PMS, Perimenopause, and Menopause



Most women’s health conditions are related to hormonal imbalance. In the reproductive years, a woman’s hormones cycle each month and women may experience symptoms of pre-menstrual disorder, PMS. Later in life as women near menopause, the hormones begin to fluctuate, ovulation is inconsistent, and menstrual bleeding patterns can change. Although the menses might still be regular each month, a woman may begin to experience early symptoms of menopause. This phase is called peri-menopause. After a woman has gone an entire year without a menstrual cycle, she is then in menopause. This is a natural body process but may produce symptoms that require treatment. Naturopathic treatments for PMS, peri-menopause, and menopause are an effective way to help women in all phases of her life.



Premenstrual syndrome refers to the variation of physical and mood symptoms that appear during the last one or two weeks of the menstrual cycle and disappear by the end of a full flow of menses. Up to 80% of women have cyclic symptoms associated with their menses but only about 3-5% have symptoms so severe that it interferes with work, school, usual activities or relationships. PMS looks more at physical symptoms such as bloating, weight gain, breast tenderness, swelling of hands and feet, aches and pains, poor concentration, sleep disturbance, appetite change, and mood changes.


PMDD-1.jpgPMDD stands for Premenstrual Dysphoric Disorder. It is the acronym for the more severe form of PMS. PMDD is characterized by severe monthly mood swings and physical symptoms that interfere with everyday life, especially a woman’s relationships with her family and friends. Symptoms include depression, anxiety, emotional swings, and concentration difficulties, lack of energy and motivation, change in appetite, sleepiness and feeling overwhelmed. PMDD symptoms go far beyond what are considered manageable or normal premenstrual symptoms. PMDD significant depression and hopelessness may occur and in extreme cases, women may feel like killing themselves or others and need to seek professional help immediately.


Dietary changes can effectively relieve symptoms of PMS. Some examples include;

1. Eat smaller more frequent meals

2. Limit Simple Sugars and carbohydrates

3. Increase complex carbohydrates, including flax seeds

4. Limit salt intake to 1,000mg-2,000mg

5. Eliminate caffeine and alcohol      


Exercise is another effective means of balancing hormones and easing PMS. As little as 30 minutes three times a week of aerobic activity can improve mood, decrease irritability and increase tolerance to stress. Exercise can decrease aches and pains, reduce fluid retention and breast tenderness. Exercise increases the body’s production of endorphins which relieve mild depression.


Botanicals can be helpful in treating the symptoms of PMS but can interact with medications including the birth control pill. Seek out the advice of a naturopathic physician before using botanical medicines. It is best to use both the whole plant and the standardized extract. Nutrients normally made by the body may be deficient and can contribute to symptoms of PMS. By adding vitamins, minerals, amino acids, and omega fatty acids one may replenish deficiencies. Be cautious to only take nutrients if you are deficient, which can be determined through blood and urine tests, so you don’t get symptoms of nutrient excess.



Perimenopause.pngMany women begin to experience physical and mental-emotional symptoms long before they meet the definition of menopause. These changes that occur over several years usually from around age 40 to 51 are a transition period called peri-menopause. On average, the onset of peri-menopause occurs around age 45 and the average duration is 4 to 5 years.


The symptoms of peri-menopause symptoms are varied, unpredictable and often go unrecognized. Often women request hormone testing during this phase which can be very difficult due to fluctuating hormone levels, irregular menstrual patterns, and inconsistent ovulation. Other conditions such as fibroids, polyps, and uterine hyperplasia may arise during this time of a women’s life and produce similar symptoms. These conditions need to be ruled out and often go undiagnosed because both women and doctors mistake the symptoms as peri-menopause.


The signs and symptoms of peri-menopause include menstrual irregularities and changes in the amount of blood loss, hot flashes, night sweats, vaginal dryness and thinning, skin changes, fatigue, decreased libido, decrease in arousal and orgasmic response, mood swings, weight gain, joint pains, depression, anxiety, changes in memory and cognition, sleep disturbance, hair loss on head, hair growth and acne of face, heart palpitations, nausea, headaches, urinary tract infections, urinary incontinence, and the beginning stages of osteoporosis and heart disease.


There are several natural treatment options for peri-menopause and depend on a woman’s symptoms. For example, if menstrual irregularities are the main concern then controlling and regulating the bleeding is the first priority. Often times, bio-identical hormone therapy is used to accomplish this goal along with botanical medicine and dietary isoflavones.



Menopause is a normal part of the aging process that affects women in their 40’s and 50’s. The definition of menopause is the cessation of the menstrual cycle. It is not a disease condition, although is often thought of and treated as a disease. A woman becomes postmenopausal after going an entire year without a menstrual cycle. A simple blood test checking estradiol and follicle stimulating hormone can confirm if a woman is in menopause.

Hormones-Menopause-Sx.jpgSymptoms of menopause include:

1. Hot flashes

2. Vaginal dryness

3. Mood changes

4. Dry skin and hair

5. Decreased concentration and memory

6. Low libido

7. Insomnia

8. Joint pain


There are several ways to treat menopause and treatment should be individualized based on a woman’s risk for breast cancer, heart attack, stroke, and blood clots. What works for one woman may not work for another. Categories of naturopathic treatments for menopause include:

1. Bio-identical, natural hormone therapy

2. Diet and nutrition

3. Lifestyle, including exercise and stress management

4. Botanical medicine

5. Homeopathy

6. Nutritional supplements


Naturopathic treatment interventions address the whole person treating not only symptoms of menopause but also prevent diseases associated with menopause. Prevention of conditions, such as osteoporosis, breast cancer, and heart disease, need to be addressed in the menopausal years.



More than ever before, women with PMS, entering peri-menopause and menopause, are educating themselves, asking their doctors questions, and requesting information about options for treatment. Naturopathic treatment options are an effective way to address a woman’s hormonal conditions. After ruling out conditions with similar symptoms, testing hormone levels in the body, assessing women’s risk factors for future health conditions, an individualized treatment plan is created.  Due to the complex nature of bio-identical hormone replacement therapy, herb-herb interactions, and drug-herb interactions, it is recommended that menopausal women seek the expertise of their naturopathic doctor.




Article contributed by Dr. Marianne Marchese