By Jane Mmeredith Adams

Later, I blame the hormones. But right now, let me just ask: Have you ever really thought about how much a cat depends on a human? I’m weeping as I watch my kitty chomping on her breakfast. Look at the trust, my God, the love this feline harbors in her little soul. What if I hadn’t put out the kibbles? What if I died or something? I’m crying nonstop. Is it just me, or is life amazingly sad?

Forty-five minutes later, I’m crying again as I tell my sweetheart about a beautiful child I saw the other day, a child with mournful eyes; I should have done something to help him. No, I don’t know if there was anything wrong. No, the child didn’t say anything was wrong. My partner asks, “What’s going on here?” as if there’s something strange about a person being in touch with her feelings.

Only after I eat a hunk of dark chocolate can I regroup from the question. I know what I’m being asked. And to prove that I am an extremely sensitive person regardless of the time of the month, I wander over to my datebook and—whoa, my period’s due in two days. Which comes as quite a surprise to me, as it does after every premenstrual weepfest.

As exciting as my PMS is around my house, the time has come to take some action. For one thing, now that I’m over 40, I’ve been waiting for the statute of limitations to kick in regarding pre-period sore breasts and generalized bloating, but so far, no luck. Not only that, the swing in my pre-period moods seems to be getting worse. Now the question is, what to do?

My remedies thus far—chocolate followed by ibuprofen—haven’t put a dent in the problem areas of mood swings and tender body parts. I could opt for one of the Prozac-style drugs that doctors recommend for severe PMS, but this seems a bit much. Even when I’m crying my eyes out, I’m still able to function pretty well. I’d like to give some gentler remedies a whirl.

Regrettably, I have only the vaguest of clues about where to begin. A friend of a friend swears by chaste tree berry. I’ve heard rumors about calcium, magnesium, and vitamin B6. But do they work? How much should I take? Clearly, I need help.

As fate would have it, a brand-new 13,000-square-foot emporium has just opened up in my hometown of Berkeley, California, promising to solve just my type of conundrum. Curiously named Elephant Pharmacy, it’s a spacious, stylish drugstore that promises not only any herbal remedy I could imagine, but an herbalist, a nurse-practitioner, and a pharmacist to coach me, free of charge. Stuart Skorman, chairman of the independent company, says he intends to open Elephants in cities all across the country.

The store is designed for people like me who want help sorting through the vast array of supplements and herbs out there, and are frustrated that most Western doctors don’t have a clue about them. To aid us, Elephant offers a mind-boggling compendium of classes. And while “Tantra for Beginners” sounds like a lot more fun than a PMS consultation, I resolve to explore only one hormonally charged situation at a time. One Wednesday afternoon when nurse-practitioner Michele Burke is on duty, ready to counsel walk-ins like me, I speed on over.

Waiting for Burke in the store’s roomy book alcove, I settle into a comfy chair to browse several paperbacks that promise to unravel the mysteries of PMS. Classic PMS symptoms read like a recipe for a truly horrible day: bloating, irritability, depression, fatigue, breast tenderness, constipation, headaches, an inability to concentrate, tension, food cravings, and anger. To meet the definition of PMS, you have to have some or all of these symptoms within two weeks of the start of your period, and they must cease within a few days after your period begins.

Researchers aren’t sure why some women are stricken with severe PMS while others sail through each month oblivious to any hormonal upheaval. Overproduction or underproduction of the hormones involved in the menstrual cycle—estrogen, progesterone, and testosterone—doesn’t tell the whole story. Instead, researchers are studying the interaction between brain chemicals and these fluctuating hormones. One theory suggests that for some women, hormone shifts interfere with serotonin, a neurotransmitter that regulates mood, emotion, sleep, and appetite.

That would be me, I suspect.

Burke comes in. I’m on. She steers me into a private room, where we sit at a small table. As I rattle off my symptoms, I can hardly believe I have a real live nurse-practitioner listening to my tale of woe for free. Not only that, Burke is in no hurry. Missing is the desperation I often feel when I’m talking to a doctor at my HMO—desperation to remember all the details and tell them quickly, desperation to have the doctor solve my problem before my time is up.
But here, I’m relaxed; she’s relaxed. Burke lobs an idea at me and I lob it back. I believe this is called a conversation. It’s rather terrific.

One of her first recommendations is that I take 1,000 milligrams of chewable calcium; studies have shown this can cut PMS symptoms by as much as half. Along with the calcium—which I am to take every day, not just before my period—she suggests 500 mg of magnesium. She writes down the dosage information in a handy note.

Now comes the question of diet. I mention that when PMS is raging, chocolate seems vital to my happiness, especially if it’s of the dark Belgian variety. Delicately, she suggests that while many women crave chocolate during such times, some have found that eliminating it helps to stabilize their moods. Delicately, I inform her that’s not an option for moi.

Nonetheless, she jots down “no caffeine, no sugar, and reduced salt and dairy.” The only substance that’s going up is water, particularly one week before my period. Also to be increased is exercise: Great idea, difficult to execute.

