Dietary supplement companies need to step it up when it comes to research for premenstrual syndrome (PMS). They should follow the lead of pharmaceutical companies, which look for other ancillary benefits of effective drugs that are already on the market, such as prescription antidepressants.
Some of these are now FDA-approved for PMS, but they also come with many side effects, including nausea, sexual dysfunction, and decreased energy. I’d start by studying supplements that have shown benefits for depression (SAM-e, 5-HTP), fatigue (American ginseng), headaches (vitamin B2, butterbur, magnesium), nausea (ginger, B6), stress and anxiety (theanine, GABA), and pain (SAM-e, again).
I just divulged the golden road map for success! The conventional drugs in this area of medicine are not better or smarter than supplements; the makers are just more strategic, business savvy, and sensitive to the distressing effects of moderate to severe PMS. Come on, supplement companies! Get off your gluteus maximus; you will obviously be well rewarded!
What is Premenstrual Syndrome (PMS)?
About 80 percent of women report experiencing some form of behavioral, psychological, or physical changes during the 2 weeks before menstruation. Most of the time PMS causes mild to moderate symptoms, but in premenstrual dysphoric disorder (PMDD), a severe form of PMS, women experience more acute symptoms that dramatically interfere with day-to-day life, including relationships, social interactions, and work.
Postovulation hormonal changes trigger PMS, and some women’s bodies are more sensitive to these shifts than others. That’s why birth control pills can be so effective for PMS; they reduce the chances of ovulation occurring and keep hormones steady throughout the month. In addition, there are at least two neurotransmitters that have been implicated in PMS: GABA (gamma- aminobutyric acid) and serotonin. Drugs that increase serotonin, like antidepressants, have proven very helpful for many women. Twin studies have shown that genetics/family history also increases the risk of experiencing PMS or PMDD.
Primary dysmenorrhea—pain during menstruation—is the most common gynecologic condition experienced by menstruating women. It involves recurrent lower abdominal cramps just before or during menses but with no underlying explanation or cause (i.e., a pelvic examination is normal). (Secondary dysmenorrhea, on the other hand, is caused by a distinct pathological condition, such as endometriosis, pelvic inflammatory disease, or interstitial cystitis.) Pain may radiate to the lower back and thighs as well.
Researchers believe dysmenorrhea is due to an imbalance of compounds—pros-taglandins, vasopressin, and others—that can cause uterine contractions, cramping, and even nausea and vomiting. Risk factors include age (younger than 30), anxiety and stress, obesity or being underweight, depression (especially if it’s associated with an eating disorder), family history, smoking, early age at first menses, heavy menstrual periods, premenstrual symptoms, bleeding in between menstrual periods, and never having given birth (nulliparity), among others.
Home Remedies For Premenstrual Syndrome (PMS)
1. Calcium carbonate 1,200 milligrams a day in two divided doses
Several randomized trials have found positive benefits for PMS with calcium carbonate dietary supplements (1,000 to 1,200 milligrams per day in two divided doses). Yet, it was a large US multicenter trial (the PMS Study Group at 12 US sites) that brought the most attention to it. A total of 466 participants took 1,200 milligrams of calcium carbonate or a placebo daily for three treatment cycles.
By the third treatment cycle those taking calcium carbonate had a 48 percent reduction in total PMS symptom scores compared to 30 percent in the placebo group. Pain was reduced by 54 percent with calcium carbonate versus a 15 percent increase with the placebo. Negative mood aspects (swings, depression, tension, anxiety, anger, crying spells) were reduced by 45 percent with calcium carbonate and 28 percent with the placebo.
Food cravings were reduced by 54 percent versus 35 percent with the placebo, and water retention was reduced by 36 percent versus 24 percent. The beneficial impact of calcium carbonate began to be significant in the last two cycles, which means you have to give it a couple of months.
The tolerable upper limit or maximum for calcium for women (ages 12 to 50 years) is 2,500 to 3,000 milligrams per day; the average dietary intake is 600 to 800 milligrams, so taking extra calcium in the form of a supplement appears safe for PMS. However, postmenopausal women should be careful about getting too much calcium because it could slightly increase their risk of kidney stones.
