First steps are dietary changes:

Caffeine. As your period begins to approach reduce your intake of caffeinated foods. Largest amounts of caffeine are found in coffee, lattes, espresso martinis, iced coffees etc. Baristas are your enemy for a few days):

Hot Chocolate, Chocolate Bars-even nice dark chocolate, and cold chocolate drinks like shakes are next for the amount of caffeine. Colas are next in line, Coke, Pepsi etc. Teas do not have a large amount of caffeine but it can add up because people tend to consume larger amounts of tea without worrying about caffeine.

Why Caffeine? Because it tends to stimulate the nerve endings in your body, at the same time that your body is holding more water which is also pressing on your nerve endings! So now your nerves are just jangling away-needless to say not a smooth calming situation to be in and everything will get on your last Nerve. See below for a Caffeine table, please note that almost no one drinks 8 ounces of coffee so multiply the amounts of caffeine by at least 2.

Drink Water but only maybe 2-3 cups a day, none of that 8 cups a day which will just make you bloat more. 2-3 cups a day works because it is enough to keep your kidneys putting out pee, you have a normal cycle. Drink water and pee regularly, drink too much water and regular peeing can’t clear it out fast enough, especially when your periods are approaching and your bodies instinct is to retain water. Drink too little water and you become dehydrated and when you are dehydrated nothing functions as normal, not your digestive system, not your brain, nothing!

Next in line is to reduce your Sodium-Salt intake. Salt is Sodium Chloride and it is the biggest source of Sodium in the diet AND sodium encourages the body to retain water, the bloating puts pressure on your nerve endings and can also increase your blood pressure and as we have already seen your nerve endings do not need any more visitors! The Salt Shaker is NEVER the biggest source of Sodium in your diet, EVER, it is in fact the smallest player! For your period times the goal is to get about 1500 mg (milligrams of Sodium per day) Behold the culprits: a)½ can of tuna (oil or broth) and 39 tortilla chips=470 milligrams of Sodium, almost 1/3 of your day’s intake. b)A dill pickle, one medium sized dill pickle= 833 mg. Even a Spear of a pickle =380 mg. c)Soy Sauce, Relishes, Corn and Potato Chips and Fast Foods Hamburgers, Deep Fried Chicken, Hot Dogs and Sausages are your next big sodium sources.

Milk and Milk Products this one is personal and may or may not apply to you. During my periods, my sisters’ periods and my daughter’s we all become Lactose Intolerant and cannot digest any sugar (lactose) in milk. Even Yoghurts/Kefir, which are normally fine for people who cannot digest lactose becomes a problem during our periods and result in diarrhea. I thought this was unique to my family but in many years of counselling found there were other women in the same boat! One patient described her Latte as passing right through her when her period was coming and that’s how she recognized when her period was about to start. So be aware of this which brings me to my next point.

Keeping Records! From now on when a period is pretty bad, more painful, heavier flow, more bloating etc. Get into the habit of noting down everything you ate the day before, if you had any particular stresses the day before—felt sick, someone died, minor fender bender, drinking party, too much weed etc.  Note it all down because I guarantee you 3 months of doing this and you will find out what all your root causes and triggers are and then you can reduce the misery of the period.

Vitamins, Minerals and Supplements: When Lab work has found your Serum Ferritin (Iron Levels) to be low (very common with heavy periods) an iron supplement will fix this, and there are many on the market. All Iron is better absorbed in the presence of Vitamin C (Ascorbic Acid) so you will notice most Iron Supplements on the market also contain Vitamin C. Sometimes a supplement will lead to constipation (and more bloating- oh god) but you can always switch to a liquid Iron supplement like Floradix which causes less bloating.  Note that low iron levels and low Vitamin B12 levels result in anemia which will also cause fatigue, low energy/sleepiness, an inability to focus or confusion.

Take a Vitamin B Complex which contains Vitamin B6 as well as the usual B1, B2 and B3 and B 12. B6 (pyridoxine) is particularly good at helping to produce healthy nerve endings, helping the body to produce red blood cells and reducing anemia.

Less scientific research surrounds supplements like: Ginkgo Biloba, Ginger, Chasteberry (Vitex agnus), Evening Primrose Oil and St. John’s Wort. But there are many stories from women who have found them to be useful. Note, Evening Primrose Oil is used to massage the abdomen and joints and St. John’s Wort may interfere with some birth control pills so check with your physician before using it.

