Premenstrual Syndrome
What is it?
Premenstrual syndrome (PMS) refers to a variety of symptoms experienced by women one to ten days before the beginning of a menstrual period. These symptoms disappear with the onset of menstruation and include physical discomforts and mood disorders. PMS is particularly common in women who are over 30 years of age.
Symptoms of premenstrual syndrome
There are more than 150 identified symptoms of PMS and these have been divided into four subgroups, each subgroup being linked to particular symptoms, hormonal and metabolic changes. These are:
- PMS-A: Anxiety, irritability, mood swings and nervous tension.
- PMS-D: Depression, insomnia, lethargy and confusion.
- PMS-H: Bloating, weight gain, headaches and breast tenderness.
- PMS-C: Increase in appetite, cravings for sugar and/or salt and fatigue.
Other symptoms include crying spells, constipation, muscle aches and pains, and acne. In some women, respiratory problems such as allergies, and infections and eye complaints may be worse. Most women experience some emotional and physical changes premenstrually, and the severity of PMS varies. Some women experience only a few symptoms, while others have many. Also, the discomfort felt as a result of PMS symptoms ranges from mild to so severe that it may interfere with everyday activities such as performance at work and/or relationships with others.
Causes of premenstrual syndrome
There are many theories as to the causes of PMS but none are universally agreed upon. Estrogen-progesterone ratio imbalance, excessive aldosterone or anti-diuretic hormone levels, carbohydrate metabolism changes, low blood sugar, high prolactin levels, allergy to progesterone, retention of sodium and water by the kidneys, psychological factors, alterations in neurotransmitters and prostaglandin levels, and nutritional inadequacies or excesses may all play a part.
Treatment of premenstrual syndrome
Oral contraceptives help relieve the symptoms of PMS in some women. Painkillers, diuretics and tranquilizers are also sometimes used. Regular exercise and good stress-reduction techniques are also beneficial.
Premenstrual Syndrome and diet
A healthy diet is essential to help minimize the symptoms of PMS. Reducing refined sugar intake and limiting alcohol, caffeine and salt are particularly beneficial. Eating several regular small meals that include complex carbohydrates may also be helpful.
Researchers involved in a 1991 double-blind randomized study looked at the effects of a vitamin and mineral supplement on premenstrual symptoms in 44 women. The women took either six tablets, 12 tablets or a placebo for three menstrual cycles. Significant effects were seen in three symptom subgroups for the six-tablet group, and in all four subgroups for the 12-tablet group.1
Vitamins, minerals and premenstrual syndrome
Vitamin B6
Several studies have looked at the effects of vitamin B6 on premenstrual syndrome symptoms, although most of these trials have involved a limited number of patients. Some have shown positive effects. Many experts recommend doses of 50 mg to 150 mg per day started on day ten of the menstrual cycle and continued until day three of the next cycle.
Researchers in Oxford, UK conducted a double-blind trial to study the effects of 50 mg of vitamin B6 per day on premenstrual syndrome symptoms. The trial involved 63 women aged 18 to 49 years old who had noticed moderate to severe premenstrual symptoms during the previous year. Thirty-two women completed the full seven months of the study and the results showed a significant beneficial effect of vitamin B6 on emotional-type symptoms such as depression, irritability and tiredness.2 Vitamin B6 is necessary for the production of serotonin and dopamine, and a deficiency may lead to or aggravate the effects of PMS through effects on these neurotransmitters.
Magnesium
Red blood cell concentrations of magnesium are low in women with PMS and this may play a role in the development of symptoms. The calcium to magnesium ratio also seems to be affected by hormonal fluctuations, which may affect neurotransmitter levels and lead to premenstrual symptoms.3
Magnesium supplements have been shown to relieve menstrual and premenstrual symptoms, including mood changes and breast tenderness. In a 1991 study, Italian researchers investigated the effects of a two-month period of magnesium supplementation on premenstrual symptoms in 32 women. The dose used was 360 mg three times a day, from the 15th day of the menstrual cycle to the onset of menstrual flow. The results showed that supplementation was effective in the treatment of premenstrual symptoms related to mood changes.4
Calcium
Calcium supplements may help to reduce the physical and psychological symptoms of premenstrual syndrome. In a 1998 randomized, double-blind, placebo-controlled clinical trial, 720 healthy, premenopausal women between the ages of 18 and 45 years were screened for premenstrual symptoms. Of these women, 466 were randomly assigned to receive 1200 mg of calcium per day or placebo for 3 menstrual cycles. After three months, the results showed that during the luteal phase of the treatment cycle, women who took calcium experienced significantly fewer symptoms than those in the placebo group. Mood swings and depression were reduced by 45 per cent (compared to 28 per cent in the placebo group), while generalized aches and pains, back pains and cramping reduced by 54 per cent in three months.5
Vitamin E
Vitamin E may be useful in reducing breast tenderness and other symptoms of PMS, possibly via effects of prostaglandins.6
Sodium
Most experts recommend avoiding salt and salt-rich foods as they may cause fluid retention and worsen the symptoms of PMS.
Zinc
Zinc deficiency may exacerbate the symptoms of premenstrual syndrome. In a study published in 1994, researchers assessed copper and zinc levels in ten PMS sufferers and compared these to those in nonsufferers. Results showed lower zinc levels in the luteal phase (latter half) of the menstrual cycle in PMS sufferers.7
Essential fatty acids
Essential fatty acid supplements may be useful in the treatment of PMS. Evening primrose and blackcurrant oils contain the fatty acid, GLA, which may affect prostaglandin production and improve breast tenderness, irritability and depression.
Essential fatty acids may also be effective in treating menstrual pain. In a 1996 study, researchers assessed the effects of fish oil supplements on girls aged from 15 to 18 who reported suffering from period pain. Twenty-one girls received fish oil supplements (1,080 mg EPA, 720 mg DHA and 1.5 mg vitamin E) and the other 21 received a placebo. After two months, the groups switched treatments for another two months. The amount of painkillers that the girls took during each menstrual period was also compared over the four months. After two months of treatment with fish oil, there were marked reductions in symptoms and painkiller use. Placebo treatment did not ease pain.8
Herbal medicine and premenstrual syndrome
Herbal treatment of PMS aims to rectify the hormonal imbalances and other underlying causes of the symptoms. Commonly used herbs include chaste tree (Vitex agnus castus), licorice (Glycyrrhiza glabra), dong quai (Angelica sinensis), raspberry (Rubus idaeus), black haw (Viburnum prunifolium) and milk thistle (Silybum marianum).