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Premenstrual Syndrome

Nutritional Therapy

Calcium and vitamin D. Calcium has a long history in the treatment of PMS and menstrual disorders (Abraham 1983). In fact, its use in symptom relief stretches back to the 1930s, when women suffering menstrual cycle problems routinely took supplemental calcium. Since then, this “folk” remedy has been tested in clinical trials with positive results.

In a study, calcium supplementation was found to be a simple and effective treatment for PMS (Thys-Jacobs 1998). After supplementing with calcium for 3 consecutive menstrual cycles, healthy menstruating women reported a 48% reduction in total PMS-related symptoms compared with menstruating women receiving placebo (Thys-Jacobs 1998).

A review study found that women receiving calcium coupled with vitamin D experienced significant relief from psychological and physical symptoms of PMS. This review confirmed that PMS represents a clinical manifestation of calcium deficiency (Thys-Jacobs 2000; Thys-Jacobs 1995).

Magnesium. Among its many functions, magnesium plays a role in maintaining parathyroid function and hormone production (Ganong 2003). Magnesium deficiency has been implicated as a cause of premenstrual symptoms (Abraham 1981).

A double-blind, randomized study investigated the effects of oral magnesium on premenstrual symptoms. This study noted significant changes on the Menstrual Distress Questionnaire (a measurement of menstrual distress) in women who had taken magnesium for two menstrual cycles (Facchinetti 1991).

Zinc. Researchers found that women with PMS had lower levels of zinc and higher levels of copper during the luteal phase of menstruation than menstruating women without PMS. They concluded that zinc deficiency occurs in women with PMS during the luteal phase of menstruation, and elevated copper further reduces their availability of zinc during the luteal phase (Chuong 1994).

Vitamin B6 (pyridoxine, pyridoxal, pyridoxamine). A meta-analysis was performed to evaluate the efficacy of vitamin B6. Researchers reviewed 9 placebo-controlled, published trials representing 940 women with premenstrual syndrome. Their conclusions showed that up to 100 mg of vitamin B6 daily is likely to be beneficial in treating premenstrual symptoms and premenstrual depression (Wyatt 1999).

In 1987, researchers conducted a double-blind controlled study on the effects of vitamin B6 supplementation on premenstrual symptoms experienced by 55 women who reported moderate to severe premenstrual mood changes. Study results suggested that vitamin B6 improved premenstrual symptoms related to autonomic reactions (eg, dizziness and vomiting) and behavioral changes (eg, poor performance and decreased social activities) (Kendall 1987).

Vitex. Extracts of the fruits of the chaste tree (Vitex agnus castus) are widely used to treat premenstrual symptoms. Double-blind, placebo-controlled studies indicate that breast tenderness (one of the most common premenstrual symptoms) is beneficially influenced by this extract, also called chasteberry. In addition, numerous studies indicate that vitex extracts have beneficial effects on other psychic and somatic symptoms of PMS (Wuttke 2003).

A group of German researchers studied the effects of chaste tree extract versus placebo in a group of women diagnosed with PMS. Both prior to and after the treatment period, women were asked to report their symptoms of PMS and the degree of severity. Researchers evaluated the changes in reported symptoms. More than 50% of the women experienced a reduction in PMS-related symptoms. The results of this study prompted the German government to allow Vitex agnus castus to be approved for menstrual irregularities, breast pain, and premenstrual complaints (Schellenberg 2001).

In a study comparing the efficacy of chasteberry extract with that of fluoxetine (a selective serotonin reuptake inhibitor [SSRI]) on mood disorders associated with PMDD, patients responded well to both fluoxetine and chasteberry extract. However, chasteberry proved better than fluoxetine at improving physical symptoms (Atmaca 2003).

Researchers investigated the efficacy of using chasteberry extract to reduce breast pain related to PMS. In a placebo-controlled, randomized study, chasteberry extract was effective and well tolerated as a treatment for cyclical breast pain (Halaska 1998).

Ginkgo biloba. In a clinical study, Ginkgo biloba was effective at reducing symptoms of anxiety and headaches. A total of 165 women age 18 to 45 years were given 160 mg ginkgo extract or placebo daily from day 16 of one menstrual cycle to day 5 of the next. Symptoms of fluid retention, particularly breast tenderness, were improved, as were psychological parameters (Tamborini 1993).

Vitamin E. Vitamin E is a powerful antioxidant and free radical scavenger that protects the integrity of the cellular membranes in the body. Researchers investigated the impact of D-alpha-tocopherol, a form of vitamin E, on women suffering from PMS. A daily treatment with 400 International Units (IU) D-alpha-tocopherol was administered for 3 monthly cycles. A significant improvement in physical symptoms was noted in participants treated with D-alpha-tocopherol (London 1987).

Theanine. Theanine, a unique amino acid in tea, can lessen the effects of PMS. Theanine readily crosses the blood-brain barrier and exerts subtle changes in biochemistry. An increase in alpha waves has been documented, and the effect has been compared to getting a massage or taking a hot bath. Theanine does not cause drowsiness; unlike tranquilizers, it does not interfere with the ability to think. Studies of green tea, which contains a high quantity of theanine, have shown that when given to rats, theanine modulated the release of dopamine in the brain (Yamada 2005). Theanine is now available as a dietary supplement in the United States.

Natural Methods to Modulate Serotonin

Among women with severe PMS, prescription antidepressants (SSRIs) are frequently prescribed. These medications inhibit the uptake of serotonin, thus making more of it available. Serotonin is an important neurotransmitter involved in the regulation of mood.

Tryptophan, a precursor of serotonin, is sometimes used by alternative physicians to treat depression by increasing the amount of serotonin. It has been shown to significantly reduce PMS symptoms if administered during the luteal phase (Freeman 2004).

5-hydroxytryptophan, the direct precursor to serotonin, may help relieve symptoms by increasing the serotonin production. It is the intermediate step between tryptophan and serotonin. Although 5-hydroxytryptophan has not been studied in PMS, it has been studied in the treatment of depression (Turner 2006).

Finally, the herb St. John’s wort is sometimes recommended for PMS. St. John’s wort (Hypericum perforatum) has gained attention as a natural antidepressant due to its role in serotonin modulation. It appears to work by multiple mechanisms, each of which is relatively weak on its own but contributes to the herb’s overall effectiveness. These mechanisms include inhibiting monoamine oxidase-A and -B activity and inhibiting the uptake of serotonin, dopamine, and noradrenaline (Butterweck 2003). In one case study, a patient with PMDD who was unable to tolerate standard antidepressant treatment was given 900 mg of St. John’s wort daily; she experienced substantial improvement in her symptoms (Huang 2003). Another observational study examined the use of St. John’s wort among women with PMS. Participants took 300 mg of St John’s wort daily (standardized to contain 900 mcg of  hypericin) for one menstrual cycle. The women experienced improvements in all symptom scores (Stevinson 2000).

The Role of Fatty Acids in PMS

Omega-3 fatty acids. Fatty acids play a role in mediating prostaglandins (Horrobin 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 rich foods, which provide eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can help control inflammation by bringing balance to essential fatty acids. In clinical studies, supplementation with omega-3 fatty acids reduced symptoms associated with PMS, including cramps (Sampalis 2003; Harel 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 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 levels of gamma-linoleic acid, a metabolite of linoleic acid, are low. This implies a problem with the conversion of linoleic acid to GLA (Brush 1984).