Premenstrual Syndrome (PMS)

What is premenstrual syndrome (PMS)?

Premenstrual syndrome (PMS) is something a lot of menstruating women experience — as many as 3 out of 4 women experience PMS [1]. PMS is a series of physical symptoms (e.g. weight gain, breast pain, headache, nasal obstruction, and pins and needles) and psychological complaints (e.g., irritability, anxiety, and depression) experienced by most women during the luteal phase of the menstrual cycle (7–14 days before the menstrual period) [2,3]. The symptoms of PMS can vary from person to person and, since physical, emotional, and behavioural symptoms may have different causes, the biological factors and symptoms of PMS should be separately evaluated [4]. However, the prevalence of PMS has been estimated to be 30–40% among women of reproductive age and 20–32% among premenopausal women.

The main cause of PMS is still unknown, and the syndrome is most likely multifactorial. Some researchers argue that hormonal agents and some micronutrients might be involved in the development of PMS [6]. These micronutrient deficiencies such as Vitamin D6, Calcium, Folic Acid, and magnesium of-which supplementing has been linked with improving symptoms associated with PMS.

1. Magnesium:

There are studies that have found that supplementing with magnesium helped participant’s ease their PMS symptoms, including depression, anxiety, insomnia, water retention, and breast tenderness [5]

Some foods high in magnesium:

• almonds

• green leafy vegetables e.g. spinach, kale

• peanuts

Recommendation: Take 200 to 250 mg per day, keeping in mind that the average daily recommendation for adults should be around 300-400 mg, depending on age and sex.  It is important to stick to the dosage recommendation by supplement manufacture [5]. 

Caution: Dietary supplements may have interactions with medications you’re taking. Talk to your doctor or dietitian if you have any questions or concerns. It is important to enquire about product information for any precautions or and read the leaflet insert on the product.

2. Calcium

Women with PMS symptoms often don’t get enough calcium from their diet. Calcium levels may also change throughout your menstrual cycle.

There are studies that found that calcium supplements helped to reduce some symptoms of PMS, like bloating and fatigue. More so, they concluded that calcium supplementation was effective for reducing psychological symptoms, including sadness, mood swings, and anxiety.

Paying attention to taking high calcium foods, adding foods that are high calcium foods to your diet.

Some foods high in Calcium:

• Dairy Products (Milk, yoghurt

• green leafy vegetables e.g. spinach, kale

• seeds 

• Sardines & canned salmon 

If you can’t get enough from your diet, supplement with 50 to 100 mg per day. Always follow the manufacturer’s dosage guidelines. If that isn’t doing it, calcium supplements are available [6]

Recommendation: Start by taking 500 milligrams (mg) per day. It’s good to keep in mind that the daily recommended allowance for calcium in adults ranges from 1,000 to 1,300 mg, depending on your age and sex.

Caution: Dietary supplements may have interactions with medications you’re taking. Talk to your doctor or dietitian if you have any questions or concerns. It is important to enquire about product information for any precautions or and read the leaflet insert on the product.

3. Vitamin B-6

Vitamin B6 is a water-soluble vitamin which is also known as pyridoxine which is involved in the production of neurotransmitters, which play a big role in your moods [5]

Some foods high in Vitamin B6:

• chickpeas

• tuna, salmon, and other fish

• potatoes and other starchy veggies

• beef liver and organ meats

• Many breakfast cereals are also fortified with this essential vitamin.

Several small studies have found that taking a daily vitamin B-6 supplement may help with many of the psychological symptoms of PMS, including moodiness, irritability, and anxiety. However, conclusions are still limited due to poor quality of the current research 

Daily intake of water-soluble vitamins is needed because the body doesn’t store Vitamin B-6.

 4. Ginkgo biloba

Gingko biloba is best known as an herbal remedy for improving memory, but it can also help with PMS symptoms.

There is limited scientific research, but some researchers have found that taking 40 mg tablets, 3 times per day reduced the severity of both physical and psychological symptoms in the students studied [8;9]

Recommendation:  it important to start with the lowest recommended dose and take for about 10 to 14 days from mid-cycle until a day or two after your period.

Caution: Herbs may interactions with medications you’re taking. Talk to your doctor if you have any questions or concerns. It is important to enquire about product information for any precautions or and read the leaflet insert on the product.

5. St. John’s wort

Many consider st.John’s wort  to be an herbal alternative to prescription antidepressants. It affects both serotonin and norepinephrine, two neurotransmitters that affect your mood and that are typically targeted in traditional antidepressants [10]

There are studies on medicinal herbs, with several studies pointing to its effectiveness in treating PMS symptoms.  The st. John’s Wort seemed to improve both physical and emotional symptoms, particularly depression and anxiety [11]

Recommendation: Dosage recommendations vary significantly depending on the manufacturer.

Caution: Herbs may interactions with medications you’re taking. Talk to your doctor if you have any questions or concerns. It is important to enquire about product information for any precautions or and read the leaflet insert on the product.

Conclusion: 

For many people, PMS is a frustrating monthly ordeal. However, there are supplements that may help with both your physical and emotional symptoms.

Many supplements become more effective over time, so don’t be disappointed if you don’t notice immediate results. Some may take 3 to 6 months to work.

Always consult with your health care profesional befor taking any dietary supplements. 

References: 

1. Abdnezhad R, Simbar M, Sheikhan Z, Mojab F, Nasiri M. The effect of Salvia (Sage) extract on the emotional symptoms of premenstrual syndrome. Iran J Obstet Gynecol Infertil. 2017; 20:84–94. [Google Scholar]

2. Brahmbhatt S, Sattigeri BM, Shah H, Kumar A, Parikh D. A prospective survey study on premenstrual syndrome in young and middle-aged women with an emphasis on its management. Int J Res Med Sci. 2013; 1:69–72. [Google Scholar]

3. Raval CM, Panchal BN, Tiwari DS, Vala AU, Bhatt RB. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar, Gujarat. Indian J Psychiatry. 2016; 58:164–170. [PMC free article] [PubMed] [Google Scholar]

4. Halbreich U, O’Brien PM, Eriksson E, Bäckström T, Yonkers KA, Freeman EW. Are there differential symptom profiles that improve in response to different pharmacological treatments of premenstrual syndrome/premenstrual dysphoric disorder? CNS Drugs. 2006; 20:523–547. [PubMed] [Google Scholar]

5. Kahyaoglu Sut H, Mestogullari E. Effect of premenstrual syndrome on work-related quality of life in Turkish nurses. Saf Health Work. 2016; 7:78–82. [PMC free article] [PubMed] [Google Scholar]

5. Fathizadeh N, et al. (2010). Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. 

6. ncbi.nlm.nih.gov/pmc/articles/PMC3208934/

7. Vitamin B6. [Fact sheet]. (2018). 

ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/

8. Ginkgo. (2018). 

mskcc.org/cancer-care/integrative-medicine/herbs/ginkgo#references-37

9. Ozgoli G, et al. (2009). A randomized, placebo-controlled trial of ginkgo biloba L. in treatment of premenstrual syndrome. 

liebertpub.com/doi/abs/10.1089/acm.2008.0493

10. St. John’s wort. (2014). 

mskcc.org/cancer-care/integrative-medicine/herbs/st-john-wort

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