妳的月經正不正常? 經痛與經前症候群(PMS)完整解讀版 子宮肌腺瘤與子宮內膜異位症(Endometriosis) 作者:蔡鴻文醫師 新光醫院婦產科主治醫師/ 鴻文婦產科診所院長
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女性月經週期是什麼? 月經週期是由於子宮內膜週期性的生長和破壞所產生。每一個月子宮內膜都準備好接受一個卵，假如未受孕則子宮內膜會受破壞，同時從陰道中排出，這種子宮內膜的變化直接受到卵巢和腦部下方的一個小腺體(即腦下垂體)荷爾蒙所控制。在腦部的指示下，垂體分泌多種荷爾蒙，一種可刺激卵巢產生成熟卵泡，並且卵泡可分泌動情素，刺激子宮內膜的成長，另一種荷爾蒙可促進排卵且讓卵泡變成黃體，黃體分泌黃體素，進一步的準備胎兒在子宮內膜著床。如無受孕，子宮內膜也隨之從陰道中排出形成月經，於是一個新的月經週期又開始產生。
2008年比利時醫生首次拍得人類排卵珍貴照 卵子由卵巢旁的囊狀卵泡及囊胞製造，在每月的排卵期，囊狀卵泡會呈現紅色而且變得突出， 受膠狀物質包圍的卵子在囊狀卵泡末端排出。
月經週期賀爾蒙與排卵圖解
月經是什麼? 所謂月經是指排卵後沒有懷孕所導致子宮內膜剝落而引起的出血，是一種自發性、週期性的出血。 月經週期分成三個階段，1.濾泡期 2.排卵期 3.黃體期 濾泡期
包含了濾泡成熟及子宮內膜組織增生到崩解的這段期間，大約是10—14天。一般定義月經是經血的第一天(Day-1)並維持平均3~7天左右，在這段期間雌激素(Estrogen)和黃體酮(LH)的含量達到最低點，當經血停止時就是濾泡期開始，子宮內膜組織生長並變厚，此時FSH的濃度上升，卵巢中的濾泡開始生長成熟，約兩星期後濾泡內的卵可達完全成熟階段(直徑約2公分)；另一方面FSH也刺激卵巢產生雌激素，藉由雌激素刺激黃體酮的分泌，黃體酮的功用是促使最成熟的濾泡中具生育能力的卵排出，並釋放到輸卵管中而進入排卵期。 妳的月經正不正常? 初經:女性第一次來經(初經)通常在12或13歲時。 過重、肥胖或是環境荷爾蒙的干擾都會導致初經的年齡提前,初經的1、2年月經週期的長度是很不穩定的，慢慢的隨著年齡增長，月經週期會變的比較規律，平均28天左右，一般而言，瘦的女性或女運動員，月經週期會較長；而飲酒的女性則較短. 年輕女孩的月經天數大約是6.6天，21歲後一直到停經前，一般是6天。瘦的女性又有抽煙習慣者會有較長的月經；女運動員月經會較短；另外，服用口服避孕藥或注射避孕藥者月經也會較短。 正常月經:正常月經大約二十一天到三十五天出現一次，每次出血三到七天左右，出血量平均每次三十三西西，最多不超過八十西西。 月經血量在頭兩天最多，多寡可以由使用衛生棉的數量來判斷，但一般而言，如果週期短於二十一天，或出血持續超過七天，或超過八十西西的出血量就可以說是不正常月經。不正常月經有著許多不同的呈現方式，如果出血週期不規則也不頻繁，通常四十天以上才來一次的情形，叫做月經次數過少。如果出血週期規則而且很頻繁，往往不到二十一天就來一次的情形，叫做月經次數過多。如果出血週期規則，但出血天數或出血量過多時，叫做月經血量過多。反之出血週期規則，但是出血天數或出血量很少時，叫做月經血量過少。另外如果出血天數或出血量正常，但是週期不規則，就叫做不規則月經。 月經來時的衛生習慣: 月經不規則的原因: 月經不規則的原因很多，最常見的原因是荷爾蒙分泌不正常所造成。而荷爾蒙分泌不正常的原因又有很多，包括：月經初來的前幾年，荷爾蒙分泌系統還不成熟；停經前的婦女，荷爾蒙系統開始退化；過胖或過瘦或快速減肥(每月減5公斤以上)；長時的心理上壓力(如，將要大考)或是體力上的壓力(如，長跑選手)致荷爾蒙分泌系統紊亂；其他內分泌系統的問題(如甲狀腺機能亢進或是低下)也會影響荷爾蒙的分泌；性荷爾蒙分泌系統的腫瘤如多囊性卵巢PCOS,腦下垂體腫瘤,高泌乳激素症
