Taking a Look at PMS
Premenstrual syndrome (PMS) is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation (1).
This means that symptoms are experienced one to two weeks before menstruation.
Symptoms experienced can be physical, psychological or behavioral. PMS is only considered clinical if:
- symptoms impair daily life,
- only occur during the luteal phase
- and cannot be explained by other health conditions (2).
If symptoms are very severe, a diagnosis of premenstrual dysphoric disorder (PMDD) is more appropriate (3).
The Menstrual Cycle
The average menstrual cycle lasts for 28 days, although it can range from 21 to 34 days.
The first phase is the follicular phase, which lasts from day one to day 13 (the today before ovulation).
The luteal phase, the second phase, lasts from day 15 to day 28. During this phase, the hormones estrogen and progesterone rise to prepare for pregnancy and then fall if this does not occur.
The Science Behind PMS
It is not known exactly what causes PMS, but there are several theories.
One is that women with PMS are more physiologically sensitive and therefore experience more symptoms than women without PMS, even if they have normal levels of estrogen and progesterone (6). The brain’s chemical messengers, called neurotransmitters, also seem to be involved.
Because the cause is not clear, the focus of PMS treatment is on managing symptoms.
Although more research is needed on lifestyle modifications, research has suggested that regular aerobic exercise can help to reduce the symptoms of PMS (7).
Aerobic exercise includes activities such as running, swimming or cycling.
There are also a number of herbal supplements that can be used alongside physical activity to help make PMS symptoms more manageable. Here’s a quick view of the eight we’re going to cover in greater detail in this article.
8 Natural Supplements for PMS Symptom Relief
Now, let’s get to the heart of the matter and examine each one a little more closely.
Vitex Agnus Castus
Vitex agnus-castus, which is also known as Chaste Tree, Vitex, or Chaste berry, is a flowering plant often used to reduce PMS symptoms.
It acts similarly to the neurotransmitter dopamine, by reducing prolactin levels, which are elevated when a person is experiencing PMS symptoms. It is also thought to work by targeting the opioid system by releasing beta-endorphins, which the body lacks during PMS.
Tentative evidence suggests that vitex agnus-castus may also increase estrogen and progesterone levels but more research is needed to confirm whether this is the case.
How does vitex help PMS?
A prospective, randomized, double-blind, placebo-controlled study found that 4 mg of BNO (an extract of vitex agnus castus), taken daily for three menstrual cycles, reduced a variety of PMS symptoms that were moderate to severe in terms of intensity (8).
Other research showed that 40 mg vitex agnus castus, taken daily for three months resulted in 66 women experiencing a dramatic reduction in PMS symptoms and 26 experiencing a mild reduction out of a total sample of 107 participants (9). The same study found that 42 % of participants halved the frequency of migraine attacks and 57% halved the number of days where they experienced migraines.
The effects of vitex seem to be dose-dependent.
A multicenter, double-blind, placebo-controlled, parallel-group study compared the effects of three different doses (8, 20 and 30 mg) of an extract of vitex agnus castus called Ze. They were taken for three menstrual cycles and found a significant reduction in irritability, mood alteration, anger, headache, bloating and breast fullness compared to placebo (10).
Both higher doses outperformed the 8 mg dose but no difference was found between 20 mg and 30 mg, suggesting that 20 mg of vitex agnus castus extract is sufficient to obtain optimal benefits for PMS.
How do I take vitex?
Vitex agnus-castus supplements are based upon the dry weight of the plant’s fruit, with a standard dose ranging from 150 mg-250 mg.
There are also two extracts of vitex agnus-castus, which are often used in research: BNO 1095 (a 10:1 extraction) and Ze 110 (a 6-12:1 extraction). Effective doses of these are 4 mg and 20 mg daily respectively.
The supplement does not appear to interact with any medications, however, due to the lack of research, it is not advisable for those using oral contraception to take vitex agnus-castus.
Saffron (Crocus sativus) is the most expensive spice in the world because the high labor costs associated with it have resulted in limited supply.
It is traditionally used to flavor food but has begun to be used as a supplement more frequently. Using saffron in food will provide the same effects as supplementation because saffron supplements are dehydrated extracts of the spice. However, obtaining saffron from food is not necessarily practical and therefore supplementing saffron is often more convenient.
The exact mechanism of saffron for improving health is not fully understood. However, it is known to influence serotonin metabolism, which can positively affect mood as well as have other positive effects.
How does saffron help PMS?