Overall, calcium carbonate is the most tested supplement for PMS; it’s safe for women who may become pregnant and also very inexpensive, which makes it the perfect Moyad product to recommend!
Rare side effects with calcium supplementation include constipation, nausea, loss of appetite, headaches, and nonspecific pain. And calcium carbonate can potentially interfere with some prescription medications, especially tetracycline drugs and thyroid hormone pills (thyroxine). You can still use these drugs; just take the calcium at least 2 to 4 hours before or after the drug because it can reduce absorption.
Many studies of calcium suggest that vitamin D may play a role in reducing PMS as well. If you’re experiencing problematic symptoms, ask your doctor about a blood test for vitamin D. (Other calcium supplements, such as calcium citrate, have not been researched in the area of PMS, so I’m not recommending them.)
2. Vitamin B6 (pyridoxine) 50 to 100 milligrams a day
An analysis of at least nine randomized trials showed that daily doses of vitamin B6 ranging from 50 to 600 milligrams reduced PMS symptoms. However, I’m not a fan of taking large doses because it can cause sensory neuropathy or nerve damage (especially at levels above 300 milligrams per day).
Plus, the clinical studies using 100 milligrams per day of vitamin B6 looked as impressive as the higher-dosage studies, so stick with my suggested range. This vitamin is also commonly used to reduce nausea—a common symptom of PMS—in the first trimester of pregnancy with good success (see the Nausea and Vomiting section).
3. Chasteberry (Vitex agnus-castus) 20 milligrams a day on average
This herbal contains casticin, an ingredient that decreases levels of the hormone prolactin by occupying specialized cellular receptors in the body known as dopa- mine (D2) receptors.
Higher levels of prolactin may cause more severe PMS symptoms in some individuals. The best trial with chasteberry—published in BMJ (formerly known as the British Medical Journal)—used an extract known as Ze 440 (which contains a standardized amount of casticin).
Fifty-two percent of the women who took the extract (there were 170 subjects total) reported at least a 50 percent reduction in their PMS symptoms, versus 24 percent of those who took the placebo. They reported a significant improvement in a variety of symptoms, including headache, irritability, mood changes, and breast symptoms, and the side effects were no different than a placebo.
This is the trial that most likely launched this herb into commercial success. Another study that was not double-blind found a 42 percent reduction in PMS symptom scores, with the largest improvements in pain, behavior changes, negative feelings, and fluid retention.
When compared to a commonly used prescription antidepressant (fluoxetine), both worked equally well.
A more recent study from Germany that compared doses of 8, 20, and 30 milligrams of Ze 440 with a placebo found that the 30-milligram dose worked no better than the 20-milligram dose, but the 20-milligram dose worked significantly better than the 8-milligram and placebo groups.
Chasteberry is arguably the most commonly recommended herbal product for PMS by alternative medicine experts, and although I agree that it has some efficacy, it also has quality-control issues. Research with this supplement has focused on two extracts, Ze 440 (one 20-milligram tablet) and BNO 1095 (one 4-milligram tablet), both of which can be hard to find in the United States. Once you venture away from these, all bets about effectiveness are off, so buyer beware. If it weren’t for this, I would have ranked chasteberry higher.
Uncommon side effects include nausea, headache, and skin rashes. There isn’t good information about major drug interactions, but ask your doctor if you’re using any type of hormonal contraceptive (which usually can help alleviate PMS anyway) or taking drugs that affect prolactin or dopamine (several antipsychotic drugs rely on dopamine); chasteberry shouldn’t be used with them. The biggest general concern is that this herb could reduce the effectiveness of oral contraceptives, and I wouldn’t recommend it if you’re planning to become pregnant or are pregnant.
Omega-3s, 1,200 milligrams daily of the active ingredients EPA and DHA, can help reduce pain during PMS, according to one study. Another trial with 2,000 milligrams daily found they significantly reduced depression, anxiety, and bloating, especially after 2 to 3 months of use.
