While 30% of women suffer from PMS each month, up to 8% suffer from a more extreme form, premenstrual dysphoric disorder (PMDD). Although the exact cause is still largely unknown, research suggests an increase in estrogen with changes in subsequent vitamin D and calcium synthesis may be involved.
PMDD Emotional Symptoms More Severe Than PMS
While PMS and PMDD both manifest with physical and emotional symptoms, PMDD causes more extreme mood shifts in women that can interfere with their work and relationships. PMDD symptoms occur during the luteal phase (latter part) of the menstrual cycle and are virtually non-existent during the follicular phase.
PMDD disappears at menopause, remits during pregnancy, and improves with ovarian hormone suppression therapy. In both PMS and PMDD, women experience symptoms in the last week of the menstrual cycle which generally improve a few days after menstruation begins.
PMDD and PMS both share symptoms of bloating, breast tenderness, fatigue, and changes in sleep and eating habits, but women with PMDD often experience a combination of the following emotional and behavioral symptoms:
- Feelings of being “keyed up” or “on edge”
- Mood swings
- Persistent irritability
- Marked anger
While the exact cause is unclear, research has shown a link between calcium deficiency and mood abnormalities which suggest PMDD may be linked to extreme fluctuations in calcium-regulating hormones in some women during their menstrual cycle.
Calcium Improves PMS & PMDD Symptoms
In a 2007 study on calcium and PMDD, lead author Susan Thys-Jacobs writes, “women with PMS were shown to have exaggerated fluctuations of the calcium regulating hormone across the menstrual cycle with evidence of vitamin D deficiency and secondary hyperparathyroidism.”
Thys-Jacobs’ research team investigated calcium’s role in PMS and PMDD based on earlier evidence linking mood disturbances and calcium metabolism. “On the basis of previous studies linking abnormalities in mood,” writes the author, “this investigation has now found that the pattern of cyclical fluctuations in the calcium-regulating hormones, specifically ionized calcium, urine calcium, and 1,25 (OH)2D (vitamin D) differs between women with PMDD and those without.”
Although there’s still no consensus among scientists the degree to which calcium-regulating hormones vary in women with PMDD, the 2007 study indicated that serum calcium declines at three points during a woman’s cycle: at menses, at mid-cycle, and during the late luteal half of her menses.Vitamin D Synthesis Involved in PMDD Symptoms
The research team found that although women with and without PMDD symptoms were low in vitamin D, women with PMDD metabolized vitamin D differently during their menstrual cycle than women without PMDD. Asymptomatic women had more access to stored calcium in their body during their menstrual cycle than women with symptoms. Researchers believe vitamin D plays a role in regulating the level of calcium released during the menstrual cycle.
Estrogen is likely involved as well. Estradiol, a component of estrogen, peaks during the ovulatory and luteal phase of menstruation to regulate vitamin D metabolism and to help prevent bone loss by keeping bone from being reabsorbed. When estrogen inhibits calcium from being released from bone, it lowers serum calcium which leads to a rise in the parathyroid hormone, triggering an increase in 1,25(OH) 2,D synthesis. Elevated 1,25(OH) 2,D may contribute to vitamin D and calcium deficiency, and subsequently cause PMDD symptoms.
While the exact cause of Premenstrual Dysphoric Disorder is still unknown, a growing body of evidence suggests there may be a link between elevated estrogen levels and how vitamin D and calcium are metabolized in some women during their menstrual cycle.Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
- Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. “Calcium and vitamin D intake and risk of incident premenstrual syndrome.” Archives of Internal Medicine, June 13, 2005.
- Khajehei M, Abdali K, Parsanezhad ME, Tabatabaee HR. “Effect of treatment with dydrogesterone or calcium plus vitamin D on the severity of premenstrual syndrome.” International Journal of Gynecology and Obstetrics, May 2009.
- Thys-Jacobs S, McMahon D, Bilezikian JP. “Cyclical changes in calcium metabolism across the menstrual cycle in women with premenstrual dysphoric disorder.” Journal of Clinical Endocrinology and Metabolism, May 2007.
