The first step in helping women with PMS is to determine which subgroup most accurately fits their symptom picture. If it is not obvious from reading this or other information, selected laboratory tests can be called upon.
Abnormal thyroid function and intestinal candidiasis should also be ruled out since these may produce, during the mid-luteal phase, a symptom picture similar to PMS. If you are affected by one or more types of PMS (A, C, D, or H) they will be listed separately. PMS type A is the most common.
General Dietary Guidelines
- Limit consumption of refined carbohydrates and other concentrated carbohydrates, such as, honey, dried fruit, and fruit juice
- Increase protein intake, particularly from vegetable sources such as legumes
- Increase green leafy vegetables consumption, except brassica family foods (cabbage, brussels sprouts, and cauliflower)
- Decrease milk and dairy product consumption
- Decrease intake of fats, especially saturated fats, while increasing intake of linoleic and linolenic acid. Use only non-estrogen-supplemented red meat and fowl
- Decrease salt intake. Restrict alcohol and tobacco use. Restrict intake of methyl-xanthines (coffee, tea, chocolate, and caffeine-containing foods and beverages).
Premenstrual dysphoric disorder, or PMDD, is a debilitating set of symptoms associated with the part of a woman’s cycle that precedes her menstrual period. PMDD is also a psychiatric term for a major mood disturbance. “Dysphoria” is used by the psychiatric and medical community as a diagnostic term, generally referring to a type of depression.
Unlike PMS, PMDD symptoms are so severe that a woman’s day-to-day activities are completely disrupted. PMDD is relatively rare, affecting perhaps 3 – 5% of women.
There are 3 conventional approaches to treating PMDD. While most experts recommend a combination of all 3, there have been no scientific studies to determine if combination treatment is really the best approach. It is likely that the best approach or combination of approaches will vary from woman to woman based on things like symptom severity and which symptoms are most troublesome. These three include:
Medications – including antidepressants, antianxiety drugs, analgesics, hormones and diuretics.
Psychobehavioral – including exercise and psychotherapies (cognitive-behavioral, coping skills training, relaxation).
Nutritional – including diet modification, vitamins, minerals and herbal preparations.
Conditions that suggest Premenstrual Syndrome / PMDD
Being/being post menopausal
Risk factors for Premenstrual Syndrome / PMDD
Low Melatonin Level
Melatonin can exhibit strong effects on the reproductive system, and the activity of the female hormones estrogen and progesterone is closely tied with its regulation of the sleep-wake cycle. Abnormal biological rhythms and sleep-wake cycle disturbances are often a primary feature of periodic depression, another common characteristic of PMS. Melatonin imbalances have been specifically linked to PMS.
A study reported finding that women with PMS had an earlier decline in melatonin secretion, resulting in a shorter overall secretion time. “The data demonstrate that women with premenstrual syndrome have chronobiological abnormalities of melatonin secretion… The fact that these patients respond to treatments that affect circadian physiology, such as sleep deprivation and phototherapy, suggests that circadian abnormalities may contribute to the pathogenesis of premenstrual syndrome.” [Arch Gen Psychiatr 1990;47(12): pp.1139-46]
Magnesium Requirement
Magnesium deficiency is strongly implicated as a causative factor in PMS. Red Blood Cell magnesium levels in PMS patients have been shown to be significantly lower than in normal subjects. The deficiency is characterized by a generalized hyperesthesia syndrome (with generalized aches and pains), and a lower premenstrual pain threshold. One clinical trial of magnesium in PMS showed a reduction of nervousness in 89%, mastalgia in 96%, and weight gain in 95%.
Manganese Requirement
In a double blind study of women with normal menstrual cycles, lower dietary manganese (1.0mg versus 5.6mg) was found to increase mood and pain symptoms during the premenstrual phase. [Am J ObstetGynecol. 1993 May; 168(5): pp.1417-23]
Premenstrual Syndrome / PMDD suggests the following may be present
Recommendations for Premenstrual Syndrome / PMDD
Theanine (L-Theanine)
Japanese researchers have discovered that theanine works for PMS. Using a distress questionnaire, they tracked the reactions of 20 women taking the new supplement for 2 months. 100mg of theanine bid caused documented reductions in mental, social and physical symptoms when taken during symptomatic periods.
Lactobacillus Acidophilus
Lactobacillus acidophilus has been shown to inhibit the fecal bacterial enzyme, beta-glucuronidase, which is responsible for deconjugating liver conjugated estrogen.
Vitex
Clinical studies using vitex extract show a reduction in headaches, breast tenderness, bloating, fatigue, cravings for sweets, and also feelings of anxiety, irritability, depression and mood swings, after only one month. Whether this would be effective for the more severe symptoms of PMDD is not known.
Caffeine/Coffee Avoidance
Several studies have linked caffeine consumption to a higher incidence of PMS symptoms including tension, irritability, anxiety, fatigue, sleep disturbance and breast tenderness. Some of coffee’s components have a mild estrogen-like effect on the body. Since estrogen is responsible for premenstrual syndrome and breast tenderness, this may be one reason why coffee aggravates these conditions.
Sugars Avoidance / Reduction
Reducing or eliminating alcohol, caffeine, nicotine and sugar are all diet recommendations that can improve PMS symptoms.