Magnesium (200 milligrams per day of magnesium oxide) has preliminary evidence for reducing water retention, breast tenderness, and mood symptoms.
What Are Useless For Treating Premenstrual Syndrome (PMS)?
In one study, taking 15 milligrams twice a day for two menstrual cycles reduced symptom severity by half in 19 out of 50 patients. However, as with most PMS dietary supplements, this study has not been replicated—or improved upon—to see if it really works better than a placebo.
Evening primrose oil
It contains the omega-6 GLA (gamma-linolenic acid), which alleviates breast pain and abdominal cramping by being metabolized into prostaglandin E1, which is a natural anti-inflammatory in the body. The problem is, rigorous studies of evening primrose oil have shown no benefit over a placebo. Adolescents with epilepsy should avoid it because there have been reports that it may lower the seizure threshold.
Black currant oil and borage seed oil are somewhat similar to evening primrose oil in that they have a high GLA content— even higher than evening primrose oil. Yet, there is no adequate human research to suggest these work for PMS either.
Recent research suggests it has minimal to no impact in this area, but it may have a role in treating menopausal symptoms because of its apparent impact on neurotransmitters (see the Hot Flashes section).
Wild yam root
Wild yams contain the compound diosgenin, which some supplement manufacturers claim gets converted into progesterone in the body, reducing PMS (and even menopausal symptoms). Unfortunately, this conversion has not yet been proven.
This herb is widely used in Chinese medicine for gynecological problems, including PMS. Yet, there is no adequate research in the area of PMS.
Soy, vitamin E, or ginkgo biloba
These individual supplements don’t yet have enough clinical research to determine if they work better than a placebo.
St. John’s wort
By itself, St. John’s wort has not worked much better than a placebo in PMS studies. But when researchers start pairing it with other supplements that have been shown to be effective for PMS, I feel more confident that it may help reduce symptoms.
What Lifestyle Changes Can Help With Premenstrual Syndrome?
Heart healthy = menstrual cycle healthy?
Maybe. Doctors generally recommend increasing exercise and reducing caffeine, salt, and refined or simple sugars when dealing with PMS, but there’s very little research to support these recommendations. In fact, there’s very little research being done at all in regard to lifestyle choices and PMS. But if you look at many of the symptoms that can occur with PMS and PMDD (fatigue, anxiety, poor focus), there is plenty of research outside of PMS to suggest that exercise and healthy lifestyle changes can make a difference.
Most of the dietary and supplement research over the past 25 years in the area of PMS has revolved around addressing deficiencies during the menstrual cycle, whether it’s calcium, vitamin D, omega-3s, B vitamins, or whatever.
The heart- healthy Moyad diet outlined in the beginning of this book addresses these deficiencies as well. So, as a result, I do believe that being heart healthy can make your menstrual cycle healthier. A well-known older study from Virginia Commonwealth University found that obese women had a nearly threefold increased risk of PMS compared to nonobese women. Another study from Basel, Switzerland, of more than 3,500 women found that PMS was associated with an increased risk of poor physical health and psychological distress. The question remains whether the poor health and distress leads to PMS or vice versa.
Eat more Bs
Researchers working on the large Nurses’ Healthy Study 2 (one of the largest and longest studies to evaluate the impact of lifestyle habits on overall health) found a lower risk of PMS in women who had higher intakes of vitamins B1 and B2 from food sources.
Foods that are high in these vitamins include organ meats, pork, brewer’s yeast, fortified cereals, beans, wheat germ, bran, wild rice, mushrooms, milk, soybeans, eggs, broccoli, and spinach (mostly heart-healthy foods). In one well-done randomized trial with 556 young women (ages 12 to 21), 100 milligrams daily of vitamin B1 (thiamin hydrochloride) worked better than a placebo at reducing dysmenorrhea during menstruation. I’d like to see more recent research on this because 87 percent of the participants had their pain eliminated in this older study!
This is getting a lot of preliminary positive research for primary dysmenorrhea. Massaging two points—just above the ankle bone and a few inches below the knee—on the inside of the lower leg (called Spleen 6 and Spleen 8) has helped reduce pain.