經痛與經前症候群(PMS): 痛經和經前症候群都是女性最常見的困擾，根據統計，大約有百分之十的婦女在十幾歲到二十幾歲之間，都有嚴重痛經的經驗。痛經是女性向學校或是公司請假最常見的原因。 經前症候群則和月經週期的荷爾蒙變化有關，患有經前症候群的婦女，會在月經之前的三天到七天左右，有明顯的情緒變化，或是生理上感到不舒服；大約有二到四成的婦女，或多或少都有經前症候群，有百分之二點五到百分之五的婦女，會因為經前症候群影響到日常生活。 月經疼痛是婦科最常見的問題,月經疼痛通常分為原發性及次發性兩種，原發性是指沒有任何骨盆腔疾病情況下發生的痛經，次發性則是指因為其他疾病所引起的痛經。 原發性月經疼痛 通常在經血出現前幾個小時就開始痛，或是疼痛伴隨著經血一起出現，可持續幾個小時到幾天。疼痛主要在下腹部，有人會有噁心、嘔吐、倦怠、腹瀉、背痛、頭痛等症狀。心理、對痛的經驗等因素都可能會影響女性對月經疼痛的感受，經痛的症狀也有許多面貌，下腹痛是最常發生的其他如絞痛、 腹漲、隱隱作痛、下背部酸、麻、脹，有多人併有噁心、拉肚子、頭痛等等持續上一整天，甚至好幾天。造成原發性月經疼痛的主要原因還是前列腺素。當月經來時子宮會產生前列腺素，如果製造過多就會增強子宮收縮，造成子宮缺血而嚴重疼痛。 次發性病理性的經痛，則可能連痛兩三天，痛到無法移動，甚至休克。 所謂病理性經痛，就是骨盆腔疾病所導致的疼痛如骨盆腔發炎、子宮肌腺瘤, 子宮外孕,子宮後傾,子宮內膜異位,子宮腔內粘黏,卵巢囊腫,多囊性卵巢)、骨盆腔黏連等等。診斷病理性經痛的方法包括詳細的病史，骨盆腔診視，超音波檢查，以及血液篩檢等，大多數的經痛原因 都可檢查得出來。 經前症候群依症狀有那些症狀呢？ 經前症候群的症狀多端，至少有一百種以上的心理性，生理性，和行為症狀與它相關。經前症候群常見的症狀如下： 依症狀與原因可以粗略分為: PMS-A(Anxiety)焦慮型 原因:雌激素荷爾蒙分泌過多,黃體素分泌不足 PMS-D(Depression)情緒低落型 原因:雌激素荷爾蒙分泌不足,黃體素分泌過多 PMS-C(Cravings)無精打采昏沈型 原因:胰島阻抗血糖過高 PMS-H(Hyperhydration)水腫抑鬱型 原因:腎上腺皮脂素分泌過多 子宮肌腺瘤(Myoma) 子宮肌腺瘤是肌肉細胞形成的良性腫瘤,也是骨盆腔最常見的腫瘤。 可能原因:子宮肌瘤形成的因素至今仍不是十分明白,幾種可能的因素:
1.雌激素(estrogen)的刺激 2.長久的痙攣:子宮長期處於緊張的狀態,在子宮壁內引起一種肌肉纖維反應而產生子宮肌瘤。
3.生長激素(growth hormone):有人認為子宮肌瘤與生長內泌素有關。 症狀：子宮肌瘤不一定會產生症狀,其症狀的產生主要決定於肌瘤的位置、大小、是否懷孕及變性的狀態,大約35-50%的子宮肌瘤患者會有以下症狀: 1.不正常的子宮出血:不正常的子宮出血是子宮肌瘤最重要的臨床表現,大約30%的病人會有此症狀。大部份的病人以月經延長及月經變大量表現,但亦可以任何形式的不正常子宮出血表現,如月經前點狀出血。 2.腹痛:一般的子宮肌瘤並不會有腹痛,但在下列的情況可能產生腹痛的現象:壓迫症狀:子宮前臨膀胱,故當子宮肌瘤壓迫周圍組織時可能引起頻尿小便失禁及輸尿管水腫等症狀,此外子宮肌瘤亦可能造成便秘、脹氣、下肢水腫和靜脈曲張等現象。 3.不孕:子宮肌瘤可能因影響精子的運輸、不正常的輸卵管移動及不正常的子宮血流而引起不孕。 4.自然流產:子宮肌瘤的患者其自然流產的可能約為正常婦女的2-3倍。
子宮內膜異位症(Endometriosis) 子宮內膜異位症就是子宮內膜細胞因某些原因，散佈至子宮以外其它地方繁殖(如卵巢、輸卵管、腹膜、腸子、肺臟..等)，造成骨盆腔慢性發炎、粘連，進而導至不孕，痛經，以及慢性骨盆腔疼等臨床症狀謂之。 可能原因: 1.月經時經血逆流至腹腔內，因其中含有活的內膜細胞，此細胞若在腹腔內著床並增生即可能演變成內膜異位症。
