit of choice with nutsHummus with celery sticksDried fruit with nutsVegetable sticks of ay kindNuts and nut buttersAvocadoRice crackersTaro chipsBrown rice cakes

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