Why doctors don’t know how PMS works and the science of what to do about it

The doctor looked at me, blinked, then started scribbling on a prescription pad while muttering, “Without exploring hormonal solutions, this is your best bet. You can get it anywhere.”

By the time the prescription was in my hand, he was already on his way out the door. I read the piece of paper and was upset, but not surprised. It read, “500 mg Ibuprofen — as needed, and/or Midol, water and rest.” And then at the bottom, a smiley face and “Hope you feel better soon.”

He might as well have given me a lollipop and a sticker.

This was the third doctor I had visited for help with troubling pangs of anxiety and sudden, uncontrollable outbursts of tears and rage. My emotions went haywire in response to things that never bothered me before, and it was turning my life upside down.

Thousands of doctors like mine continue to receive millions of patients reporting of a sharp and sudden increase in some combination of anxiety, sadness, anger, uncontrollable mood swings and irritability that make normal life impossible.

Doctors are trained to treat these symptoms seriously. That is, unless the patient is a woman and the symptoms occur a week before her period. In that case, most will shrug their shoulders, feign sympathy and prescribe some combination of Motrin, exercise and “deal with it.”

Sometimes hormonal birth control, or in severe cases even antidepressants, are suggested. Sometimes they work to varying degrees, but for many women it’s not an option or leads to powerful side effects that just swap one kind of suffering with another.

All sorts of cultural forces have worked hard to minimize the impact of PMS on a person’s life and career, link PMS to weakness and keep it out of any serious conversation (unless of course, it’s a punchline).

Thus, most women suffer alone in silence, even though PMS affects 75 percent of all menstruating women.

The impact on our healthcare is a system that treats alarming mental health symptoms, when associated with menstruation, as just an unfortunate but unchangeable part of life as a woman. This is a cultural belief, not a fact of science.

But what does the science say? There has been considerable research into solutions for physical PMS symptoms, with vitamins and minerals like phosphatidylserine, calcium, magnesium and Vitamin D showing promise in clinical trials.

But when it comes to the psychological symptoms known as Emotional PMS, which often carry the more significant negative impact on women’s lives, there is shockingly little research followed far enough to find a solution.

While there are plenty of herbal remedies touted on the market, none have gone through any type of scientifically rigorous clinical trial.

That is, until last year.

A double-blind, placebo controlled clinical trial involving 48 women affected by mild to moderate Emotional PMS tested the effects of 100 milligrams of oxaloacetate, housed in a newly developed chemical formula, taken daily. Women who received this form of oxaloacetate experienced:

Improved PMS-related anxiety by 51 percent

Improved PMS-related gloominess by 54 percent

Improved PMS-related stress by 36 percent

Improved PMS-related irritability by 18 percent

National Institutes of Health — clinicaltrials.gov

This type of improvement across a broad spectrum of symptoms is unheard of, even amongst prescription anti-depressants. But most importantly, it works, and it works multitudes better than anything else for Emotional PMS ever tested in a clinical trial.

51 percent improvement in PMS anxiety could mean the difference between speaking up with a new idea in a meeting or staying silent. It could be the push to try a new exercise class that becomes a lifelong passion.

54 percent improvement in PMS-related gloominess could mean the difference between staring at your phone on the park bench or jumping into the sandbox with your kids and making memories.

How it Works

Scientists behind the study say the problem with Emotional PMS, believe it or not, isn’t actually hormones. Using birth control to alter hormones related to menstruation does not actually fix the underlying problem. While hormones play a part in the timing of PMS, they are not the cause of these symptoms. Emotional PMS symptoms are driven largely by glucose utilization in the brain.

If you have ever experienced sugar cravings during PMS, you already instinctively know this. Your body craves what it needs most at any given time, and what it needs during PMS is sugar. Scientific studies that track glucose levels in the brain have shown that women with extreme PMS mood swings experience a much larger consumption of glucose in the cerebellum.

The cerebellum lies in the lower part of the brain and plays a key role in motor control, attention, and regulating fear and pleasure responses. People with bipolar depression have been shown to have an increased demand for sugar in the cerebellum, just like people with severe PMS.

The true answer to Emotional PMS, however (sadly) does not lie in just eating more sugary chocolate and junk food.

While binging sugar and fats to appease a hungry cerebellum brings temporary relief to some women, the sugar spike and crash brings on many more problems, including increasing the risk of depressed mood.

Scientists at Columbia University investigated the link between sugary foods and depression In a study of about 70,000 women. The work, recently published in “The American Journal of Clinical Nutrition”, found a statistically significant increase in depression in women who consumed foods with added sugars. In contrast, women who consumed fruits and vegetables had a significantly lower incidence of depression. So just loading up on chocolate and candy is not the answer, and adjusting your hormones to eliminate your natural cycling doesn’t address the underlying problem.

In comes oxaloacetate. This naturally occurring metabolite is necessary for gluconeogenesis and the Krebs cycle — in short, it’s how cells turn fats to glucose and glucose into energy. Normally, humans have enough oxaloacetate to get by, as it is found in trace amounts in food and can be produced by the body. However, during PMS the cerebellum demands extra energy and attempts to process more glucose than normal. To do so, it requires higher amounts of oxaloacetate than normal. Without the extra oxaloacetate, it can’t process the energy it needs and can’t function properly, sending emotions haywire.

In addition, oxaloacetate has been shown to modify the glutamate to GABA (a calming neurotransmitter) ratio in the brain, further acting to reduce PMS-related anxiety, stress and irritation.

My Favorite Part

Since oxaloacetate is a naturally-occurring compound, anyone has the right to buy it without a doctor’s permission slip.

Currently, it’s available from a few brands on Amazon and elsewhere. Of course, if men had PMS, oxaloacetate would already be available at the counter of every 7–11. But for now, I’m just happy it exists, so that women like me can go for a clinically proven option without having to go through being dismissed by yet another doctor.

It may be just a small step forward in the span of medical science, but it’s a leap toward a world where an endless struggle with PMS is no longer an unchangeable part of life as a woman.