2.腹膜細胞經由某些刺激(如感染)後造成。
3.經常卵泡黃體化而不排卵的病人，因為體內長期處於低濃度的動情素及黃體素易造成此病。
4.免疫系統發生障礙者 症狀: 1.痛經
2.性交痛
3.慢性骨盆腔痛
4.不孕(經常月經疼痛且同房會痛的病人需格外注意) 如何與好朋友和平共處? 痛經與月經不規則的調理 到醫院尋求幫助是最好的方法,不正常月經的原因大部分與內分泌功能有關，但一定要先排除由器官病灶或其他疾病所引起不正常出血的可能性。因此對於不正常月經，應該尋求婦科醫師的幫助，不要等閒視之而延誤健康。 藥物療法: 一般的經痛，忍個一天便可以度過，有的人會用熱敷下腹部、喝熱飲、糖水、洗熱 水澡等，讓骨盆腔血液循環改善，來去除不少的疼痛。如果這些方法均無法有效地改善經痛，大多數的止痛藥都可以對經痛作適當的抑制，若無效可加上抗痙攣藥物 或輕型鎮靜劑等。對於次發性月經疼痛，要依據疼痛的原因做治療。如果是原發性月經疼痛，則可以服用一種抑制前列腺素產生的藥物，有超過百分之七十的效果。避孕藥也可以減少月經時前列腺素的產生，減少疼痛。除了藥物以外，針灸或用腹腔鏡做神經切除術也有一些療效。不論原發性或次發性，治療月經疼痛的關鍵還是在於要有正確的診斷。 營養及維他命補充療法: 天然植物黃體素-瑞士聖潔莓:特別適用於痛經與月經不規則,長痘痘,不孕。 每天早晨食用2~4顆的聖潔莓標準萃取膠囊來作為保養,月經來時暫停食用,月經乾淨後再繼續食用,大約連續食用2~4個月。 聖潔莓是一種天然植物西洋牡荊樹(Chaste
berry)的果實,
聖潔莓是歐洲常用的傳統藥草,聖潔莓含有一種很類似人體黃體素(Progesterone)的成份(Vitex).可以發揮類似人體黃體素賀爾蒙的功能，它可能會調節腦下垂體釋放出促黃體素,刺激卵巢釋放出促黃體激素(PRG)而抑制刺激濾泡形成激素(FSH)及抑制過高的泌乳激素(Prolactin ,
PRL)所造成的經前症候及月經不規則症候。2001年大英醫學期刊BMJ發表的文獻報告證實:聖潔莓可以刺激腦下垂體釋放出促黃體素,調節行經症候群PMS及月經不規則。文獻來源:Schellenberg
R. Treatment for the premenstrual syndrome with agnus castus fruit extract:
prospective, randomized, placebo controlled study. BMJ 2001;20:134–7. 史丹福醫學院發表在2004年生殖醫學期刊的研究報告史丹福醫學院針對不孕女性進行營養品的服用實驗，結果顯示，三個月後，五分之一的實驗者可以成功地受孕。「生殖醫學期刊Journal of Reproductive Medicine」的最新研究報告顯示，讓不孕女性服用含有洋牡荊-聖潔莓萃取物(Vitex)、維他命、礦物質等營養補充品，確實有助於提高受孕機率。實驗採用雙盲設計的方式進行，受試者每天服用營養處方或安慰劑，評估指標則以體內黃體素、基礎體溫變化、及月經週期當作觀察參考。實驗三個月後發現，與服用安慰劑的對照組相比較，服用營養處方的實驗組，黃體素含量增加、基礎體溫達到攝氏37度的時間增加了，這些狀況都顯示排卵狀況有了較好的表現。實驗三個月後，服用營養處方實驗組的五個人懷孕了，而對照組則毫無動靜。文獻來源:Journal of Reproductive Medicine 2004;49(4):289-293.CLINICAL STUDY OF FERTILITY BLEND, A NUTRITIONAL SUPPLEMENT USED FOR THE OPTIMIZATION OF REPRODUCTIVE HEALTH IN WOMEN.