A double-blind, randomized and placebo-controlled trial where 15 mg of saffron, twice daily, was supplemented for two menstrual cycles significantly reduced PMS symptoms relative to placebo (11).
75% of the group receiving saffron reported more than halving their symptoms. Depression was also more than halved in 60% of this group. This compared with 8% and 4% in the placebo group respectively.
How do I take saffron?
Saffron does not have a high margin of safety, so it is important to be cautious when supplementing and speak to your doctor beforehand.
The standard dose for saffron is 30 mg, ideally, split into two doses and can be used for up to eight weeks at a time. Further research is needed to determine the safe upper level of saffron supplementation.
Ginkgo biloba has been used in traditional Chinese medicine for over a thousand years and started to be used in the west a few centuries ago.
It is the most commonly ingested herb for boosting brain function, but it also has a wide range of other health benefits. The supplement form of ginkgo biloba is also referred to as EGb-761 extract.
How does ginkgo biloba help PMS?
A single-blind, randomized, placebo-controlled trial found that 40 mg of ginkgo biloba taken three times per day over the course of one menstrual cycle was able to reduce both physical and psychological symptoms of PMS significantly more than placebo (12). The average reduction in the supplementation group was 24% compared to only 9% in the placebo group.
How do I take ginkgo biloba?
The standard dose for ginkgo biloba is 120 mg per day. It is recommended that this is split into three doses. The product you choose should be a 50:1 concentrated extract to obtain the benefits for PMS.
Calcium is a micronutrient often used to support bone health but also provides a number of other health benefits. It is considered to be a macromineral due to the high amount needed daily.
There are a number of different forms of calcium, which differ in terms of bioavailability. However, as calcium can be absorbed at any point along the intestine, absorption is more affected by the diet than by the form of calcium taken.
A diet high in fermentable fibers, such as those found in many vegetables, can slow the rate at which food passes through the intestines and thus increase absorption.
How does calcium help PMS?
A randomized, double-blind, placebo-controlled trial found that 500 mg of calcium taken daily for two months significantly reduced anxiety, depression, emotional changes, water retention, and somatic symptoms compared with a placebo group (13).
Similar results have been found when calcium is obtained in high amounts through food.
Another randomized, controlled, trial found that consuming 50g of Turkish kasseri cheese, 400 ml of milk and 150 g of yogurt every day for two months (equivalent to 1000 mg calcium) significantly improved both mental and physical symptoms of PMS compared to a control group (14).
How do I take calcium?
Calcium supplementation should fit within the recommended daily intakes (RDI) for adults, which is 1,000 mg for those between the ages of 19 and 50. This can be obtained through both supplementations as well as eating foods high in calcium such as dairy products and green leafy vegetables.
It is not advisable to obtain higher amounts as this can cause constipation. It is recommended to take calcium with a meal to optimize absorption but it can be taken at any time during the day.
Magnesium is an essential mineral and is the second most prevalent electrolyte in the body. Deficiencies in magnesium increase blood pressure, reduces glucose tolerance, and causes neural excitation.
It is common to be deficient in magnesium because few foods in the western diet are high in the mineral. The main food sources of magnesium are nuts and green leafy vegetables.
The absorption of magnesium varies depending on how much the body needs so there are very few sides effects associated with supplementation. Even if an excess is taken in, the body will only absorb what it needs.
However, high amounts can cause gastrointestinal issues so it is not recommended to consume above the recommended daily limits.
How does magnesium help PMS?
A randomized, controlled trial found that supplementation with 250 mg magnesium alone, or 250 mg magnesium with 40 mg vitamin B6 significantly reduced PMS symptoms relative to placebo for the duration of one menstrual cycle (15).
However, the combination of magnesium and B6 was more effective than magnesium on its own.
The symptoms found to be reduced included anxiety, depression, water retention, and somatic issues.
Another open-label study found that 250 mg modified-release magnesium, taken daily for three menstrual cycles significantly reduced PMS symptoms (16).
How do I take magnesium?
The standard dose for magnesium supplementation is 250 mg but the RDI is 400 mg for those between the ages of 19 and 30 and 420 mg for adults above the age of 30.
Most forms of magnesium are suitable for supplementation, with the exception of magnesium L-threonate, because it contains less elemental magnesium per dose and thus is less effective.
In general, magnesium citrate is advisable for supplementation.
Gastrointestinal effects can occur if high doses are taken but these are much more common with magnesium oxide or magnesium chloride. Magnesium should always be taken with food.
