Case History

A 32-year-old female client presented to the clinic interested in 'balancing her hormones' as she had been experiencing symptoms of dysmenorrhoea, breast tenderness leading up to her menses, irritability and depression throughout the cycle, but particularly in the luteal phase, as well as a reduced capacity to cope with stress. 

The client had a history of oral contraceptive pill (OCP) use for the last fourteen years however ceased the OCP three months ago when her fiancé went overseas for work. Since ceasing the OCP, the client noticed that the dysmenorrhoea had been significantly worse on the day prior to menses and the first two to three days of her period; she had been using Ibuprofen three times daily to reduce pain during menses however was still finding that she would need to take one to two days off work each cycle.

The client's cycle was 29 days in length and her menses moderately heavy with some small clots and darker coloured blood.  She described the pain as a dull aching pain alternating with sharp stabbing pains when her menses commenced. The client's GP investigated the symptoms referring her for a pelvic ultrasound however no abnormalities were found.

The client has a BMI of 31 and has been a weekend smoker for the last twelve years. Her diet was high in refined and processed foods, her vegetable intake predominantly from her home delivered pre-packed meals each evening and she would consume two to three large latte style coffees each day with

Treatment Plan

Vitex agnus-castus (Chaste tree) was recommended in tablet form as it has been shown reduce prolactin levels via its dopaminergic action; by reducing prolactin levels, breast tenderness in the luteal phase is expected to be reduced. A dosage of one tablet daily throughout the cycle was prescribed.

Research has shown that symptoms such as breast pain, abdominal cramping, irritability and frustration are often due to raised prostaglandin levels and high leukotriene levels. In order to reduce pain and discomfort, support healthy mood and improve stress coping ability, a herbal formula containing the following herbs was recommended to be taken twice daily throughout the cycle. A liquid herbal formula to be taken daily was prescribed, containing the key herbs Curcuma longa (Turmeric), to reduce prostaglandin and leukotriene levels, alongside nervine tonic, Hypericum perforatum (St John's Wort), adrenal supportive Withania somnifera, spasmolytic and antiinflammatory Paeonia lactiflora (Peony), which is also beneficial in menstrual dysfunction in combination with Glycyrrhiza glabra (licorice), and the warming, circulatory stimulant Cinnamomum zeylenicum ().  A nutrient powder containing magnesium, B vitamins, including specifically B1 and B6, and chromium was recommended to support muscle relaxation, insulin sensitivity and hormonal regulation.  Ensuring cofactors are available for production of serotonin, melatonin and dopamine was also a priority to support healthy mood and sleep.

To take prior and during menses, a herbal formulation in tablet form was recommended containing Corydalis ambigua (Corydalis), Zingiber officinale (Ginger), Rubus idaeus (Raspberry), Dioscorea villosa (Wild Yam) and Viburnum opulus (Cramp Bark). The recommended dosage was two tablets taken three times daily commencing two days prior to menses until day four of the period. Cramp bark has traditionally been used as a uterine relaxant, while Corydalis works as an anodyne, Raspberry regulates uterine muscular activity and Ginger is a warming circulatory stimulant included to improve the action of the anti-spasmodic herbs. Wild Yam, traditionally termed 'colic root', has shown to be effective for reducing gastrointestinal irritation and spasm as well as menstrual cramps.

Symptomatically, a warm lavender wheat pack application to the lower back was recommended.  The client was also advised to schedule in some rest and relaxation time during the menses to reduce the sense of pressure and stress that can arise during this time and the addition of ginger tea made from freshly grated ginger suggested as a soothing, warm beverage. The client was advised not to smoke in the luteal phase or during menses as this may potentially contribute to raised levels of COX-2 exacerbating pain and inflammation levels.

3-Week Follow-Up

The client returned three weeks later following her next period, she reported significantly less pain overall, particularly the stabbing type of pain as well as reduced usage of ibuprofen from five days to three days over menses and an overall better mood.  Although skin was not raised as an issue in the initial appointment, the client mentioned that she felt her skin was a lot clearer over the two weeks.

The client's prescription was repeated with the addition of an Omega 3 liquid (4.5grams daily) to decrease levels of eicosanoids from arachidonic acid and support cell membrane fluidity. Dietary recommendations included looking at a reduction in the number of coffees from three to one per day, both to reduce caffeine consumption and to reduce dairy intake as both have been shown to play a significant role in dysmenorrhoea. Swapping protein sources in the diet from predominantly fried foods and red meat to fish and legumes to decrease inflammatory pathways and to increase fibre intake in the diet was also suggested; this is important for reducing reabsorption of oestrogen in the bowel as well as increasing sex hormone binding globulin levels to maintain circulating oestrogen levels within a healthy range. Studies have also shown that women following a vegetarian style diet experience a lower incidence of dysmenorrhea. The client was also asked to diarise her next menses.

7-Week Follow-Up

Upon return, the client was elated as she had 'enjoyed' her last menses and reported experiencing a much happier mood throughout the luteal phase, no breast tenderness and just slight lower back pain on day one of her menses. She really enjoyed the idea of taking time out to rest during her menses and found that by avoiding stressing herself during this time of each month, she was feeling a lot less 'hormonal' the rest of the time.  The client was now looking to move her treatment plan towards a preconception focus.