The many faces of PMS

Most women have experienced unpleasant symptoms before their period. The term “PMSing” has even become a politically correct term to refer to someone’s irritable behaviour. These unpleasant symptoms may present as mood changes or physical pain such as breast tenderness and migraines. Irrespective of the shape it takes, all premenstrual symptoms point to a common underlying cause: hormonal imbalance. Believe it or not, premenstrual symptoms (PMS) are NOT normal. The hormonal fluctuation that occurs in a woman’s body throughout the month is meant to be a seamless, efficient, and a comfortable process.


PMS symptoms occur 7-14 days before your period. These symptoms can include any the following:



-Cravings (sugar, chocolates, carbohydrates)

-Breast swelling and tenderness



-Increased apetite

-Changes in libido





-Water retention


-Constipation or diarrhea


What do PSM symptoms mean?

Throughout the month cyclical hormonal fluctuations occur naturally as part of our reproductive process. PMS symptoms often mean there is an imbalance in the ratio of estrogen and progesterone in the body. If there is too much or relatively too little of either one of these hormones circulating in the body during at the appropriate times, it can cause many issues around menstruation. These hormones can influence neurotransmitters, circadian rhythm and serotonin. Further, if the liver is not appropriately breaking hormones down for elimination further hormonal symptoms arise.


What can cause PMS?

Anything that eventually influences the ratio of estrogen and progesterone to shift outside it’s healthy normal range can cause PMS. The following are some common causes:


* Birth control pill- Although this is often prescribed to treat PMS, it can also often be the cause. Even history of birth control usage can contribute to PMS by shifting the normal rhythm of your body’s hormones. It also puts stress on the gall bladder and liver which are the organs responsible for the breakdown and elimination of estrogen.


* Endocrine disruptors- Toxins in our environment are such PCB’s, biphenyl A, parabens and phthalates bind to hormone receptors and mimic hormones. Exposure to these toxins often come from food stored in plastic, cans and beauty products.


* Diet- Hormones can also be found in food such as dairy and diets high in animal protein. Further foods such as coffee, chocolate, alcohol and sugar can also influence our hormones and cause PMS. Nutrient deficiencies like protein and iron can also lead to fatigue, insomnia and headaches prior to menstruation.


* Lifestyle- A sedentary lifestyle can have a profound effect on our mood and energy. Lack of sleep further can disrupt our hormonal rhythm and promote premenstrual symptoms.


* Stress- Chronic stress without adequate down-time and recovery leads to Increased cortisol and can shift our sex hormones leading to relative deficiencies.


* Underlying hormonal conditions- Ovarian cysts, fibroids, endometriosis, hypothyroidism or adrenal fatigue are common conditions that influence progesterone and estrogen. If these conditions are present PMS is often a secondary result.


Naturopathic Approach for the treatment of PMS

Your naturopathic doctor will assess for any underlying condition that could be contributing to your PMS. Appropriate collection of health history, testing and a physical exam will identify which hormones are out of balance.


At Naturopathic Foundations we offer comprehensive testing which includes the use specialized tests such as saliva hormone panels, adrenal panels and food allergy testing which measure important and often overlooked markers of hormone balance. We also have the ability to requisition blood work when needed to identify other health markers. Further, unique testing is also available and commonly used to identify how the body is metabolizing and breaking down hormones allowing us to better understand and identify areas that need special support.


Naturopathic treatment focuses on balancing the physiological hormonal imbalances, however we also recognize that psychological and emotional factors also influence our hormones. Stress management techniques, diet and lifestyle counseling as well as liver support are often foundational work that is required for long lasting benefits. Herbs, vitamins and supplements are often prescribed to help relieve uncomfortable symptoms and help balance the hormones. Bio-identical progesterone may also be extremely effective in some cases.



Dr. Pearl Arjomand is a Naturopathic Doctor at Health in Balance that focuses on women’s health. Her practice consists on treating a variety of hormonal imbalances affecting women. Dr. Arjomand is also board certified to prescribe bio-identical hormones and dessicated thyroid. Please call the clinic at ______ to book a visit with Dr. Arjomand.


Last month we took an in-depth look at hormone replacement therapy and the complications. This month we are going to examine the natural alternatives for treating menopausal symptoms.

Two thirds of women experience menopausal symptoms during menopause-mainly hot flashes-and are recommended hormone replacement therapy (HRT). However, after the Women’s Health Initiative (WHI), many women are reluctant to use HRT and are turning to more natural options ( Let’s find out why.

Phytoestrogens. What exactly is a phytoestrogen? Phytoestrogens are naturally occurring nonsteroidal plant compounds. Due to their structure being similar to estradiol (17-beta-estradiol), they have the ability to cause both estrogenic or antiestrogenic effects. Phytoestrogens exert their effects primarily through binding to estrogen receptors throughout the body.