Vitamin B6, also known as pyridoxine, is a water-soluble vitamin used in producing hemoglobin, the substance in red blood cells that carries oxygen around the body. It also plays a significant role in protein, fat and carbohydrate metabolism as well as the creation of red blood cells and neurotransmitters.
Vitamin B6 can be found in whole grains, vegetables, and potatoes.
Consuming sufficient amounts of vitamin B6 is important for optimal health and can help to prevent a number of health conditions.
Vitamin B6 at a dosage of 80 mg per day has also been studied and recommended as treatment for primarily psychological symptoms of PMS
How does vitamin B6 help PMS?
One randomized controlled trial found that taking 50 mg of vitamin B6 daily for three months improved the emotional symptoms of PMS including depression, irritability, and tiredness by 69% (17).
Another study found that Vitamin B6 at a dosage of 80 mg per day was associated with a reduction in psychological symptoms of PMS, including low mood, irritability, and anxiety (18).
In addition, as mentioned above, when vitamin B6 is taken alongside magnesium, this is more effective for reducing PMS symptoms than magnesium alone.
How do I take vitamin B6?
To obtain the benefits of vitamin B6 for PMS, it is recommended to take between 50 mg and 100 mg per day. It can be taken at any time of the day but ideally should be taken with food to optimize absorption.
If taking alongside magnesium, it is recommended to take 250 mg of magnesium and 40 mg of vitamin B6.
Essential Fatty Acids
There are three different types of fatty acids: omega 3, omega 6 and omega 9. It is important to get enough of each of these as well as obtaining them in the correct ratio.
Two fatty acids, gamma-linolenic acid (GLA, an omega 6 fatty acid) and alpha-linolenic acid (APA, an omega 3 fatty acid) have anti-inflammatory effects that can help with PMS symptoms. These fatty acids tend to be supplanted together in PMS.
How do essential fatty acids help PMS?
A randomized, double-blind, placebo-controlled trial found that 2g or 1g of essential fatty acids taken daily for three months significantly improved physical PMS symptoms compared to placebo (19).
Results were significantly better for the 2g group, suggesting that the effects of essential fatty acids are dose-dependent.
The improvement in symptoms even better after six months of taking the supplement, compared to results after three months, demonstrating the importance of taking the supplement over the long term to optimize effectiveness.
Researchers were concerned that supplementation of fatty acids might negatively affect lipid levels but there was no change in total cholesterol levels during the study.
How do I take essential fatty acids?
It is recommended to take a supplement that combines GLA and APA in a total dose of 2g. They can be taken at any time of the day but it is recommended to take alongside food.
Supplementation should be continued for at least six months in order to obtain maximum benefits for PMS.
St John’s Wort
St John’s Wort (Hypericum perforatum) is a herb that contains the active ingredient hypericin, which affects the neurotransmitters dopamine, serotonin and norepinephrine, which affect mood and thus it is often used to help reduce the symptoms of depression.
How does St John’s Wort help PMS?
A randomized, double-blind, placebo-controlled trial found that 900 mg taken daily for two menstrual cycles significantly reduced the physical and behavioral symptoms of PMS compared to placebo (20).
However, mood and pain were not significantly affected, which suggests either that St John’s Wort is less effective for these symptoms or that a longer supplementation period is required to see benefits.
How do I take St John’s Wort?
To obtain the benefits of St John’s Wort for PMS symptoms it is recommended to supplement with 900 mg per day for no longer than six weeks at a time.
When taking St John’s Wort, it is important to apply sunscreen before going outside as the supplement can make the skin more sensitive to sunlight.
The Bottom Line
Although the causes of PMS are not fully understood, there are a number of supplements that can help to reduce symptoms.
Before deciding to take any of these supplements, it is essential to speak to your doctor first if you are taking any medications.
As many of these supplements take several months to be effective, it is essential to take these over the long-term in order to see benefits for PMS.
Alongside taking supplements, regular aerobic exercise, such as running, swimming or running, can also help reduce symptoms as well as boost mental and physical health more generally.
It may not be possible to fully eliminate PMS symptoms but these are strategies that can certainly help to make them more manageable.
Keep Reading: 11 Most Beneficial Supplements for Women
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About the Author
Emma Green has a PhD, MSc and BSc in Psychology and is a certified personal trainer. She currently works as a freelance writer, producing on content on science, health and fitness for a number of online platforms. She also coaches clients online on a one-to-one basis to help them achieve their health and fitness goals. Contact Emma.