Premenstrual syndrome (PMS) is a complex disorder that affects a woman’s emotional and physical well-being. Broadly defined, PMS is a constellation of behavioral, psychological and physical symptoms that affect a woman during the luteal phase, 7 to 14 days before the onset of the menstrual flow. Over 200 symptoms have been associated with PMS. See the table below for a list of the most common symptoms of PMS.
Common Symptoms of Premenstrual Symptoms
Behavioral symptoms: fatigue, insomnia, dizziness, changes in sexual interest, food cravings, overeating, social isolation
Psychological symptoms: irritability, anger, depressed mood, crying, tearfulness, anxiety, tension, mood swings, lack of concentration, confusion, forgetfulness, restlessness, loneliness, decreased self-esteem, tension, forgetfulness, restlessness, loneliness, decreased self-esteem, tension
Physical symptoms: headaches, breast tenderness, back pain, abdominal pain, bloating, weight gain, swelling of extremities, water retention, nausea and joint pain, acne, constipation, diarrhea, carbohydrate cravings
It is estimated that up to 85% of women between 25 and 35 years old are affected by PMS symptoms. 20% to 40% suffer from PMS, defined by the American College of Obstetricians and Gynecologists (ACOG) as “the cyclic occurrence of symptoms that are of sufficient severity to interfere with some aspects of life and that appear with consistent and predictable relationship to the menses.” Two to 10 percent suffer from premenstrual dysphoric disorder (PMDD) which results in serious impairment of some aspect of their social, family, or work life.
PMS and PMDD are diagnoses of exclusion meaning that other physical and psychiatric disorders must be ruled out before either diagnosis can be made. Disorders such as anemia, diabetes, thyroid disease, endometriosis, other endocrine abnormalities and breast disease may be confused with PMS. Major depression, dysthymia (chronic low-grade depression) and anxiety disorders are among the key psychiatric disorders that also need to be ruled out.
The cause of PMS and PMDD remain uncertain. Proposed etiologies include: hormonal dysregulation, fluid and electrolyte imbalances, neurotransmitter (serotonin) deficiency, prostaglandin excess or deficiency, vitamin and mineral deficiencies, genetic risk, psychological factors and social factors.
Supplements that may help:
- Calcium: A prospective, randomized, double-blind, placebo-controlled, parallel group multi-center clinical trial was conducted to evaluate the effectiveness of calcium carbonate for PMS. Women who took 1200 mg per day of calcium for three menstrual cycles had a 48% reduction in PMS symptoms (depression, water retention, pain food cravings, fatigue and insomnia), compared to a 30% reduction in the placebo group. In 1999 Annals of Pharmacotherapy published a review of studies focusing on calcium supplementation for PMS. The authors concluded that, “calcium supplementation of 1200 to 1600 mg/day, unless contraindicated, should be considered a sound treatment option in women who experience premenstrual syndrome.” Calcium may impair absorption of the following medications if taken simultaneously: tetracycline, iron, thyroid hormones and steroids.
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Vitamin D: A study published in 2005 indicated that Vitamin D when taken in addition to supplemental calcium may decrease PMS symptoms. Doses of the two supplements taken in combination were: 400 IU of vitamin D3 and 1200 mg of elemental calcium.
- Vitamin B6: Many studies have studied pyridoxine in the treatment of PMS. A systematic review of the 28 trials published between 1975 and 1999 showed that pyridoxine (Vit B6) was helpful in the treatment of PMS. 25 - 50 mg two-times per day is the recommended dose. Possible side effects: Neurologic changes can occur at doses greater than 100 mg/day.
- Magnesium: Women with PMS may have lower serum magnesium levels. Several well done studies have evaluated the effect of magnesium supplementation on various premenstrual symptoms. One trial showed a significant reduction of fluid retention, weight gain, swelling, breast tenderness and bloating after only 2 months of treatment with 200 mg per day. Possible side effects: abdominal cramping, diarrhea, low blood pressure, irregular heartbeat, muscle weakness, nausea and change in mental status.
- Other supplements that may be beneficial: Potassium, L-tryptophan, soy protein, vitamin E and krill oil. Additional studies are underway to assess their efficacy.
1. OBGYN.net
2. American Academy of Family Physicians
3. womenshealth.gov
References:
1. ACOG Practice Bulletin #15, 2000
2. Daugherty JE. Treatment strategies for premenstrual syndrome. Am Fam Physician. 1998;58(1)
3. Bertone-Johnson ER, et al. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165:1246-1252.
