Premenstrual Syndrome

The Role of Fatty Acids in PMS

Omega-3 fatty acids. Fatty acids play a role in mediating prostaglandins (Horrobin DF 1983). Supplementation with the right proportions of fatty acids can maximize the production of anti-inflammatory prostaglandins (E1 and E3) while suppressing pro-inflammatory prostaglandin E2 and leukotriene B4. In addition to avoiding saturated fats and high glycemic foods that contribute to chronic inflammation, eating omega-3 foods, which provide eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can help control inflammation by bringing balance to the essential fatty acids. In clinical studies, supplementation with omega-3 fatty acids reduced symptoms associated with PMS, including cramps (Sampalis F et al 2003; Harel Z et al 1996). Flax seed oil, which is derived from flax, is rich in alpha-linolenic acid. In the body, alpha-linolenic acid is converted into EPA, providing another possible source of EPA.

Gamma-linoleic acid. Gamma-linoleic acid (GLA) is a long-chain polyunsaturated fatty acid found in evening primrose oil and borage seed oil. Like levels of omega-3 fatty acids, levels of GLA are abnormal among women with PMS. For example, one study found that levels of linoleic acid are normal or elevated in women with PMS, but the levels of gamma-linoleic acid, a metabolite of linoleic acid, are low. This implies a problem with the conversion of linoleic acid to gamma-linoleic acid (Brush MG et al 1984).

Conventional Treatment

Conventional treatment for mild PMS usually focuses on NSAIDs, which reduce smooth muscle contractions and cramping. In addition, some of the drugs that have shown benefit, such as benzodiazepines, have risk for addiction and abuse.

Antidepressants. Antidepressants such as SSRIs are commonly used for the depression associated with PMS and PMDD (Freeman EW et al 2004; Baldessarini R 2001). Serotonin reuptake inhibitors that are commonly used to treat PMS include Prozac® (fluoxetine) and Zoloft® (sertraline) (Berga S 2005). These drugs typically require a two- to three-week phase-in period before they reach maximum effectiveness. If they are prescribed, they should be used continuously until both patient and physician agree to stop using them, and then they should be phased out gradually. They cannot be used on an “as needed” basis. Side effects associated with SSRIs include nausea, diarrhea, tremor, weight loss, and headache.

Benzodiazepines. This class of medications is used to induce sedative, muscle-relaxant, and anticonvulsant effects (Baldessarini R 2001). Benzodiazepines have effects similar to allopregnanolone, a metabolite of progesterone that acts at the brain receptor sites at which benzodiazepines operate. Alprazolam is a commonly prescribed benzodiazepine. However, these drugs have a serious risk of addiction and abuse.

NSAIDs. Over-the-counter (OTC) medicines such as ibuprofen (Motrin®) and naproxen sodium (Aleve®) are commonly used to ease uterine cramping and breast tenderness (Mayo Clinic 2005). These drugs inhibit prostaglandin synthesis (Neal M 2002).

Others. Bromocriptine, an ergot alkaloid that blocks the release of prolactin from the pituitary gland, is often given to treat breast tenderness associated with PMS (Meden-Vrtovec et al 1992).

Lifestyle Changes to Reduce PMS Symptoms

Stress reduction. Stress reduction is important to reduce symptoms of PMS and PMDD. One study determined that women with significant PMS symptoms had more stress and a lower quality of life than women with low-grade or no PMS symptoms (Lustyk M et al 2004). Stress has an effect on the hypothalamic-pituitary-adrenal axis by causing an increase in “stress” hormones with wide-ranging effects throughout the body (Young EA et al 2002).

Women who suffer from high PMS may benefit from psychotherapy, massage therapy, yoga, and other alternative methods to reduce stress.

Smoking cessation. In a study of behavior and lifestyle factors associated with menstrual symptoms, researchers found that cigarette smoking was the lifestyle factor most highly associated with all types of measured menstrual symptoms and cycle disorders (Kritz-Silverstein D et al 1999). Many strategies are available to help people quit, including group therapy, nicotine replacement patches, gums, hypnotism, and support lines.

Exercise. Exercise seems to help reduce PMS symptoms. Both aerobic and other forms of exercise appear to be helpful (Fugh-Berman A et al 2003). Exercise also helps reduce weight. Although obesity is not consistently associated with menstrual symptoms, endometrial hyperplasia and other gynecological disorders are associated with overweight and obese women. Women who suffer from PMS and other menstrual disorders and who are overweight should seriously consider a weight reduction program. Mineral supplementation with chromium picolinate, which helps stabilize blood sugar levels, has been shown to help women who suffer from PMS reduce their cravings for sugar. Chromium picolinate has also been found to help with weight reduction (Bell SJ et al 2002). For more information, see the chapter Obesity.

Product Availability

All the nutrients and supplements discussed in this section are available through the Life Extension Foundation Buyers Club, Inc. For ordering information, call anytime toll-free 1-800-544-4440, or visit us online at www.LifeExtension.com.

The blood tests discussed in this section are available through Life Extension National Diagnostics, Inc. For ordering information, call anytime toll-free 1-800-208-3444, or visit us online at www.LifeExtension.com.