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Home > Living Well > Health Library > Premenstrual Syndrome (Holistic)
A daily supplement of 1,000 to 1,200 mg of calcium and 200 to 400 mg of magnesium to reduce the risk of mood swings, bloating, headaches, and other symptoms
Emphasize low-fat, high-fiber foods and plenty of fruits and vegetables to improve hormone metabolism
Aim for regular aerobic exercise to help reduce symptoms
20 mg a day of a concentrated herbal extract for up to three months may help balance hormones
Premenstrual syndrome (PMS) is a poorly understood complex of symptoms occurring a week to ten days before
the start of each menstrual cycle.
PMS is believed to be triggered by changes in progesterone and estrogen levels.
Many premenopausal women suffer from symptoms of PMS at different points in their menstrual cycle. Symptoms include cramping, bloating, mood changes, and breast tenderness tied to the menstrual cycle.
Women with PMS who jogged an average of about 12 miles a week for six months were reported to experience a reduction in breast tenderness, fluid retention, depression, and stress.1 Doctors frequently recommend regular exercise as a way to reduce symptoms of PMS.
Several studies suggest that diets low in fat or high in fiber may help to reduce symptoms of PMS. Many doctors recommend diets very low in meat and dairy fat and high in fruit, vegetables, and whole grains.
Alcohol can affect hormone metabolism, and alcoholic women are more likely to suffer PMS than are nonalcoholic women. Some doctors recommend that women with PMS avoid alcohol for several months to evaluate whether such a change will reduce symptoms.
In a study of Chinese women, increasing tea consumption was associated with increasing prevalence of PMS. Among a group of college students in the United States, consumption of caffeine-containing beverages was associated with increases in both the prevalence and severity of PMS. Moreover, the more caffeine women consumed, the more likely they were to suffer from PMS. A preliminary study showed that women with heavy caffeine consumption were more likely to have shorter menstrual periods and shorter cycle length compared with women who did not consume caffeine. Some doctors recommend that women with PMS avoid caffeine.
Our proprietary "Star-Rating" system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
Women who consume more calcium from their diets are less likely to suffer severe PMS. A large double-blind trial found that women who took 1,200 mg per day of calcium for three menstrual cycles had a 48% reduction in PMS symptoms, compared to a 30% reduction in the placebo group. Other double-blind trials have shown that supplementing 1,000 mg of calcium per day relieves premenstrual symptoms.
Many, though not all, clinical trials show that taking 50–400 mg of vitamin B6 per day for several months help relieve symptoms of PMS. A composite analysis of the best designed controlled trials shows that vitamin B6 is more than twice as likely to reduce symptoms of PMS as is placebo. Many doctors suggest 100–400 mg per day for at least three months. However, intakes greater than 200 mg per day can cause side effects and should never be taken without the supervision of a healthcare professional.Vitamin B6 has also been reported to relieve cyclic breast pain.
Vitex has been shown to help re-establish normal balance of estrogen and progesterone during the menstrual cycle. Vitex also blocks prolactin secretion in women with excessive levels of this hormone; excessive levels of prolactin can lead to breast tenderness and failure to ovulate. A double-blind trial has confirmed that vitex reduces mildly elevated levels of prolactin before a woman's period. Studies have shown that using vitex once in the morning over a period of several months helps normalize hormone balance and thus alleviate the symptoms of PMS. Preliminary and double-blind research has found that vitex relieves PMS symptoms. The amount in most of these trials was 20 mg per day of a concentrated vitex extract for three menstrual cycles experience a significant reduction in symptoms of PMS.
Vitex has been shown to be as effective as 200 mg vitamin B6 in a double-blind trial of women with PMS.Two surveys examined 1,542 women with PMS who had taken a German liquid extract of vitex for their PMS symptoms for as long as 16 years. With an average intake of 42 drops per day, 92% of the women surveyed reported the effectiveness of vitex as "very good,""good," or "satisfactory."
Some healthcare practitioners recommend 40 drops of a liquid, concentrated vitex extract or one capsule of the equivalent dried, powdered extract once per day in the morning with some liquid. Vitex should be taken for at least four cycles to determine efficacy.
Women with PMS have been shown to have impaired conversion of linoleic acid (an essential fatty acid) to gamma linolenic acid (GLA). Because a deficiency of GLA might, in theory, be a factor in PMS and because evening primrose oil (EPO) contains significant amounts of GLA, researchers have studied EPO as a potential way to reduce symptoms of PMS. In several double-blind trials, EPO was found to be beneficial, whereas in other trials it was no more effective than placebo.
Despite these conflicting results, some doctors consider EPO to be worth a try; the amount usually recommended is 3–4 grams per day. EPO may work best when used over several menstrual cycles and may be more helpful in women with PMS who also experience breast tenderness or fibrocystic breast disease.
Women with PMS have been reported to be at increased risk of magnesium deficiency. Supplementing with magnesium may help reduce symptoms. In one double-blind trial using only 200 mg per day for two months, a significant reduction was reported for several symptoms related to PMS (fluid retention, weight gain, swelling of extremities, breast tenderness, and abdominal bloating). Magnesium has also been reported to be effective in reducing the symptoms of menstrual migraine headaches. While the ideal amount of magnesium has yet to be determined, some doctors recommend 400 mg per day. Effects of magnesium may begin to appear after two to three months.