女性連續服用聖潔莓(Vitex)3個月後的黃體素(Progestorone)增加約80% 有20%不孕女性成功懷孕(Pregnant)
其他的醫學文獻報告曾經證實:
1.4,500位月經不規則及行經症候群PMS的女性在每天服用30~40mg的聖潔莓萃取物3個月後,52~57%的症狀完全消失. 2.52位高泌乳激素症病患以雙盲試驗,17位實驗組每天服用20mg的聖潔莓萃取物3個月後,黃體期平均延長5天,其中2位病患成功懷孕. 3.45位黃體不足病患,每天服用30~40mg的聖潔莓萃取物3個月後,25位完全恢復正常,7位病患成功懷孕. 4.德國婦產科醫師曾追蹤
1,542 位經前症候群PMS使用聖潔莓萃取物,平均約25.3天可以達到90%的效果. 5.61位行經困難的女性在每天服用3.5~4.2mg的聖潔莓萃取物3個月後,77.1%的症狀穫得良好的改善,36%症狀完全消失.
天然植物雌激素-紅花苜宿異黃酮(Premasil):特別適用於情緒低落型。 每天早晨服用1~2顆的紅花苜宿異黃酮(Premasil)標準萃取膠囊來作為保養。特別適用於:PMS-D(Depression)情緒低落型 異黃酮Isoflavone可以抑制雌激素荷爾蒙分泌過多而造成的經前症候群PMS。每天早晚服用1~2顆的膠囊來作為保養即可。
高濃縮有機月見草油EPO膠囊:特別適用於下腹痛與乳房脹痛。 平時每天早晚服用2~3粒500mg的高濃縮有機月見草油膠囊來作為保養，在月經來潮前３天，增加到每天早晚服用4~6粒膠囊，直到月經結束。高濃縮有機月見草油特別適用於各型PMS合併有下腹痛與經前乳房脹痛。 造成月經疼痛的主要原因是月經來潮時子宮內膜的剝落出血而引發體內發炎,加上前列腺素(PGE)荷爾蒙分泌過多更會增強子宮收縮，造成子宮嚴重缺血而疼痛。除了吃止痛藥以外，現在可以經由飲食或其它自然方法，來舒緩經期的困擾。月見草油含有大量次亞麻油酸(GLA)，有助均衡前列腺素濃度的上升，自然對經痛問題有良好效果。尤其是特別容易發生經前乳房脹痛的女性，定期服用月見草油會有明顯的改善效果。1981年，倫敦湯馬士醫院六十五名患有嚴重經痛的女士，在月經前三天開始每天服用4~6 粒500mg月見草油丸直至經期完結為止，發現六成患者完全沒有經痛現象，兩成半感到有一定幫助，證明月見草在這方面的功效。 美國藥物學會期刊2000年曾經發表一篇比較月見草油與治療子宮內膜異位正的藥物療得高(danazol), 治療泌乳素過高症的藥物(bromocriptine),用於乳房漲痛(mastalgia)的雙盲人體臨床實驗,結果發現:
雖然療得高danazol的效果最佳,月見草油的效果與bromocriptine接近,但月見草油的副作用極低,因此有許多的歐洲婦產科醫師會以月見草油為第一線的治療方式.文獻來源:J Am Pharm Assoc 40(2):234-242, 2000 法國濱海松樹皮萃取物:特別適用於子宮內膜異位症。 法國濱海松樹皮萃取物(Pine Bark Extracts)含有極為豐富的生物類黃酮及40種以上的有機酸, 最近的醫學文獻證實法國濱海松萃取物可以降低子宮內膜異位的症狀約33%,每天早晚各服用50mg毫克的法國濱海松萃取物來作為保養,可搭配月見草油更佳。 文獻來源:2007/03/07 - the Journal of Reproductive Medicine reveals that an antioxidant plant extract from the bark of the French maritime pine tree, significantly reduces symptoms of endometriosis by 33 percent. 子宮內膜異位症補充維生素,礦物質與魚油omega-3,月見草油omega-6有助降低子宮內膜異位症術後骨盆疼痛,月經困難,性交疼痛: 文獻來源:Hormonal suppression and dietary therapy improve pain control in women with endometriosis who undergo conservative therapy Fertil Steril 2007;88:1541-1547.
