The often distressing symptoms of premenstrual syndrome, or PMS, are familiar to women. A week or two before the menstrual period, many women experience some combination of bloating, breast pain, fatigue, headaches, depression, crying, angry outbursts, or other symptoms often associated with PMS.
For most women, the number and severity of symptoms varies from month to month, and most of the time PMS is no more than a bothersome inconvenience. Yet for others, PMS affects them so severely that it interferes with activities of everyday living.
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In the week or two before the menstrual period:
Irritability, anxiety, depression, hopelessness, major mood swings
Breast pain or tenderness, bloating, weight gain
Insomnia, fatigue, lack of energy
Headaches, backaches, joint and muscle aches
Constipation, diarrhea, urinary disorders
Food cravings, especially for carbohydrates.
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Scientists have never explained why some women have PMS and others don't. Among the theories:
PMS may stem from an imbalance of the female hormones estrogen and progesterone following ovulation. Ovulation occurs at the midpoint of the menstrual cycle. When estrogen is in relatively higher concentrations than progesterone in a woman's system, the brain may have more difficulty producing chemicals that control mood and pain. This may lead to the mood shifts and food cravings of PMS. It also may trigger the release of the hormone prolactin, which causes breast tenderness and blocks the liver from efficiently clearing excess estrogen from the body.
PMS symptoms may also be due to low levels of serotonin, a neurotransmitter, or brain chemical, which sends signals between nerve cells. Although serotonin studies have been inconsistent, many women report less trouble with PMS when they are under treatment to normalize serotonin levels. More efficient production and use of serotonin has been shown to help lift one symptom of PMS – depression.
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Conventional Treatments
Because symptoms vary from woman to woman, treatment is highly individualized. The American College of Obstetricians and Gynecologists(ACOG) recommends a three-step approach to treating PMS, which includes lifestyle changes, conventional medications, nutritional supplements and steroids. Lifestyle changes such as eating a diet high in complex carbohydrates and getting aerobic exercise is the foundation of treating PMS. More severe symptoms may require conventional medications.
Medication
The first step of the ACOG treatment guidelines includes conventional drugs such as analgesics, NSAIDs, and diuretics to target specific symptoms. For headache, backache, or cramping, acetaminophen (Tylenol) or NSAIDs (ibuprofen, naproxen, etc.) may provide relief. For bloating and fluid retention, spironolactone (Aldactone) may work as a diuretic to decrease fluid retention. The second step includes antidepressants and anti-anxiety medications, while the third step uses hormonal ovulation suppression to address specific complaints of PMS.
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Tests and Procedures
Your doctor may ask you to keep a record of PMS symptoms over several months, and you may need to undergo a gynecological exam to help determine a diagnosis or rule out other conditions.
A psychological exam also may be used to determine if further psychological and emotional support in addition to your physical symptoms may help.
For women who do not respond to conventional treatments or supplements, hormone therapy may be recommended.
The lifestyle changes recommended by the ACOG help both in the prevention and treatment of symptoms if followed all month. Most significant improvements are seen when stress is reduced, exercise is increased and dietary changes are made around the time of menstruation.
A number of nutrients and herbs, taken alone or in combination for part or all of the menstrual cycle, may also offer relief.
Just a reminder: It is always a wise idea to talk with your doctor or health care provider before beginning a nutritional or herbal supplement. Several herbs that affect the hormones and menstrual flow may also affect birth control and are contraindicated in pregnancy.
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Chasteberry, also called Vitex, is a popular PMS remedy in Europe and is becoming one of modern medicine's most popular and well-studied herb in the treatment of PMS. It acts on the brain's pituitary gland, which controls the production of estrogen and progesterone, and so may correct hormone imbalances. In the early 1990s, more than 1,500 women participated in two surveys of gynecologic practices in Germany, during which chasteberry was graded by physicians as good or very good in the treatment of PMS. One third of the women with PMS reported complete resolution of symptoms, and another 57 percent reported significant improvement. (1, 2) Chasteberry is contraindicated in pregnancy. It is recommended that this be used only under the supervision of a skilled practitioner such as an experienced herbalist.
Further studies have found chasteberry seems to be best for physical symptoms, such as breast tenderness, edema, and constipation, as well as improving irritability, mood, anger, and headache. (3-6) In some women, chasteberry has been found to improve symptoms of PMS by 50 percent. (3)
Dong quai is an Asian herb that has little effect on its own, but it may enhance chasteberry's activity. Its ability to relax the uterus after contraction may help women who, along with PMS, experience painful menstruation. (7) Dong quai is contraindicated in pregnancy and should not be used by women experiencing heavy menstrual flow. Its use is recommended only under the supervision of an experienced health care professional. Traditional Chinese medicine practitioners will usually prescribe Dong quai in a tonic combination with other time-tested Chinese herbs. (In Chinese herbal formulas, a number herbs are compounded together to minimize side effects and relieve most of the symptoms associated with the main complaint.)
Black Cohosh. The extract of black cohosh (Remifemin) that has been used in Germany for more than 40 years, has been shown to reduce feelings of depression, anxiety, tension, and mood swings associated with PMS. (8)
Vitamin B6 may work if chasteberry is not effective. It helps the liver process estrogen, increases progesterone levels, and stimulates the brain to make serotonin. More than a dozen double-blind clinical trials examining vitamin B6 as treatment for PMS have been performed since 1975. (9, 10) The majority of trials have demonstrated positive effect on symptoms. For example, in one double-blind crossover trial, 84 percent of patients studied reported fewer/less intense symptoms. (11) However, a German study found that vitamin B6 is less effective than chasteberry for reducing PMS-related breast tenderness, swelling, tension, headache, and depression. For maximum relief, some practitioners suggest using both, starting at the time of ovulation and continuing until menstruation begins.
