A case study by Jo Barnett

This case has proven to be quite interesting.  A natural response to dealing initially with menstrual issues in teens is to manage the discomfort and premenstrual symptoms in a more traditional sense with either painkillers and/or analgesic and antispasmodic, given also the buy in at this age can be tricky and getting them to pursue a longer course of treatment can be an impediment.  A visit to a GP offered the oral contraceptive pill as a treatment option (something a worrying number of her agemates are taking) – and an option she was told would ‘treat’, not mask, her symptoms.  She was also offered mefenamic acid.  Wanting a quick fix especially at this age is completely understandable, but this young teen was becoming so debilitated and missing so much school that she was fully prepared to stick to taking her supplements and herbs. 

Initial Consultation

This patient is a 14-year-old female, who started menstruating at 12 years old. She didn’t have too many problems for the first 6-9 months of menstruation. She has always been a fit, high energy, happy and easy- going kid. Then hormones kicked in! 

In the week before her period, she would become very moody, irrational, fatigued, with a lot of cramps and digestive issues. She would often find herself bedridden for 1-3 days a month with a myriad of symptoms from nausea, cramps, vomiting, fatigue and sometimes flu-like symptoms as well. These symptoms could come with her period, or in the week before. Her flow she described as clotty, very heavy, and thick. She often woke vomiting in pain in the night. Normal pain relief including ibuprofen, paracetamol, codeine, magnesium and antispasmodic herbs never seemed to give her any relief.  Using a portable tens machine would help for a bit while using it but then she developed skin sensitivity to the pads. 

Prescription

• Oestrogen Metabolism Nutritional Powder, 1 tsp twice daily; containing Brassica oleracea (Broccoli) seed powder 200 mg, from dry seed 2 g, standardised to 13% glucoraphanin, Punica granatum (Pomegranate) peel extract dry conc. 60 mg, standardised to 40% punicalagin 24 mg, Curcuma longa (Turmeric) rhizome extract dry conc. 85 mg, standardised to curcuminoids (95%) 81 mg, Rosmarinus officinalis (Rosemary) leaf extract dry conc. 133.3 mg, from dry leaf 1 g, Camellia sinensis (Green Tea) extract dry conc. 83.4 mg, from dry leaf 2.08 g, standardised to 40% catechins 41.8 mg, Agaricus bisporus (White Button Mushrooms) extract 125 mg, from whole mushroom 2.5 g
• Endometriosis Support Tablets, 2 tablets daily; containing Angelica polymorpha (Dong Quai) extract 118 mg, from root dry 826 mg, Paeonia lactiflora (Paeonia) extract 206 mg, from root dry 824 mg, Alchemilla vulgaris (Ladies Mantle) extract 1.3 mL, from herb dry 650 mg, Calendula officinalis (Calendula) extract 0.8 mL, from flower dry 400 mg
• Dietary and Lifestyle advice.  We talked about prioritising sleep, which she was struggling with a bit especially in the luteal phase.  Staying off devices after 8-8.30pm and trying to allow some time to read, play her musical instrument, write in her diary in the wind down window before bed.  She exercises regularly – over summer mountain biking, walking, volleyball, surfing and in winter she has a lot of football. 
• Her diet is fundamentally pretty good.  Encouraged a decent, savoury, protein rich breakfast, making sure she eats her lunch at school (not 4pm when she gets home) and keeping up her water intake (from a stainless-steel water bottle).  We discussed the problem with eating a lot of sugar/processed foods and their inflammatory nature, as well as the impacts on energy and concentration. 

She struggled with the taste of the Oestrogen Metabolism Nutritional Powder, and we decided to encapsulate it and gave her three OO caps twice a day. Her job was to make up the capsules which she quite enjoys doing.

Follow Up – Three Months

There was not a lot of change noted in the first month, however she didn’t wake at 4am vomiting as she had the previous three months. After three months we started to notice some changes, her digestion seemed better, less nausea and no vomiting and the dreaded week before her period was no longer such a drama. She noticed that those intense emotions were only for 1-2 days before her period, but she was still quite anxious each month before her period onset, about what was ahead.  We added in the following:

Prescription

• Anxiolytic herbal tablets, 2 tablets twice daily for 1 week prior to menses; containing Piper methysticum (Kava) root dry ext. 400 mg, from root dry 3.2g, Ziziphus jujuba var. spinosa (Zizyphus) seed dry ext. 300 mg, from seed dry 3 g, Passiflora incarnata (Passionflower) herb top flowering dry ext. 75 mg, from herb top flowering dry 1.5 g, Magnolia officinalis (Magnolia) stem bark dry ext. 150 mg, from stem bark dry 1.5 g, Melissa officinalis (Lemon Balm) flower and leaf dry ext. 75 mg, from flower and leaf dry 750 mg, Magnesium amino acid chelate 250 mg, equiv. Magnesium 50 mg, Glycine 100 mg
• Fibroid Support Formula Tablets, 2 tablets twice a day a few days before menses onset and for the first two days of menstruation; containing Paeonia lactiflora (Paeonia) extract 160 mg, from root dry 640 mg, Capsella bursa-pastoris (Shepherd's Purse) extract 1.28 mL, from herb dry 640 mg, Achillea millefolium (Yarrow) extract 640 microlitre, derived from herb dry 320 mg, Thuja occidentalis (Thuja) extract 1 mL, from leaf dry 200 mg

Follow Up – Seven Months

This treatment has worked really well in making the patient’s flow more manageable. She has now had four cycles of often getting surprised her period has arrived, the awful mood swings and high emotions are better controlled, and the pain is very manageable.  She still gets some cramps but can carry on her day without needing to go to bed. This is a big win for her! 

Long-Term Treatment Plan

• Oestrogen Metabolism Nutritional Powder, 2 capsules (1/2 tsp) twice daily
• Endometriosis Support Tablets, 2 tablets daily
• Anxiolytic herbal tablets, 2 tablets twice daily premenstrually. Continue for another cycle or two, then cease.
• Fibroid Support Formula Tablets, 2 tablets twice a day premenstrually. Continue for another cycle or two, then cease

Clinical Reflections

It is often challenging to navigate treatment options, particularly when conventional pharmaceutical or herbal/nutritional approaches prove ineffective.  However, a deeper consideration of potential underlying pathology has led to surprising and highly beneficial outcomes in this case.

Managing hormonal imbalances in young individuals can be especially daunting due to their unique physiological and psychological circumstances.  Discovering effective solutions that foster compliance and empower individuals to regain control over their health is immensely gratifying. 

Through my practice, I’ve gained valuable insights into the challenges young girls face in processing and metabolising hormones.  I am particularly concerned about the prevalent use of hormonal treatments, such as the contraceptive pill, among adolescents particularly in the early stages of puberty.  Listening to clients in their 20s and 30s express regret over similar treatments when they were young, underscores the necessity of personalised approaches tailored to each individuals needs and circumstances.  

In this case, I envisage monitoring the patient’s progress as we gradually taper off her treatment, which I imagine will provide valuable insights into its long-term efficacy. 

By offering education and support to young girls and their parents on managing menstrual health without solely relying on medical hormone treatments, we empower them to embrace their natural physiology and take control of their well-being.  Promoting this paradigm shift can yield significant benefits for the long-term health of young girls navigating adolescence.