Introduction
Premenstrual syndrome (PMS) is a common health issue affecting up to 90% of women during their reproductive years, with 5-8% experiencing severe symptoms that substantially impair normal functioning (Jarvis 2008). Symptoms of PMS can include both physical manifestations like breast tenderness, headaches, and abdominal bloating, as well as psychological and behavioural changes such as depression, irritability, and difficulty concentrating (O’Brien 2011).
While the exact causes of PMS are not fully understood, research suggests that deficiencies in certain vitamins and minerals including vitamin B, vitamin D, calcium, and magnesium may play a role (Posaci 1994, Rosenstein 1994, Bertone-Johnson 2005, Thys-Jacobs 2007, Chocano-Bedoya 2011). Consequently, supplements for PMS are often recommended as a natural approach to help alleviate symptoms. Some of the most well-studied supplements for PMS include chasteberry, magnesium, vitamin B6, and calcium.
This article will provide an overview of the scientific evidence on various supplements for PMS, including their proposed mechanisms of action, dosage recommendations, and safety considerations. By understanding which supplements may be beneficial and how to use them appropriately, women can make informed decisions about incorporating natural remedies into their PMS management plan. However, it is always advisable to consult with a qualified healthcare provider before starting any new supplement regimen.
Chasteberry (Vitex agnus-castus)
Chasteberry, also known as Vitex agnus-castus, is one of the most popular herbal supplements used to manage PMS. It is thought to work by influencing hormone levels – increasing dopamine activity to improve mood and reducing prolactin levels which contribute to symptoms like breast tenderness and fluid retention. A number of clinical trials support the use of chasteberry for PMS, particularly for alleviating physical symptoms.
For example, a randomised controlled trial in Chinese women found that chasteberry significantly improved moderate-to-severe PMS symptoms compared to placebo (Ma et al., 2010). An earlier study also reported that chasteberry was superior to placebo for relieving PMS symptoms like breast fullness and headaches (Berger et al., 2000). A 2013 open-label clinical observation study noted improvements in headache, breast fullness, and mood in women with PMS who took chasteberry (Ambrosini et al., 2013).
The typical dose used in studies is 20-40 mg per day of a chasteberry extract, usually standardised to contain 0.5% agnuside or 0.6% aucubin. It may take up to three menstrual cycles to see the full benefits. Chasteberry is generally well-tolerated, but it can cause side effects like nausea, headache, gastrointestinal disturbances, and skin reactions in some women (Daniele et al., 2005). It should not be taken with dopamine-related medications or hormone replacement therapy.
Magnesium
Magnesium is an essential mineral involved in hundreds of processes in the body. It plays a key role in regulating the stress response through its calming effects on the nervous system and HPA axis. Magnesium is also important for managing menstrual cramps and pain by relaxing smooth muscles. Some research indicates that magnesium deficiency may be common in women with PMS.
Clinical trials evaluating magnesium supplements for PMS symptoms have yielded inconsistent findings. Two studies found that magnesium significantly reduced PMS symptoms compared to placebo (Facchinetti et al., 1991; Walker et al., 1998), while two other studies reported no benefit (De Souza et al., 2000; Quaranta et al., 2007). However, the studies had some methodological limitations.
Magnesium glycinate and citrate tend to be better absorbed than magnesium oxide. Doses used in studies typically range from 200-400 mg per day. Magnesium supplements can cause digestive side effects like diarrhoea, so it’s best to start with a low dose and gradually increase as tolerated. High doses can interact with some medications, including antibiotics and diuretics.
Vitamin B6
Vitamin B6, or pyridoxine, is a water-soluble vitamin that serves as a coenzyme in many important reactions in the body. It is needed for the synthesis of several neurotransmitters involved in mood regulation, such as serotonin and dopamine. B6 also facilitates the production of progesterone and the breakdown of estrogen. Consequently, B6 may help with PMS by promoting healthy hormone balance and neurotransmitter function.
A few small clinical trials conducted in the 1980s and 90s reported that B6 supplementation significantly reduced psychological PMS symptoms like moodiness, irritability, and anxiety compared to placebo (Doll et al., 1989; Smallwood et al., 1986; Williams et al., 1985). A 1999 systematic review combined the results of nine trials and determined that B6 more than doubled the odds of PMS improvement (odds ratio 2.32) (Wyatt et al., 1999). While promising, most of these studies were small and not of the highest quality.