Next, Burke and I wander over to the counter where herbalist Nathalie Babazadeh works. Babazadeh, who holds a master’s degree in traditional Chinese medicine, asks me to stick out my tongue. I comply, even though there’s a customer at the other end of the counter who I’m sure would rather be spared the sight.

We talk about symptoms, including irritability and forgetfulness, and Babazadeh asks if I tend to be anxious and tired. Yes and yes. A second later, she recommends two formulas that strengthen liver qi and nourish the heart, thereby calming irritability and increasing energy. Called “Free & Easy Wanderer” and “Tian Wang Bu Xin Dan” (also known as the Emperor’s Tea Pills), the formulas are black balls of herbal substances packed in bottles labeled with tiny type, much of it in Chinese.

This is the part that requires me to have faith that the herbalist knows what she’s doing. At first, I’m a bit dubious, since my encounter with her lasts about three minutes and doesn’t include the words “I’m absolutely sure this will help you.” But at the register, I’m relieved to discover that the herbal balls, which I am to take as pills, cost just $12 total. At this price, I’m willing to try.

Before I start my fine new regimen, I decide to check in with the left side of my brain and research what PMS remedies have been proven effective in large-scale, well-run studies. The data bear out my experience at Elephant: Burke, with her medical training, did a good job of steering me toward proven remedies including calcium, magnesium, and exercise. And since not many herbal remedies have been studied thoroughly, it makes sense that Babazadeh recommended supplements with at least an anecdotal tradition of being helpful for PMS, if not a scientific track record.

So for the next few weeks I take my little black balls of Chinese herbs, I chew calcium tablets, I force myself to do some kind of exercise every day, even if it’s just a walk. I haven’t ventured into the world of chaste tree berry or vitamin B6: If I take everything at once, how will I know what’s working?

Clearly, something is. Now my period’s due in two days and my cat, my darling Martina, is curled up on a fuzzy blanket on the couch. As I pause to say good-bye to her for the day, I’m choked up in a way that lets me know that PMS has indeed descended. But I’m not weeping as I head out the door. Nor am I stopping strangers on the street to talk about my remarkable feline. I’m actually okay.

Proven PMS Potions: Our Choices

Here’s how to use the remedies recommended by the experts at Elephant Pharmacy, plus several others that are also backed by scientific evidence.

Calcium
This is a clear winner, according to the American College of Obstetricians and Gynecologists (ACOG), which has added calcium to its treatment guide for PMS. It works best for moderate symptoms, says Susan Johnson, a professor of obstetrics and gynecology at the University of Iowa who helped ACOG revise its guidelines. Though you can get some calcium in dairy products and green leafy vegetables, most women need to take a supplement.
User’s tip: Chewable calcium is easiest to digest. Look for calcium carbonate, which contains the most elemental calcium by weight. Dividing the 1,000 to 1,200 daily mg into two doses makes it easier to absorb. But you should expect to wait at least two months to see results.

Chaste Tree Berry
“Chaste tree stands out as the single most important herb for PMS,” says Portland naturopath Tori Hudson. Also known by its Latin name Vitex agnus-castus, chaste tree berry extract reduces the severity of many symptoms, including anger, irritability, and breast tenderness, according to a recent review of studies published in Reproductive Toxicology.

User’s tip: Take a daily dose of 175 mg of standardized extract of chaste tree berry or 1 teaspoon of tincture.

Magnesium
The research review that gave the nod to chaste tree berry found that magnesium is effective, too. In one study, women got relief from water retention and bloating after taking 360 mg three times a day for two months during the last half of their cycle. The benefits were even greater when women continued the magnesium for an additional two months.

User’s tip: Try a supplement of 360 mg three times a day, either for the last two weeks of your cycle or continually. Two good food sources of magnesium are avocado (206 mg each) and wheat germ (180 mg per 2 ounces).

Vitamin B6
Most research on vitamin B6, also called pyridoxine, has shown some benefit, but many studies have had methodological flaws. Still, Hudson says women at her clinic have found it effective, perhaps because the nutrient is important for the functioning of mood-boosters like serotonin.

User’s tip: In the largest study to date, women who took 100 mg of B6 a day showed improvement in PMS symptoms. But don’t overdo it: Large doses of B6 (more than 2,000 mg a day) can cause neurological damage.

Exercise
It may be hard to get out the door to exercise if you’re feeling premenstrual, but aerobic activity is an almost surefire way to reduce symptoms, says Diana Taylor, a professor of nursing at the University of California at San Francisco and coauthor of Taking Back the Month.

User’s tip: Studies have shown that an hour of aerobic exercise three times a week can make a real difference. If you’re feeling so weepy or blue that it’s hard to muster the energy, at least try getting out for a walk with a friend.

Nutrition
Studies have shown that women with PMS eat more refined carbohydrates, sugar, dairy, and sodium than women who don’t. Cutting back on these substances in the second half of the menstrual cycle can lessen irritability, fatigue, anxiety, bloating, and cravings, says Taylor. Increasing whole grains, fruits, and vegetables and eating small, frequent meals during PMS episodes also seem to help.

User’s tip: Get your pantry in order ahead of time, so you’ll have the right foods on hand when you need them.