Alcohol Avoidance
See the link between PMS and Sugar Avoidance.
Conventional Drugs / Information
In the October 2006 issue of the Journal of Clinical Psychiatry, researchers reported that low doses of sertraline taken for two weeks before the onset of the menstrual period may be an effective and well-tolerated treatment for some women who experience moderate-to-severe premenstrual syndrome, or PMS.
The researchers also tested and found two other anti-depressant dosing strategies to be effective. One of those dosing strategies was taking medication daily throughout the menstrual cycle. The other was waiting until PMS symptoms begin to start medication each cycle, which is known as ‘symptom-onset’ dosing. Sertraline is a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression and anxiety, as well as for premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome.
“Our study is the first to evaluate the use of low-dose antidepressant medication for women who have moderate-to-severe PMS, and the first placebo-controlled study to include the novel dosing strategy of ‘symptom-onset dosing,'” said Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU’s School of Medicine and lead author on the study.
“Our findings suggest that women with less severe forms of PMS than PMDD may also benefit from treatment with antidepressant medication, and they may be able to take medication only on the days that they are symptomatic,” she said.
Tobacco Avoidance
See the link between PMS and Sugar Avoidance.
Progesterone
Progesterone continues to be widely prescribed by clinicians and widely used by patients, but remains a controversial subject. Some doctors have observed that progesterone administered vaginally, rectally, or topically (to the skin) can relieve the symptoms of premenstrual syndrome (PMS), BUT most well-controlled studies have not found natural progesterone to be effective against PMS.
Magnesium
Menstrual cramps, irritability, fatigue, depression and water retention have been lessened by taking supplemental magnesium, usually given along with calcium and often with vitamin B6. Magnesium is often at its lowest level during menstruation, and many symptoms of premenstrual syndrome (PMS) are relieved when this mineral is replenished. Supplementing magnesium in the same amount (or more) as calcium (about 500-1,000mg daily) is currently recommended for premenstrual problems. Women with PMS have been reported to be at increased risk of magnesium deficiency.
A 1998 study in The Journal of Women’s Health found that 200mg a day of magnesium reduced PMS fluid retention, breast tenderness and bloating by 40%. Magnesium is important to regulate muscle relaxation, blood sugar, and to promote sound sleep – all particularly important during PMS.
Zinc
A study was conducted at the Department of Obstetrics and Gynecology, Baylor College of Medicine in Houston, Texas to determine whether changes in peripheral zinc and copper levels are associated with symptoms of PMS. Ten PMS patients and ten controls gave blood at 2 to 3 day intervals through three menstrual cycles. Lower levels of zinc were noted during the luteal phase in PMS patients compared with the controls. Copper levels were noted to be higher during the luteal phase in PMS patients compared with the controls. The researchers concluded that zinc deficiency occurs in PMS patients during the luteal phase, and the elevated copper further reduces the availability of zinc in PMS patients during the luteal phase . The recommended dose of elemental zinc is 30 mg daily to help relieve PMS symptoms. [Chuong and Dawson, 1994]
Vitamin B6 (Pyridoxine)
Numerous clinical studies have demonstrated the efficacy of vitamin B6 supplementation in treating PMS. In one double blind crossover trial, 84% of the subjects had a lower symptomatology score during the B6 treatment period. Although PMS is of multifactorial origin, B6 supplementation alone appears to benefit most patients. In another study, premenstrual acne flare-up was reduced in 72% of 106 affected young women taking 50mg of pyridoxine daily for one week prior and during the menstrual period. Pyridoxine acts as a mild diuretic, reducing the symptoms of premenstrual syndrome.
Vitamin A
Vitamin A has been shown to be beneficial in reducing PMS symptoms when given in doses of 100,000 to 300,000iu per day in the second half of the menstrual cycle. These levels should only be achieved by a water-soluble form of vitamin A and supervised by a Natural Doctor. Beta-carotenes may be better indicated since they are less toxic and endogenous regulation of conversion to retinol helps maintain more appropriate levels. The enzymatic conversion of beta-carotene to vitamin A is increased twofold during mid-ovulation. It is believed that there is a storage capacity for beta-carotene, which is converted to retinol as needed by the corpus luteum.
Vitamin E
Although vitamin E research concerning PMS has focused primarily on mastalgia, significant reduction of other PMS symptomatology has been demonstrated in double-blind studies. Nervous tension, headache, fatigue, depression, and insomnia were all significantly reduced.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Strongly counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Premenstrual Syndrome
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Candidiasis
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.
Carbohydrates
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Saturated Fat
A type of fat that is readily converted to LDL cholesterol and is thought to encourage production of arterial disease. Saturated fats tend to be hard at room temperature. Among saturated fats are animal fats, dairy products, and such vegetable oils as coconut and palm oils.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Diuretic
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
Mineral
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Herbs
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Estrogen
One of the female sex hormones produced by the ovaries.
Copper
An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.
Melatonin
The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Red Blood Cell
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Hyperesthesia
An abnormal or pathological increase in sensitivity to sensory stimuli, as of the skin to touch or the ear to sound.
Manganese
An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.
Milligram
(mg): 1/1,000 of a gram by weight.