Doses used in studies ranged from 50-100 mg per day. Vitamin B6 is best absorbed when taken as part of a B-complex supplement. High doses of B6 (above 200 mg/day) can cause neurological symptoms like numbness and tingling, so it’s important not to exceed the tolerable upper intake level of 100 mg per day (Institute of Medicine, 1998).
Calcium
Calcium is an important mineral for bone health that also plays a vital role in muscle contraction, nerve signaling, and hormone secretion. Adequate calcium intake has been linked to a lower risk of PMS in several studies. It likely helps by supporting healthy muscle and nerve function.
In a 2017 randomised controlled trial, women who took 500 mg calcium twice daily for three months had significant reductions in both physical and psychological PMS symptoms compared to those taking a placebo (Shobeiri et al., 2017). A large prospective study also found that women with high intakes of calcium from food sources had a significantly lower risk of developing PMS over the 10-year follow-up period (Bertone-Johnson et al., 2005).
Food sources of calcium include dairy products, leafy greens, legumes, and fortified foods. If using supplements, doses of 500-1000 mg per day are typically recommended. Total daily calcium intake from food and supplements should be in the range of 1000-1300 mg for most adults (Institute of Medicine, 2011). Calcium supplements can interfere with the absorption of iron and other minerals, so it’s best to take them at a different time than other supplements.
Vitamin E
Vitamin E is a fat-soluble vitamin with antioxidant and anti-inflammatory properties. It helps protect cell membranes from damage. Inflammation and oxidative stress are thought to play a role in PMS by promoting hormonal imbalances.
In a randomised, double-blind, placebo-controlled trial, vitamin E supplements significantly reduced PMS symptoms of anxiety, cravings, depression, and hydration compared to placebo (Ziaei et al., 2005). Another study found that a combination of vitamin E and essential fatty acids decreased PMS symptoms more than either treatment alone (Pinho-Neto et al., 2010).
Good dietary sources of vitamin E include nuts and seeds like almonds and sunflower seeds, as well as avocados and olive oil. Vitamin E is also available in supplement form, with typical doses ranging from 100-400 IU per day. High doses can increase the risk of bleeding, especially in people taking blood thinners.
Essential Fatty Acids
Essential fatty acids are important for maintaining healthy cell membranes, producing hormone-like substances, and regulating inflammation. The two main types are omega-3 and omega-6 fatty acids. Evening primrose oil is a popular supplement that provides gamma-linolenic acid (GLA), an anti-inflammatory omega-6 fatty acid that can get converted into prostaglandin E1.
A 2011 randomised controlled trial found that a combination of omega-3 and omega-6 fatty acids significantly reduced PMS symptoms compared to placebo (Rocha Filho et al., 2011). The benefits were seen for both physical and emotional symptoms and were greater when the supplements were taken for six months rather than three months.
Dietary sources of essential fatty acids include oily fish like salmon, flax seeds, chia seeds, and walnuts. Evening primrose oil is another option that specifically supplies GLA. Doses used in studies are typically 1-2 grams per day. Omega-3 supplements can thin the blood, so they should be used cautiously in people with bleeding disorders or those taking anticoagulant medications.
Ginkgo Biloba
Ginkgo biloba is an herb used in traditional Chinese medicine that is known for its antioxidant and anti-inflammatory effects. It also enhances blood flow and has been studied for its potential benefits for brain health and cognition.
In one randomised controlled trial, ginkgo biloba significantly reduced PMS symptom severity compared to placebo, with the most marked improvements seen for congestive symptoms like breast tenderness and fluid retention (Ozgoli et al., 2009). The dose used in the study was 40 mg tablets taken three times per day, starting from day 16 of the menstrual cycle.
While these results are promising, more research is needed to firmly establish the efficacy of ginkgo for PMS. It’s important to note that ginkgo can interact with certain medications like blood thinners and antidepressants. It should not be taken with other supplements that affect bleeding, such as vitamin E, garlic, and ginger.
St. John’s Wort
St. John’s wort (Hypericum perforatum) is an herbal supplement commonly used to treat mild to moderate depression. Since depression is a common symptom of PMS, St. John’s wort has been explored as a potential PMS remedy.