When compared to synthetic hormones, phytoestrogens only contain 2% of the strength (Duar, 2005). Therefore, in terms of treatment, they provide a more safe and modulating approach. If estrogen is low within the body, phytoestrogens increase the effect of estrogen. In addition, if estrogen is high, the binding of phytoestrogens to estrogen receptors will actually decrease the effect of estrogen.

Food sources of phytoestrogens consist of: soybeans, flaxseeds, apples, carrots, fennel, celery, parsley, and other legumes. Herbal phytoestrogens include: Trifolium Pratense (Red Clover), Cimicifuga Racemosa (Black Cohosh), Panax Ginseng (Chinese or Korean Ginseng), Dong Quai (Angelica Sinensis), Dioscorea Villosa (Wild Yam Root) and Glycyrrhiza Glabra (Licorice).

The phytoestrogens found in soy are the isoflavones: genistein, daidzein and glycitein. These isoflavones bind to estrogen receptors on the uterus, breast, brain, bone and arteries. They weakly mimic estrogens in some tissues and block the effect of estrogen in others. Soy has been found to decrease the risk of fractures in post-menopausal women by increasing bone mineral density, decrease the frequency of hot flashes and help with mood and sleep disturbances (Pizzorno, 2008). In a study by Powles et al., it was shown that diets high in phytoestrogen isoflavones (such as soy) were protective against osteoporosis and hot flashes (Powles et al., 2004).

In terms of herbal treatments, Red Clover is an herb commonly used in a naturopathic medical practice to reduce symptoms of menopause. In the 1940s, farmers noticed for the first time that red clover fields were found to have a positive effect on grazing sheep and their fertility. In a study by Hidalgo et al., 53 women took red clover for 90 days to determine that their menopausal symptoms were reduced compared to placebo and their cholesterol and triglyceride levels were also reduced (Hidalgo et al., 2005). Black Cohosh is another common herb used to treat hormonal dysregulation, particularly menopause. Geller et al., proved that Black Cohosh is safe and effective for reducing menopausal symptoms, primarily hot flashes and possibly even mood disorders (Geller et al., 2005).

Contrary to the western medical belief system phytoestrogens ARE protective against breast cancer. The issue that comes up is that if HRT can increase your risk of breast cancer, then what about phytoestrogens? In a study conducted by Atkinson et al., 205 women (age 49-65) were monitored for one

year taking red clover daily to determine the effect on breast tissue. It was found that unlike conventional HRT, which increases breast density, red clover did not increase breast density (Atkinson et al., 2004). Therefore phytoestrogens are unlikely to cause an increased risk of breast cancer.

The trend is catching on! In July 2010, 423 menopausal women were contacted with questions about their menopausal symptoms and status. 91% of the women reported trying alternative therapies for their symptoms. The most common treatments were vitamins (61.5%), relaxation techniques (57%), yoga/meditation (37.6%), soy products (37.4%) and prayer (35.7%). The most beneficial therapies reported were prayer/spiritual healing, relaxation techniques, counseling/therapy, and therapeutic touch/Reiki (Lunny et al., 2010).

Make empowered and educated decisions when it comes to your health. Do your research! Know that there are EFFECTIVE AND SAFE alternatives to HRT.

Yours in health,

Dr. Sarah Hawthorn, BAS, ND

TO HRT OR TO NOT HRT? A serious look at Hormone Replacement Therapy.

What did we as women do before Hormone Replacement Therapy? Did we not need it? Is it possible that our symptoms worse in 2010 because of our western diet and lifestyle? Are we too busy to want to overcome the challenges and deal with the changes that come with menopause because of our hectic busy fast paced lives? Are symptoms worse because of the lack of awareness within our own body? Are we resistant to our bodies’ natural aging progression and changes? We live in a society where appearance carries so much weight; so does taking HRT make us feel younger and more youthful? But seriously, what did women do hundreds of years ago? How did they deal with the hot flashes and other menopausal symptoms--symptoms which we feel as modern women, need to be medicated?

To HRT or to not HRT? For Naturopathic Doctors, this is a very common inquiry. Patients are curious about alternatives to Hormone Replacement Therapy (HRT), complications of HRT, and alternative treatments to give menopausal relief. Women are getting conflicting advice from their varied health practitioners and are left confused and unaware of what the right option is for them to relieve their menopausal symptoms.

HRT made its debut in the 1950s. It began to rise in popularity however in the 1970s with increased prevalence in the 1990s. HRT is either given as estrogen alone or in combination with progesterone. These hormones are preferably given in combination as estrogen alone can increase the risk of endometrial cancer.