My personal favourite and one that I still use even after my periods ended is Ginger Tea. Attached below is the recipe for Ginger Tea that my family has used for decades. It is ideal for any abdominal discomfort, bloating, diarrhea, constipation and the key feature is that the value of ginger lays in the skin so never peel it, wash well cut off any dry nobs and use.

Medical Help: Your Physician my have already tried some of these treatments but if not, here are the most commonly prescribed ones so you can discuss ideas with them:

Antidepressants. Selective serotonin re-uptake inhibitors (SSRIs) — which include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. selective serotonin re-uptake inhibitors (SSRIs) are the first line treatment for severe PMS. These medications are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve, Anaprox) can ease cramping and breast discomfort.

Note: Naproxen Sodium is the drug I took for many years under the brand name Anaprox, it reduces prostaglandins which are hormones that make muscles cramp-your uterus is a big muscle. Unfortunately, it also took a toll on my stomach lining and has known side effects of ulcers, gastric reflux, hiatal hernia and other gastrointestinal problems. However, it was the only thing that allowed me to function as a normal human being during my periods or make it possible for me to even leave the house so I do not regret taking it.

Diuretics. When exercise and limiting salt intake aren’t enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.

Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms.

Healthy Eating, by which we mean eating foods as close to their original forms as possible is always good whether you have PMS or are Perimenopausal or just trying to stay healthier. Get used to making Oatmeal or Cream of Wheat cereals instead of buying the ready to eat cereals. I make bulk servings of these cereals at one time; it takes about 20 mins then divide it up into about 6 containers in the fridge. When I want cereal, I scoop some out, add milk and microwave and stir, voila faster than shaking a box and twice as nutritious! You can prepare seasoned or plain rice the same way and put it in individual bags in the freezer. And of course, it only takes about 15 minutes to boil pasta so no need to make ahead. Meats, Chicken, Fish can be rubbed with seasoning and baked in the oven on an oiled pans for a quick meal or use a favourite traditional way of cooking them and freeze leftovers for other meals.  Whole fruits even sprinkled with sugar and cinnamon are just fine, you will get the vitamins and minerals in a tastier way. Same goes for the vegetables, stir fry some cabbage with onion, apple slices and some dried sage, delicious and the oil used in cooking will not take away the benefits. Glazed carrots cooked with butter, maple syrup and salt will be loved by even non-vegetable lovers. Remember the basic rule of this dietitian. A ripe cantaloupe will sit in the fridge and gradually rot away! A peeled cantaloupe, cut up and sliced with a sprinkle of cinnamon gets eaten in under 30 minutes!  

Source	Caffeine (mg)	Servings per day	Total (mg) Caffeine
Coffee (250 ml or 8 oz)	95	__	__
Tea (250 ml or 8 oz)	50	__	__
Iced or green tea (250 ml or 8 oz)	30	__	__
Pop with caffeine (280 ml or 10 oz)	35-50	__	__
Hot chocolate from mix (250 ml or 8 oz)	25	__	__
Dark chocolate bar (56 g or 2 oz)	45	__	__

GINGER TEA

3-inch piece of fresh plump Ginger Root

½ of a large Lemon

1 litre of Water (4 cups)

Sweeten to taste with sugar, maple syrup or honey at time of drinking

Method

• Wash ginger well, check for any dried-out spots on the surface and slice those off but leave the majority of the skin on.
• Grate the ginger on the big side of box grater-the side with the large holes
• Put into a sauce pan with the water making sure any juices that ran off when you grated also ends up in the pot
• Squeeze the juice of the lemon into the pot and then put in the juiced rind
• Bring the whole pot to simmer for about 10 mins and then strain into a container pressing out as much juice as possible. I always put about a tablespoon of the strained-out pulp back into the tea. Refrigerate and heat up a cup when needed adding sweetener of your choice or not.

Because ginger works for other conditions that trigger nausea, e.g. chemotherapy, I recommend keeping a supply of ginger cubes in the freezer. I chop finely about ¾ pounds (340 grams) of fresh ginger, cleaned as above, in the food processor. Pack into an ice cube tray with a cover and freeze. Then I pop them out into a freezer bag and there you go, ready for tea, smoothies or a stir-fry.