Premenstrual syndrome (PMS) is a common name for a wide variety of recurring psychological and physical symptoms experienced by some women in the week or two before menstruation. Symptoms include sudden episodes of tearfulness, irritability, or depression; fatigue; water retention; headaches; and joint or muscle pain. Twenty to 50 percent of all women are believed to experience at least one symptom of PMS regularly; only five percent of these women are estimated to have symptoms severe enough to interfere with normal activity. PMS can begin with puberty but is most common in women over age 25. The cause is still unknown, but one theory proposes that low progesterone levels in the second half of the menstrual cycle may be responsible.
Conventional medical treatment of PMS sometimes involves prescription of diuretics for water retention and if symptoms are severe, tranquilizers and antidepressants (one study found that Prozac reduced PMS symptoms). Some conventional medical practitioners prescribe progesterone for PMS symptoms. From a complementary and alternative medicine standpoint, certain herbs and nutrients are often used in the treatment of PMS. Following is a discussion of those herbs and nutrients.
Research has shown that the herb Vitex (Vitex anguscastus; aka, Chasteberry) is able to increase progesterone levels.1 Studies have shown that using Vitex once in the morning over a period of several months helps normalize hormone balance to alleviate the symptoms of PMS.2 Vitex has been shown to be as effective as 200 mg vitamin B6 in a double-blind study of women with PMS.3 In another placebo-controlled clinical study, women with PMS were given Vitex or a placebo. By the end of the study, women taking the Vitex had a significantly greater reduction in overall PMS symptoms (including irritability, headache, breast tenderness, etc.) than the placebo group.4 Another recent, multi-center trial on the efficacy of a Vitex extract investigated 50 patients with PMS. The conclusion was that the extract successfully treated PMS, with the main effect seemingly related to symptomatic relief rather than to the duration of the syndrome.1 Since Vitex is a slow acting herb, an extract providing 40 mg extract (standardized for 0.5% agnuside) should be taken for at least three menstrual cycles to determine if it will work for you.
Many PMS sufferers have reported beneficial results with vitamin B6. Furthermore, many5,6,7,8,9 but not all10 studies have shown that taking 50–400 mg of vitamin B6 per day for several months can relieve symptoms of PMS. The mechanism of action for vitamin B6 with PMS may have to do with this nutrients ability to increase the conversion of the fatty acid GLA to prostaglandin E1; a chemical which may reduce the effects of PMS.11 Vitamin B6 is one of the most useful of the B-vitamins for reducing PMS symptoms. It particularly reduces fluid retention, breast swelling, and tenderness, bloating and edema in general, as well as anxiety, irritability, insomnia, sugar craving and symptoms caused by refined sugar. About 100 mg of vitamin B6 daily is a good dose.
Women with PMS are often deficient in magnesium.12,13 Supplementing with magnesium may help reduce symptoms.14,15 Furthermore, like vitamin B6, magnesium has the ability to increase the conversion of GLA (see following paragraph on GLA) to prostaglandin E1C a biochemical, which may reduce the effects of PMS.16 In some research, 400 mg of magnesium daily was used.17
Dong Quai, a traditional Chinese medicinal herb that is often referred to as the "female ginseng", helps promote normal hormone balance and is particularly useful for women experiencing premenstrual cramping and pain.18 An appropriate dose seems to be about 600 mg of Dong Quai extract daily.
Black Cohosh appears to help modulate female hormone levels, which may have an effect on the balance of menstrual hormones. Although extensive research supports the use of this herb in the treatment of menopause, it also has been used extensively in the treatment of PMS. In fact, Germany’s Commission E (an internationally authoritative source of credible information on the use of herbs for various disorders) has approved Black Cohosh for use in women with PMS.19 About 40–80 mg/day of Black Cohosh extract standardized for 2.5% triterpene glycosides is recommended.
Although generally associated with improving short-term memory, Ginkgo biloba extract has also been shown to be beneficial in the treatment of congestive symptoms of PMS (e.g., painful or tender breasts, edema/water retention). In a French study,20 Ginkgo extract demonstrated statistical significance in reducing breast pain and tenderness. There were also improvements in edema, anxiety, depression and headaches but there were not statistically significant. However, in another study21 of patients with cyclic edema, Ginkgo extract was found to have anti-edema activity. The recommended daily dose of Ginkgo biloba leaf 50:1 extract is 160 mg, standardized for 24% flavone glycosides, 6% terpene lactones.
Diet and/or other considerations
Dietary considerations for PMS involve the avoidance of refined sugar, excessive alcohol, and caffeine while consuming a high-fiber, low-fat diet. Women who consume high-sugar foods appear to have an increased risk of PMS.22 Although an occasional drink is not a problem, keep in mind that alcohol can affect hormone metabolism, and alcoholic women are more likely to suffer PMS than are non-alcoholic women.23 Also, research has shown an increase in the prevalence and severity of PMS in women consuming caffeine-containing beverages.24,25 Moreover, the more caffeine women consumed, the more likely they were to suffer from PMS.26 In addition, several studies suggest that diets low in fat or high in fiber may help to reduce symptoms of PMS.27
- Blumenthal M, Hall T, Goldberg A, Kunz T, Dinda K, Brinckmann J, et al, eds. The ABC Clinical Guide to Herbs. Austin, TX: American Botanical Council; 2003.
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- Lauritzen C, et al, Phytomedicine(1997) 4:183B89.
- Schellenberg R. Treatment of the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ(2001) 332:134–7.
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- Nicholas A. Traitement du syndrome pre menstruel et de la dysmenorrhee par l=ion magnesium. In First International Symposium on Magnesium Deficit in Human Pathology (1973) ed. J Durlach. Springer Verlag, Paris, pp. 261B63.
- Facchinetti F, et al, Obstet Gynecol (1991) 78:177B81.
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- Blumenthal M, et al (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines(1998) American Botanical Council and Boston: Integrative Medicine Communications, Austin, pp. 90.
- Tamborini A, Taurelle R. Rev fr Gynéol Obstét (1993) 88:447.
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- Werbach MR, Nutritional Influences on Illness, 2d ed. (1993) Third Line Press, Tarzana, California, pp. 540B41.