鈣質: 經前症候群與長期鈣的缺乏有很大的關係, 若能即時補鈣, 則能夠調節一些荷爾蒙的分泌狀況, 以達到緩解經前症候群的功效,一般女性多處在長期缺鈣的狀況, 這使得她們受到經前症候群的威脅, 而中年以後更帶來骨質疏鬆症, 一般女性甚至每天攝取500mg不到的鈣, 與建議量1200mg 相差甚多. 生育醇天然體維他命E: 可以調整經期,促進血液循環，減輕乳房不適、焦慮及沮喪等症狀。 金絲桃(洋甘菊萃取物):特別適用於憂慮型與情緒低落。 抗憂鬱藥對於焦慮有極佳的效果,但是抗憂鬱藥最大弱點就是有很多副作用(如性慾低落、姿態性低血壓、口乾及白天昏昏欲睡,便秘等)，所以在歐洲尤其是德國很多人選擇用傳統天然草藥，其中最廣為使用的是金絲桃 (St.John's wort)。在歐洲用金絲桃已超過 15 年。 對於輕度至中度憂鬱症的患者, 除了接受正統的藥物治療外, 最新的臨床報告指出: 採用金絲桃的副作用較小。不妨和您的醫師討論一下是否可採用金絲桃萃取物來治療, 以避免藥物治療的嚴重副作用。 食物療法: 痛經的自我調理痛經的飲食及營養療法：痛經以腰腳痠痛、腹部抽痛、乳房脹、抽痛為主的人，平日應攝食富含維他命B1、B2的食物，如．糙米．胚芽米、肝臟、杏仁、乳製品等。而平日有骨盆腔充血、月經來時下腹子宮卵巢部位疼痛的人，則建議多攝取富含維他命C、E的食物，如：黃綠色蔬菜、柳丁、檸檬、核桃、杏仁、小麥胚芽等，以改善骨盆腔的血循環，緩解骨盆腔充血的疼痛。至於月經來時整個腹部都痛的人，則平日尤宜注意飲食及營養，少吃生、冷、油膩的食物，可以維他命B群(綜合維他命)、乳酸菌等調理腸胃。因貧血而引起痛經的人，則可以補充鐵劑、深綠色蔬菜、或偶爾喝一些白蘭地酒，痛經的情形可以逐漸改善。 物理療法: 痛經時，有些人覺得以熱水袋在腹部上熱敷可以減輕疼痛，此種體質的人，可以在平日多洗溫泉或作熱水盆浴，每次約一小時，盆浴時同時作臍旁（約手掌之寬）的按摩，對骨盆腔血液循環的改善及瘀血（充血）的消除，有良好的效果。唯月經期間並不適合盆浴，此時可以拇指按壓臍下二橫指之部位（此為中極穴），一般按壓10分鐘至20分鐘，可以減輕或消除痛經。 參考文獻: 1. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The
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castus (Agnolyt). Ther Ggw 1967;106:124–6 [in German]. 經痛與經前症候群(PMS)的自然療法PMS...Help is on the way! 加拿大婦女健康手冊“Women’s Health for Canadians,” by Prentice Hall Canada, 2001. If you are a woman between 20 and 45 chances are you are all too familiar with premenstrual syndrome, or PMS. After all it affects over one-half of women in this age group.No, it is not “all in your head.” The symptoms are real and can be quite distressing, affecting both your physical and emotional well-being. But don’t dismay, help is on the way. There are a variety of natural or complementary approaches that can help you beat the PMS blues.The symptoms Feeling emotional, crying for no reason, irritability, bloating, these are just some of the symptoms associated with PMS. Over 100 different symptoms have been linked to PMS ranging from mild to severe.PMS symptoms may start anywhere from two weeks to a few days before menstruation and then slowly diminish once menstruation has started. The list below outlines some of the most common symptoms. · Mood swings, anxiety, depression · Bloating · Breast tenderness or enlargement · Acne and skin eruptions · Headache and backache · Joint pain and swelling · Increased appetite · Food cravings (salt and sugar) · Changes in sex drive · Fatigue · Insomnia · Constipation or diarrhea · Nausea and vomiting
If you suspect that you are suffering with PMS, talk to your doctor or health-care provider because there are other health conditions that can have similar symptoms.Unfortunately there is no simple blood test or marker to confirm a diagnosis of PMS. It is the cyclic pattern of your symptoms that will guide your doctor in making a diagnosis. Keeping a diary for several months, noting your symptoms and the severity (scale of 1 to 10) can be very helpful in this process.Causes The symptoms of PMS are triggered by hormonal imbalance.Normal fluctuations in hormone levels before menstruation,along with dietary, lifestyle and environmental factors,can contribute to this imbalance. Here are some of the hormones and other factors that play a role:
Aldosterone – a hormone released by the adrenal gland.Stress can increase levels of aldosterone, causing water retention and bloating. Estrogen – Estrogen levels are high the week before menstruation, which can cause fluid retention, breast swelling and tenderness, nausea, and headache. Poor diet, stress, obesity and liver dysfunction can further increase estrogen levels and lead to a situation known as “estrogen dominance.” Progesterone – levels are low during menstruation,causing headaches, anxiety, nervousness, and irritability. Serotonin – a chemical messenger in the brain that regulates mood, emotions and satiety. Levels are low in women that