PMS Exact Causes and Treatment Remain Elusive
The Centers for Disease Control’s National Women’s Health Information Center cites that 30-40% of women experience some impairment of their daily activity due to premenstrual syndrome (PMS), 75% experience at least some symptoms, and 3-8% have severe premenstrual symptoms, a condition called premenstrual dysphoric disorder (PMDD).
Yet the exact cause of PMS and PMDD, and therefore most effective treatments, remain elusive, largely due to the variability of underlying triggers across women. Writes Dr. Tori Hudson, a naturopathic physician, on her website: “It is difficult to identify the cause in a condition that overlaps so broadly with normal physiology, affects so many, and has such a wide array of symptoms. Many theories have been explored and none found completely satisfying. Most likely this is because it is such a complex interaction of factors both physiologic and social.”PMS symptoms vary according across women and can change in severity each month, generally however, women experience some combination of physical and emotional changes including, according to WebMd:
- Bloating and tender breasts
- Food cravings
- Lack of energy
- Low back pain
Emotional and Cognitive:
- Feel sad, angry, or anxious
- Be less alert
- Find it hard to focus on tasks
- Want to withdraw from family and friends
- Act in a forceful or hostile way.
A number of factors are thought to contribute to PMS and PMDD such as inadequate vitamin B6, calcium, or magnesium intake, lack of exercise, too much caffeine, hormonal changes that contribute to the symptoms of estrogen dominance, and neurotransmitter imbalances such as a drop in serotonin levels. Stress can also exacerbate symptoms. The underlying relationship of stress to PMS, while still not entirely understood, is likely related to differences in the stress-regulation feedback system in women as they enter their cycle.
Premenstrual Syndrome and the Cortisol ConnectionCortisol, often referred to as the “stress hormone,” is produced and secreted by the adrenal glands. In excess cortisol has been linked to abdominal obesity, Type 2 diabetes, and an inflammation state in the body, the cause of numerous diseases. Cortisol increases in response to chronic stress, triggering the body to make glucose from amino acids which causes blood sugar to rise. Cortisol is primarily released in response to feelings of fear, danger or even a sense of competition.
As with any hormone, when cortisol is left to do its job and kept in balance, it isn’t harmful to health. Emma Adam, Northwestern University assistant professor of Education and Social Policy, explains cortisol’s role in the body, “Cortisol helps us respond to stressful experiences and to do something about them,” she said. “It is necessary for survival — fluctuations in this hormone assist us in meeting the changing demands we face in our daily lives.” A stress-cortisol-activated body that never comes back into balance however, is at risk for health problems.
Cortisol works within its own circadian rhythm with levels increasing before people wake up in the morning so their body can prepare for the stresses of the day. Levels generally drop during various times of the day and evening hours, yet if cortisol remains high or surges at night, the disruption to the circadian rhythm can lead to insomnia or early waking. Lack of sleep alone can exacerbate symptoms of PMS, yet physical or emotional stress produces higher than normal levels of cortisol, which can make some premenstrual symptoms worse.
Dr. John R Lee M.D, writes in his book, What Your Doctor May Not Tell You about Premenopause, [Warner Books, 1999], the way in which cortisol, stress and hormones contribute to PMS, “Since cortisol and progesterone compete for common receptors in the cells, cortisol impairs progesterone activity, setting the stage for estrogen dominance. Chronically elevated cortisol levels can be a direct cause of estrogen dominance, with all the familiar PMS symptoms,” writes Lee.PMS and Cortisol: The Blood Sugar, Food Cravings and Weight Gain Cycle
High cortisol also levels affect blood sugar, sending glucose into the cells, a process that may partially explain the common food cravings many women experience during PMS. The initial flood of glucose may at first feel good, but a half hour later or so the body has to work overtime to produce more glucose.
The result? High cortisol promotes cravings, pushing people to grab candy bars, cookies and potato chips in an attempt to get their blood sugar (glucose) and energy back up. The vicious cycle continues with the long term affect of eating empty calories, negatively affecting mood and packing on the pounds, explains Lee.
The fluctuations in blood sugar also prompts another type of negative feedback cycle. High blood sugar stimulates the release of adrenaline, which in turn stimulates the release of cortisol which stimulates cravings for quick calories, and so, the cycle continues.
