Many women suffer from various discomforts during the premenstrual or luteal phase, but what many don't realize, is it's not necessary. Studies have found that lifestyle modifications and therapies can alleviate discomforts associated with normal menstrual cycle changes.
Bloating, cramps, mood swings, acne... these symptoms are common, but they can be alleviated by correcting micronutrient deficiencies and/or adding certain botanicals into your daily routine.
Supplements:
Calcium- Estrogen is involved in the metabolism and absorption of calcium. Many women who suffer from PMS have low calcium levels. Calcium supplementation of 1200-1600 mg/day, unless contraindicated, is an effective treatment for Premenstrual Syndrome. Calcium has been shown to greatly reduce all symptoms relating to the luteal phase.
Magnesium- Women with PMS have been shown to have magnesium deficiency. This leads to fatigue, irritability, brain fog, or mental confusion, insomnia, and muscle cramps. Studies have shown that 200mg of Magnesium and 50mg of vitamin B6 is beneficial in alleviating PMS. Notably in women who suffer from significant bloating, cramping, and menstrual migraines. Magnesium inhibits prostaglandins which are associated with breast tenderness, cramping, headaches, irritability, and depression, which is likely why it works so well.
Dose: 200-400 mg/day. 600 mg might be needed if woman suffers from PMS and migraines.
Vitamin B6- Vitamin B6 has been used to alleviate PMS since 1975! It works to ease PMS through its ability to increase synthesis of serotonin, dopamine, norepinephrine, histamine, and taurine. Low levels of dopamine and serotonin are linked with PMS. The liver cannot process more than 50mg of vitamin B6 at once.
Recommended dose: 50 mg/day within a multivitamin or with magnesium.
Vitamin D- Studies have shown that women with a high intake of vitamin D from foods have a significantly lower risk of suffering from PMS. Among the studies done, 400-1600 IU of vitamin D along with calcium were shown to be effective in decreasing PMS symptoms.
Vitamin E- 400 IU of vitamin E has been shown to significantly decrease the severity of PMS symptoms within just 3 months.
Botanicals:
Chaste Tree (Vitex agnus-castus)- Dates back nearly 2000 years ago as an effective herbal treatment of PMS and is supported by randomized human trials. So why don't we know about it?!?
Chaste Tree helps alleviate irritability, mood alterations, anger, headache, and breast tenderness. However, it is not effective in decreasing or treating bloat. Chaste Tree works by reducing prolactin, increasing progesterone, and binding to opiate receptors (decreasing beta-endorphin levels which is associated with anxiety, food cravings, and physical discomfort).
Recommended dose: 250-500 mg/day of dried fruit or 20-40 mg/day of chaste berry extract.
Note: Should not be used with combined contraceptives or other hormone therapies.
Black Cohosh (Actaea racemosa, cimicifuga racemosa)- Historically Black Cohosh was used by early physicians to treat restlessness, nervous excitement, breast pain, and menstrual headaches. Current studies have found it effective in reducing anxiety, tension, and depression in women suffering from PMS. Research found that compounds in Black Cohosh bind to 5-HT7 receptors, which may explain the positive effects on mood.
Recommended dose: 20-40 mg of standardized extract twice daily or 150- 300 mg of the herb equivalent twice daily. Use caution in women with liver disease.
“To keep the body in good health is a duty…otherwise we shall not be able to keep the mind strong and clear.” – Buddha
Ginko (Ginko Biloba)- Effective at reducing congestive symptoms such as fluid retention, breast tenderness, and weight gain. Ginko augments the venous tone and reduces capillary fragility, however the exact mechanism of action in treating premenstrual symptoms is unknown. Studies have shown either 80 mg twice daily or 40 mg three times a day both starting from day 16 of menstrual cycle through day 5 of the next cycle effective at reducing both physical and psychological symptoms associated with pms. Caution: May cause GI disturbances.
Although bleeding risk is low, it is advised to use caution in women taking anticoagulant medications.
St. John’s Wort (Hypericum perforstum)- Popular herb used for depression and often recommended for women suffering from depression and irritability during the premenstrual period. Studies have shown statistically significant improvements in physical and behavioral symptoms of PMS but not in mood or pain associated with PMS.
Recommended dose: 300-600 mg TID.
Do not use if taking medications that increase photosensitivity, protease inhibitors (for HIV), cyclosporine, or other medication metabolized by the cytochrome P-450 CYP3A4 or P-glycoprotein.
Valerian (Valeriana officinalis)- Effective in treating/reducing irritability, anxiety, and sleep disturbances. Found in many over-the-counter relaxants and sleep-aids. World Health Organization recognizes Valerian as a mild sedative, sleep-promoting agent that is a good alternative and possible substitute for stronger sedatives such as benzodiazepines.
Recommended dose: 2-3 g about 1 hour before bedtime. Smaller doses may be used throughout the day to relieve irritability and anxiety. Standardized extracts are widely available. Take as directed on label.
Generally safe, non-habit forming but contraindicated during pregnancy and delivery due to lack of research.
References
Dadkhah, H., Ebrahimi, E., & Fathizadeh, N. (2016). Evaluating the effects of vitamin D and vitamin E supplement on premenstrual syndrome: A randomized, double‑blind, controlled trial. Iranian Journal Of Nursing & Midwifery Research, 21(2), 159-164. doi:10.4103/1735-9066.178237
Schuiling, K. D., & Likis, F. E. (2017). Womens gynecologic health. Burlington, MA: Jones & Bartlett Learning.
Rakel, D., MD. (2018). Integrative Medicine(4th ed.). Philadelphia, PA: Elsevier.