suffer with PMS, causing depression,increased appetite, and cravings for sweets. Nutritional deficiencies – a lack of vitamins B, C, E,selenium, and magnesium can hinder the body’s ability to break down estrogens and also lead to a deficiency of essential neurotransmitters, such as serotonin and dopamine. Excess consumption of caffeine (cola, coffee, tea, and chocolate) can aggravate the emotional symptoms (anxiety, nervousness, insomnia and depression). Even one cup a day can be damaging! A diet high in refined sugar and flour can cause mood swings and irritability. This type of diet often equates to a lack of nutritious fresh fruits,vegetables, whole-grains, and fibre. Obesity – carrying excess body fat can contribute to “estrogen dominance” since body fat manufactures the female hormone estrone (an estrogen). Treatment Options I often see drugs such as antidepressants, tranquilizers and pain- killers prescribed for women struggling with PMS.While drugs may be necessary for women suffering with severe symptoms, these “magic bullets” do have drawbacks:side effects, health risks, nutrient depletion and even addiction. I see more and more women today looking for natural, non-drug approaches to manage their health.Simple changes to your diet and lifestyle, along with the use of herbs and nutritional supplements can be very effective in managing PMS. Dietary recommendations: This is often the hardest step; making changes to your diet. Many of the foods we crave during PMS: chocolate,salty snack foods, and caffeine, can actually contribute to our symptoms. If these foods are part of your daily diet,make small and gradual changes to adopt a healthier diet.Focus on eating lots of fresh vegetables, fruit, whole grains, nuts, seeds, and fish products. An occasional treat is not a problem, but if these foods constitute your average daily diet then making some changes is essential.Not only will this diet help to lessen your PMS symptoms,it will also improve your overall health. Lifestyle:Exercise and stress management are key components to health, and can significantly reduce many PMS symptoms.Exercise stimulates the release of endorphins, which are naturally occurring chemicals that help alleviate depression and pain. For this reason, these chemicals are commonly referred to as “happy hormones.” Exercise comes in many forms, and offers great health rewards for a small investment in time. Walking, playing tennis,swimming,biking, and even doing housework with vigor count! Exercise is also a great way to reduce stress – and stress is a significant factor with PMS, along with many other health conditions. Stress causes the release of certain hormones, such as cortisol, adrenalin and aldosterone,which can aggrevate or even initiate PMS symptoms, such as bloating, headache, and depression. There is something that we can do about this because stress is our internal response to external stimuli (job, traffic, spouse). Learn what your stressors are, and find effective ways to minimize or avoid these forces. Exercise is one way of coping. Other methods of stress management include yoga,tai chi, meditation, massage and breathing techniques. Nutritional Supplements: There are a variety of supplements that can be used effectively to prevent and minimize PMS symptoms. Here are some of my suggestions: · Multi-vitamin and Mineral Complex – to correct any nutritional deficiencies and optimize health. · B complex – the B vitamins are very important for health of the nervous system and for managing stress.Vitamin B6 is particularly important for PMS, since it has natural diuretic properties; it is required by the liver to break down estrogen; and it is required for the production of serotonin and dopamine. A deficiency