Tulsi Lowers Cortisol Levels, May Improve PMS Emotional Symptoms
In a 1998 study Boston researchers studied women with varied intensity of premenstrual symptoms in relation to their cortisol output. Results showed that during the follicular and luteal phases (the latter is the day after ovulation that runs through the remainder of a woman’s cycle); women experienced statistically significant differences in symptom severity.
Researchers also found that during the luteal phase (but not the follicular) there was a difference in cortisol output among the women. The authors of the study suggest that during the phases of the monthly menstrual cycle some women experience changes in the stress regulation-feedback system in relation to their cortisol output.
Reducing cortisol levels may help reduce premenstrual symptoms in some women, and Tulsi or Holy Basil, a highly honored herb in India with numerous medicinal properties, can decrease cortisol output.
Tulsi assists in maintaining equilibrium by modulating several biochemicals associated with stress responses, including cortisol, serotonin, epinephrine, norepinehprhine, dopamine, and inflammatory mediators.
Sacred in the Hindu religion, Holy Basil, or Tulsi, (sometimes spelled Tulasi) can be found growing profusely around temples. As a principal herb of Ayurveda, the ancient traditional holistic health system of India, Holy Basil’s medicinal properties are: anabolic, hypoglycemic, smooth muscle relaxant, cardiac depressant, antifertility, adaptogenic, immunomodulator, antioxidant, hepatoprotective (liver protecting) and gastrointestinal protective.
Certain herbs have the ability to improve the body’s resistance to stress, a process referred to as a State of Non-specific Increased Resistance (SNIR). SNIR was proposed by N.V. Lazarev in 1958, and the herbs and tonics that evoked SNIR were named “Adaptogens” or “Athenktotropics.” Adaptogens help the body adapt to stressors or cause adaptive reactions by increasing the defensive power of an organism. Adaptogens support the body’s systemic response to stress and can increase stamina.
Holy Basil Dosing and Safety
Holy Basil can be ingested as a supplement, herbal tea, dried powder, fresh leaf, or mixed with ghee, a Southeast Asian clarified butter.
The appropriate dose depends on several factors such as the user’s age, health, and several other conditions. According to WebMd.com there is not enough scientific information to determine an appropriate range of doses for holy basil. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.
While the symptoms of premenstrual syndrome are complex and often tied to a variety of interrelated physical, emotional and social conditions, the ancient and revered herb Tulsi, or Holy Basil, may be effective to lower cortisol levels, the stress hormone known to exacerbate PMS symptoms in some women.
- Cahill, CA., “Differences in cortisol, a stress hormone, in women with turmoil-type premenstrual symptoms.” Nursing Research, 1998 Sep-Oct;47(5):278-84.
- Khanna, N. “Antinociceptive action of Ocimum sanctum (Tulsi) in mice: possible mechanisms involved.” Journal of Ethnopharmacology. October 2003.
- Lazarev, N. V., Farmacology Toxicology. (1958): 21, 81. Quoted from Ref. No.4.
- Mondal S, Mirdha BR, Mahapatra SC. “The science behind sacredness of Tulsi (Ocimum sanctum Linn.). “ Indian Journal of Physiology Pharmacology. Oct-Dec 2009.
- Prakash P, Gupta N. “Therapeutic uses of Ocimum sanctum Linn (Tulsi) with a note on eugenol and its pharmacological actions: a short review.” Indian Journal of Physiology Pharmacology. April 2005.
- Singh, N., Nath, R., Mishra, N. and Kohli, R.P. “An Experimental Evaluation of Anti-stress Effects of Geriforte (An Ayurvedic Drug).” Quarterly Journal of Crude Drug Research. 1978.
- Singh, N., Hoette, Y., and Miller, Ralph, “Tulsi: The Mother Medicine of Nature.” International Institute of Herbal Medicine (Lucknow, India). 2002.
- Shinrigaku, Kenkyu “Influences of premenstrual syndrome on daily psychological states and salivary cortisol level.” 2005 Dec;76(5):426-35.
- Vaughan Tremmel, Pat. “Day-to-day experience-cortisol dynamics.” Institute for Policy Research, Northwestern University. November 15, 2010. Web.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.