Evening primrose oil, or the less-expensive borage oil, both containing omega-6 essential fatty acids with anti-inflammatory properties, may ease breast tenderness and take the edge off carbohydrate cravings. (12) Like chasteberry and vitamin B6 evening primrose oil works best during the second half of the menstrual cycle.
Magnesium supplementation, taken daily, is well-known as an effective treatment for PMS. (Magnesium deficiencies have been found in the red blood cells of women who have PMS and this deficiency has been implicated as one of the causes of PMS symptoms.) In a double-blind, randomized study in Italy in 1991, 32 women ages 24-39 years old were given 360 mg of magnesium or placebo three times a day from the 15th day of the menstrual cycle to the onset of menstrual flow for two months. The women receiving magnesium supplementation reported improvement in symptoms related to mood changes. (13) Other studies indicate efficacy in improving fluid retention and reducing premenstrual migraine. (14-16)
Although magnesium may be effective on its own, research suggests that even better results when combined with vitamin B6 and other nutrients. Several studies have shown that when PMS patients are given a multivitamin and mineral supplementation containing high doses of magnesium and the active form of vitamin B6, pyridoxine, they experience a substantial reduction in symptoms. (17, 18) If you have been getting magnesium in a calcium/magnesium bone-building supplement, you should change to taking equal amounts of magnesium and calcium at different times of the day. They compete with each other for absorption from the intesting to blood stream and if you are low on magnesium the calcium may inhibit the uptake of magnesium.
St. John's Wort, an herbal antidepressant, is a useful addition to a daily program, especially when the primary PMS symptoms are emotional (mood swings, irritability, depression) rather than physical. The herb works best when taken continuously and may require two complete menstrual cycles before its full effect is noticed. However, St. John's Wort can interfere with several drugs, including decreasing the effectiveness of oral contraceptives, which could result in unexpected pregnancy. (19, 20)
Theanine, a mild and non-sedating tranquilizing herb, can be helpful for PMS patients who are feeling especially anxious and tense.
Kava, a traditional Polynesian herb is anothet mild tranquilizer that may work quickly and is not at all habit-forming. However, the FDA has issued warnings on kava due to its adverse effects on the liver. Do not use this herb unless under medical supervision.( please read the entry on kava in the WholeHealthMD Reference Library)
Natural progesterone, either as a cream (available over the counter) or taken orally (by presciption only), acts to balance the excessive estrogen that contributes to many PMS symptoms. However, studies have found progesterone does not work better than placebo. (21, 22) If used, progesterone supplementation should occur in the second half of the menstrual cycle, usually during the week to 10 days before your anticipated menstrual flow, stopped at flow, and restarted on approximately the same day every month.
Get supplement dosages and tips in our WholeHealthMD Supplement Recommendations for PMS.
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Keep a symptom diary. Many women feel more in control when they keep track of PMS symptoms. A written record is handy when discussing symptoms with a health care provider.
Regular aerobic exercise helps restore a sense of balance and improves mood while relieving water retention.
Learn to relax. Low levels of progesterone can leave you feeling more exposed to the stresses of life. But there are methods other than drugs to restore your physical and emotional reserves. Yoga, meditation, and progressive muscle relaxation can relieve stress-related symptoms.
Make healthy lifestyle choices. Watch what you eat. Lifestyle decisions you make can put additional stresses on your system. Cut down on caffeine, eliminate refined carbohydrates and sugar, alcohol, and salt. If you smoke, stop. No one is certain how these changes affect the symptoms of PMS, but it may have to do with the overall toxin load on the body that reduces its ability to process estrogen. Or it may be the added stimulation these substances put on already reduced reserves. Nobody knows for sure, but virtually all women report significant improvement when they make healthy choices.
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Alternative Therapies
Relaxation techniques such as meditation, yoga and qigong, therapies known for their ability to strengthen the flow of qi (or energy) in the body, have been shown to help improve mood in patients with PMS. (23) In a 2004 randomized, placebo-controlled trial study of qigong, which uses meditation, visualization and repetitive physical exercises to balance qi, 36 college women with PMS received real qigong therapy or placebo to determine its efficacy on PMS symptoms. The 18 individuals receiving real qigong therapy reported significant improvements in the symptoms of negative feeling, pain and water retention. (24)
A 2003 review of studies suggests acupuncture (the use of hair-thin needles at specific body points) and acupressure (the use of pressure by fingers, knuckles and palms) may be helpful for painful menstruation. However, more research is needed. (25)
Some studies indicate homeopathic remedies may help improve symptoms of PMS such as bloating, pain, irritability and mood swings.
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If PMS is severe and includes deep depression, intolerable breast pain, or other symptoms that interfere with your quality of life.
If symptoms seem to remain the same throughout your entire cycle. Clinical depression and an underactive thyroid are treatable conditions that resemble PMS.
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Evidence Based Rating Scale
The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.
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Therapy
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Rating
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Explanation
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Acupressure/
acupuncture
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Preliminary studies indicate some efficacy for pain. More research is needed.
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Chasteberry
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