of this vitamin is known to worsen PMS symptoms. Look for a product containing 50 mg of each B vitamin, and take extra B6 (50-100 mg) during PMS time. · Calcium has been shown to reduce many PMS symptoms,such as water retention, mood swings, cravings, and pain. Dosage range is 1000 to 1500 mg daily in divided doses. · Magnesium is helpful in alleviating fluid retention and cramping. Try 300 to 500 mg magnesium citrate with your evening meal. If diarrhea occurs, reduce the dosage. · Vitamin E may help reduce breast tenderness and swelling. Try 400 to 800 IU daily. · Essential Fatty Acids, such as evening primrose oil and flaxseed oil may help reduce pain and inflammation, as well as some of the emotional symptoms of PMS. Try 1000 mg evening primrose oil three times daily and 1000 mg flaxseed oil twice daily. Herbal Therapies · Phytoestrogens - plant-based compounds that are structurally similar to the estrogen that our body produces. These products work to block the effects of estrogen-dominance. Examples include soy, black cohosh and red clover. Follow package directions or the advice of your health care practitioner. · St. Johns Wort - an effective treatment for mild to moderate depression. In a recent study, St. John’s Wort was found to be effective in reducing nervous tension, insomnia and depression in women with PMS.(Source: British Journal of Obstetrics and Gynaecology, July 2000) Be careful about mixing St.John’s Wort with prescription medication. It may interact with antidepressants, oral contraceptives and drugs taken for organ transplant. · Chasteberry (Vitex) is useful for balancing hormone levels and reducing many PMS symptoms. A recent German study of 170 women found that chasteberry was effective in reducing irritability, headache, mood swings and breast tenderness. Over half of women given chasteberry experienced a 50% or greater reduction in symptoms, with no significant adverse effects. The dosage used was 20mg daily. (Source:British Medical Journal 2001;322:134-137). · Natural progesterone therapy may helpful for women with moderate to severe PMS. It helps to balance high estrogen levels, promotes relaxation and may be effective in treating PMS headaches. In Canada, this is available by prescription only. Note:If you decide to try nutritional supplements or herbs to manage your PMS symptoms, understand that these products do not provide instant relief. Most need to be taken on a regular basis and it may take two to three months to notice the benefits. If you are taking prescription medication or have other medical conditions, check with your health care provider before supplementing. Why do I crave sweets during that time of the month?There are a couple of theories that explain sweet cravings during PMS. The first is that cravings result from a lack of serotonin in the brain during PMS. Serotonin is a chemical in our brain that acts to elevate our mood and feeling of well being. Sweets or carbohydrates, such as chocolate and other sugar-rich foods, are converted in our body to tryptophan – a precursor for serotonin. Another possibility is that excess insulin is released in response to sugar consumption. This results in low blood sugar levels and further cravings for sweets. Lastly, magnesium deficiency has been associated with carbohydrate cravings,and our magnesium levels are lower during PMS. This may explain those strong urges for chocolate. Chocolate provides us with magnesium, as well as sugar and caffeine. Although these substances can worsen PMS symptoms, they temporarily elevate the mood and make us feel better. Author:Sherry Torkos is a pharmacist in the Niagara area. She isthe author of “Women’s Health for Canadians,” by Prentice Hall Canada, 2001. 婦女私密衛生健康相關知識推薦: |