Some of the nutrients helpful for premenstrual syndrome appear together in multivitamin-mineral supplements. One double-blind trial used a multivitamin-mineral supplement containing vitamin B6 (600 mg per day), magnesium (500 mg per day), vitamin E (200 IU per day), vitamin A (25,000 IU per day), B-complex vitamins, and various other vitamins and minerals. This supplement was found to relieve each of four different categories of PMS symptoms. Related results have been reported in other clinical trials.
A preliminary, uncontrolled trial found that women with severe PMS who took potassium supplements had complete resolution of PMS symptoms within four menstrual cycles. Most participants took 400 mg of potassium per day as potassium gluconate plus 200 mg of potassium per day as potassium chloride for the first two cycles, then switched to solely the gluconate form (600 mg potassium per day) for the remainder of the year-long trial. Without exception, all of the women found their symptoms (i.e., bloating, fatigue, irritability, etc.) decreasing gradually over three cycles and disappearing completely by the fourth cycle. Controlled trials are needed to confirm these preliminary observations.
Oral contraceptives can deplete the body of vitamin B6, a nutrient needed for maintenance of normal mental functioning. Double-blind research shows that women who are depressed and who have become depleted of vitamin B6 while taking oral contraceptives typically respond to vitamin B6 supplementation. In one trial, 20 mg of vitamin B6 were taken twice per day. Some evidence suggests that people who are depressed—even when not taking the oral contraceptive—are still more likely to be B6 deficient than people who are not depressed.
Several clinical trials also indicate that vitamin B6 supplementation helps alleviate depression associated with premenstrual syndrome (PMS), although the research remains inconsistent. Many doctors suggest that women who have depression associated with PMS take 100–300 mg of vitamin B6 per day—a level of intake that requires supervision by a doctor.
Although women with PMS do not appear to be deficient in vitamin E, a double-blind trial reported that 300 IU of vitamin E per day may decrease symptoms of PMS.
Black cohosh is approved in Germany for use in women with PMS. This approval appears to be based on historical use as there are no modern clinical trials to support the use of black cohosh for PMS.
In Traditional Chinese Medicine, dong quai is rarely used alone and is typically used in combination with herbs such as peony (Paeonia officinalis) and osha (Ligusticum porteri) for menopausal symptoms as well as for menstrual cramps. However, no clinical trials have been completed to determine the effectiveness of dong quai for PMS.
In one trial, women with IBS who experienced worsening symptoms before and during their menstrual period were helped by taking enough evening primrose oil (EPO) to provide 360–400 mg of gamma linolenic acid (GLA) per day. In that trial more than half reported improvement with EPO, but none was helped in the placebo group. The effects of EPO in other groups of IBS sufferers have not been explored.
A double-blind trial has shown that standardized Ginkgo biloba extract, when taken daily from day 16 of one menstrual cycle to day 5 of the next menstrual cycle, alleviates congestive and psychological symptoms of PMS better than placebo. The trial used 80 mg of a ginkgo extract two times per day.
Most well-controlled trials have not found vaginally applied natural progesterone to be effective against the symptoms of premenstrual syndrome. Only anecdotal reports have claimed that orally or rectally administered progesterone may be effective. Progesterone is a hormone, and as such, there are concerns about its inappropriate use. A physician should be consulted before using this or other hormones. Few side effects have been associated with use of topical progesterone creams, but skin reactions may occur. The effect of natural progesterone on breast cancer risk remains unclear; some research suggests the possibility of increased risk, whereas other research points to a possible reduction in risk.
In a double-blind trial, supplementing with soy protein (providing 68 mg of isoflavones per day) for two menstrual cycles was significantly more effective than a placebo at relieving premenstrual swelling and cramping. The placebo used in this study was cow's milk protein. Some doctors believe that cow's milk, because of its estrogen content, can worsen premenstrual symptoms. If that is the case, then the beneficial effect of soy protein may have been overestimated in this study.
Very high amounts of vitamin A—100,000 IU per day or more—have reduced symptoms of PMS, but such an amount can cause serious side effects with long-term use. Women who are or who could become pregnant should not supplement with more than 10,000 IU (3,000 mcg) per day of vitamin A. Other people should not take more than 25,000 IU per day without the supervision of their doctor. As yet, no trials have explored the effects of these safer amounts of vitamin A in women suffering from PMS.
Many years ago, research linked B vitamin deficiencies to PMS in preliminary research. Based on that early work, some doctors recommend B-complex vitamins for women with PMS.
Based on anecdotal evidence, yarrow tea has been used by European doctors when the main symptom of PMS is spastic pain. Combine 2–3 teaspoons of yarrow flowers with one cup of hot water, then cover and steep for 15 minutes. Drink three to five cups per day beginning two days before PMS symptoms usually commence. In addition, 1–3 cups of the tea added to hot or cold water can be used as a sitz bath.
1. Prior JC, Vigna Y, Sciarretta D, et al. Conditioning exercise decreases premenstrual symptoms: a prospective, controlled 6-month trial. Fertil Steril 1987;47(3):402-8.
Last Review: 06-08-2015
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