Several studies in the late 1990s, opened our eyes to the notion that HRT could lead to uterine and breast cancer. This theory exploded and numerous studies were completed to further examine the possibilities. Currently, the connection between HRT and cancer is listed on every website promoting HRT drugs and can be found in medical journals. Femhrt (ethinyl estradiol tablets) which is a combination of estrogen and progesterone, created by Warner Chilcott pharmaceutical company, states on their website that Femhrt may cause “breast cancer, cancer of the uterus, stroke, heart attack, blood clots, dementia, gallbladder disease, ovarian cancer” ( Premarin, a common estrogen derived from the urine of pregnant mares, manufactured by Wyeth pharmaceutical company, is used to treat moderate to severe menopausal symptoms. On their website it states: “estrogens increase the chance of getting cancer of the uterus. Using estrogens, with or without progestins, may increase your chance of getting heart attacks, strokes, breast cancer and blood clots” ( Hormones from pregnant mares are not the same molecules as the hormones in our bodies and soon after the introduction of Premarin in 1969, a sharp increase in endometrial cancer was observed.

Here’s some food for thought - In 2000, 46 million prescriptions worth $1 billion were written for Premarin, making it the second most prescribed drug in the US after Lipitor (cholesterol lowering drug) made by Pfizer. In a study conducted by the Women’s Health Initiative in 2002, it was found that compared to placebo, estrogen plus progestin resulted in : increased risk of heart attack, increased risk of stroke, increased risk of blood clots, increased risk of breast cancer, increased risk of dementia and no protection against mild cognitive impairment. The same study concluded that long-term use of estrogen and progestin increased a woman's risk of a stroke by 41 per cent, of a heart attack by 29 per cent, and of breast cancer by 24 per cent. With this the FDA states that: “hormone therapy should be

used at the lowest dose for the shortest duration needed to achieve treatment goals. Also, postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks with their physicians before starting treatment” ( In a study by Beral et al., they confirmed the theory that the length of treatment affected the outcome. The study revealed that the longer the use of HRT, the greater the incidence of cancer of the breast and endometrium (Beral, 1999). As if further evidence is needed, a brand new study was published in May 2010 by Renard et al., noting a decline in breast cancer incidence with a decline in the use of HRT in Belgium (Renard, 2010). If the question of whether or not there is a link between cancer and HRT, the resources in this article alone should be sufficient evidence for you to make an empowered and educated decision about your health.

As for alternatives, talk to your ND about phytoestrogenic herbs, acupuncture and homeopathy to treat your menopausal symptoms. Daily ground flax and soy are beneficial at reducing hot flashes as well. Consider this: Hot flashes affect 75% of North American women. However, less than 10% of women in Japan are affected (Kaur, 2005). Now compare dietary differences. The lignans in flax have estrogenic activity and the isoflavones, genistein and daidzen, in soy have the ability to weakly bind to estrogen receptors in the body. These factors work to increase bone density, decrease the number of hot flashes, decrease sleep disturbances and decreases the amount of TNF (cytokine found in cancer). Avoiding dairy, gluten, caffeine, sugar, caffeine, and alcohol can do wonders for reducing the severity of hot flashes and other menopausal symptoms. As can decreasing stress, meditation, exercise, performing yoga and embracing the natural aging process J

As a health care practitioner I have seen breast cancer in patients with no known risk factors other than using HRT. This clinical evidence is hard to ignore and should be available to anyone who is debating on how to handle their menopausal symptoms. Be empowered. Be educated. Look into other alternatives. Talk to your MD. Talk to your ND. Take your health into your own hands. Just remember the alarming evidence when you decide if it’s really worth it?

Stay tuned for part two where we will go more in depth on natural alternatives!

Yours in health,

Dr. Sarah Hawthorn, BAS, ND


1. Beral et al. “The use of HRT and the subsequent risk of cancer”. J Epidemiol Biostat. 1999. Vol 4 (3).

2. Kaur, Dharam Sat. “The Complete Natural Medicine Guide to Women’s Health”. Robert Rose. 2005.

3. Lambe et al. “Reductions in the use of hormone replacement therapy: effects on Swedish breast cancer incidence trends only seen after several years”. Breast Cancer Res Treat. June 2010. Vol 121 (3). 4. “Women’s Health Initiative”. Department of Health and Human Services. 2010. 5. “Premarin”. Wyeth Pharmaceuticals Inc. 2009.

6. Renard et al. “Decline in breast cancer incidence in the Flemish region of Belgium after a decline in hormonal replacement therapy”. Ann Oncol. May 2010. 7. Warner Chilcott. 2009.



Dr. Sarah Hawthorn, ND is a Naturopathic Doctor. She completed her undergraduate honours degree at the University of Guelph in Biomedical Science and Music. She then went on to complete the four year naturopathic medicine program at the Canadian College of Naturopathic Medicine (CCNM) in Toronto. During her internship at CCNM, she worked at the Sherbourne Health Centre for HIV patients. She also has additional training in Facial Rejuvenation Acupuncture and has studied with herbalist, John Redden. Sarah currently practices in Cambridge, ON. Sarah is a licensed Naturopathic Doctor and is registered through the Board of Directors of Drugless Therapy – Naturopathy . She is also a member of the Ontario Association of Naturopathic Doctors (OAND) , the Canadian Association of Naturopathic Doctors (CAND) , the Ontario Herbalists Association (OHA) and the Cambridge Chamber of Commerce. Website :