General Information & Selected Studies

PMS Basics
"Premenstrual Syndrome" has been a recognized condition since ancient times, with scholars such as Aristotle having written on the subject. And then, as now, it was a subject surrounded by many stereotypes and superstitions. The fact is that most women experience some degree of physical or even emotional discomfort that is associated with the menstrual cycle. The simplest definition of the premenstrual syndrome (PMS) is the appearance of one or more symptoms just prior to menses occurring to such a degree that lifestyle or work is affected, followed by a period of time that is entirely free of symptoms. Although there are over 100 possible symptoms associated with this condition, some of the more common include: breast tenderness, bloating, headache, acne, appetite changes and cravings, and emotional symptoms. The emotional symptoms can range from minor fatigue and irritability to crying spells and depression. These usually occur in the 7 to 10 days before menses begins.

The vast majority of women are able to tolerate these symptoms and go about their daily business, although none the happier. However, in 3-5% of these women, the symptoms are so severe that they cannot function in their normal day-to-day routines. These women are classified as having the premenstrual dysphoric disorder.
(Source: Excerpted from Topical Women’s Health Articles, Bradley G. Goldberg, M.D.)

Menopause Basics
Menopause is the permanent end of menstruation and fertility. It is a normal, natural event, usually confirmed when a women has not had a menstrual period for twelve consecutive months, in the absence of other obvious causes. Menopause is associated with reduced functioning of the ovaries, resulting in lower levels of ovarian hormones, primarily estrogen.

Natural menopause is a spontaneous, permanent ending of menstruation that is not caused by any medical intervention. In the Western world, most women experience natural menopause between the ages of 40 and 58, with the average at about age 51. Some women reach natural menopause as early as their 30’s and a few in their 60’s. Although there has been an increase in life expectancy over the years, the age of menopause has not changed during the past few centuries. Today, most North American women spend at least one-third of their lives post-menopausal.

Only one factor has been conclusively proven to affect a women’s age at menopause – smoking. Smokers reach menopause approximately two years earlier than non-smokers. Women often experience menopause around the same age as their mothers and sisters, which suggests a genetic link. Although several studies support this link, the evidence is not conclusive.

Physical signs of menopause begin many years before the final menstrual period. This menopause transition phase is called perimenopause, literally meaning “around menopause.” It can last six years or more and ends the first years after menopause. Perimenopausal changes are brought on by changes in ovarian hormone levels and the hormones that regulate them. Irregular menstrual periods, hot flashes, vaginal dryness, sleep disturbances, and mood swings are common, normal signs of menopause.

Induced menopause is immediate menopause caused by a medical or surgical intervention that removes or seriously damages both ovaries. Premature menopause is menopause that occurs before age 40. Postmenopause is all the years beyond menopause, whether induced or natural.
(Source: “Menopause Guidebook: Helping Women Make Informed Healthcare Decisions Through Perimenopause and Beyond, The North American Menopause Society)

Black Cohosh
Black Cohosh is a derivative of the root of the plant Cimicifuga racemosa. It contains a type of compound called phytoestrogens, and these are commonly used for a variety of female complaints. Phytoestrogens have been shown to exhibit weak estrogenic activity, and therefore are commonly used for menopausal symptoms.
(Source: Marshall L. Smith, Jr., M.D., OBGYN.net Menopause and Perimenopause Advisory Board member)

Black cohosh is used primarily for hot flashes and other menopausal symptoms.
In 2001, the American College of Obstetricians and Gynecologists stated, primarily on the basis of consensus and expert opinion, that black cohosh may be helpful in the short term (6 months or less) for women with vasomotor symptoms of menopause.
(Source: American College of Obstetricians and Gynecologists: Use of botanicals for management of menopausal symptoms, ACOG Practice Bulletin 28: 1-11, 2001.)

Red Clover
Premenstrual breast pain is related to hormone changes during the menstrual cycle and is very common among women - at least those in Western countries. There has been growing scientific evidence over the past five years that isoflavones, which are natural compounds found in plants like Red Clover, mimic the activity of the body's own hormones. Women in Eastern countries have less trouble with premenstrual breast pain; they also have more isoflavones in their diet compared to Western women, largely from soy products. The Red Clover isoflavones are believed to act as a weak estrogen, which reduces the amount of estrogen produced in breast cells. Phytoestrogens have mild estrogenic properties that block estrogen receptors. This is also believed to be the key to Red Clover's ability to modify symptoms of menopause.

Chasteberry
Chasteberry is frequently called by its Latin names: vitex or, alternatively, agnus-castus. A shrub in the verbena family, chasteberry is commonly found on riverbanks and nearby foothills in central Asia and around the Mediterranean Sea. After its violet flowers have bloomed, a dark brown, peppercorn-size fruit with a pleasant odor reminiscent of peppermint develops. This fruit is used medicinally.

The modern use of chasteberry dates back to the 1950s, when a German pharmaceutical firm first produced a standardized extract. This herb has become a standard European treatment for cyclic breast tenderness, a condition related to PMS that is sometimes called cyclic mastitis. Chasteberry is believed to work by suppressing the release of prolactin from the pituitary gland. Prolactin is a hormone that naturally rises during pregnancy to stimulate milk production. Inappropriately increased production of prolactin may be a factor in cyclic breast tenderness, as well as other symptoms of PMS.
(Source: The Natural Pharmacist, Consumer Edition, March 1, 2002 Update)

Suma
Suma (Pfaffia paniculata) is an indigenous plant to South America, most notably Brazil, Ecuador, Peru and Venezuela. Traditionally it has been used to promote robust health and was occasionally administered for medicinal reasons. Modern use has isolated it for its ability to act as an adaptogen, hence its other common name "Brazilian Ginseng". While not a true Ginseng, it has displayed properties very similar to the Ginseng (Panax) family. Among other uses, Suma root is used in Western herbal medicine as a regenerative tonic to counteract exhaustion and chronic fatigue, PMS and menstrual problems, menopausal symptoms, impotence, hormonal disorders, and many types of stress. Suma extract has a history of use as an aphrodisiac and it is widely believed to improve sexual performance and function.