A 2010 systematic review concluded that St. John’s wort was superior to placebo for improving physical and behavioral PMS symptoms (Canning et al., 2010). It’s thought to work by increasing the levels of serotonin and other neurotransmitters involved in mood regulation. The standard dose is 300 mg per day of an extract standardised to contain 0.3% hypericin.
St. John’s wort can interact with many medications, including birth control pills, so it’s essential to consult with a healthcare provider before taking it. Side effects are generally mild but can include gastrointestinal upset, dizziness, confusion, fatigue, and photosensitivity (Schulz, 2006). Rarely, it can cause serotonin syndrome when combined with antidepressants.
Conclusion
In summary, several vitamin and mineral supplements show promise for alleviating PMS symptoms. The most well-studied include chasteberry, magnesium, vitamin B6, and calcium. Vitamin E, essential fatty acids, ginkgo biloba, and St. John’s wort also have some evidence of benefit. However, more high-quality research is still needed for most supplements.
The doses and forms of nutrients used in studies vary. It’s important to choose high-quality supplements and not exceed recommended dosages to minimize the risk of adverse effects. Supplements can also interact with medications and other supplements, so it’s always best to check with a healthcare provider before starting a new regimen, especially for herbs like chasteberry and St. John’s wort.
While supplements may help manage PMS symptoms, they should be used in conjunction with other lifestyle approaches like regular exercise, stress management, and a balanced diet. If PMS symptoms are severe or not responding to natural treatments, it’s important to consult with a qualified healthcare provider for further evaluation and care.
Conclusion
The available evidence suggests certain vitamin and mineral supplements may help alleviate PMS symptoms, especially chasteberry for physical symptoms and overall PMS; magnesium glycinate or citrate for mood and pain; vitamin B6 as part of a B-complex for psychological symptoms; calcium for mood, bloating and cramps; vitamin E for mood and fluid retention; essential fatty acids for physical and emotional symptoms; ginkgo biloba for congestive symptoms; and St. John’s wort for behavioural symptoms.
However, more high-quality research is still needed to firmly establish the efficacy and safety of most supplements for PMS. The doses and forms of nutrients used in studies vary, and it’s important to choose reputable brands and not exceed recommended dosages to minimise the risk of adverse effects. Supplements can also interact with medications and other supplements, so it’s always advisable to consult with a qualified healthcare provider before starting any new supplement regimen, especially for herbs like chasteberry and St. John’s wort which have a higher potential for interactions.
While supplements may be a helpful addition to a holistic PMS management plan, they should be used in conjunction with other evidence-based lifestyle approaches such as regular exercise, stress reduction techniques, and a nutrient-dense, balanced diet. If PMS symptoms are severe or not responding to natural treatments, it’s crucial to seek further evaluation and care from a healthcare professional to rule out underlying health conditions and discuss additional treatment options. By working with a trusted provider and using supplements judiciously, women can safely harness the potential of natural remedies to find relief from bothersome PMS symptoms and improve their overall quality of life.
Key Highlights and Actionable Tips
- There is evidence of benefit for calcium and vitamin B6 supplementation in women with premenstrual syndrome (PMS), with mixed findings for magnesium and evening primrose oil.
- Insufficient data exists to support the use of St John’s Wort, Vitex agnus castus, or ginkgo biloba for PMS.
- Larger, well-designed, double-blind, placebo-controlled randomised controlled trials are needed to further evaluate dietary and herbal treatments for PMS.
- Future studies should use strict criteria to prospectively diagnose PMS, enrol representative populations, and standardise diagnostic methods, outcome measures, and assessment measures.
What is the most effective dietary supplement for managing PMS symptoms?
Based on the review, calcium supplementation for at least three menstrual cycles may be beneficial for managing PMS symptoms. Two well-designed studies showed positive results for calcium. The evidence for other dietary supplements, such as vitamin B6, magnesium, and evening primrose oil, was mixed or insufficient.
Are there any herbal remedies that have been proven to alleviate PMS?
The review found insufficient evidence to support the use of herbal remedies like St John’s Wort, Vitex agnus castus, or ginkgo biloba for PMS. While some studies showed positive effects for Vitex agnus castus and ginkgo biloba, the authors noted that many of these studies had methodological problems. More high-quality research is needed to establish the effectiveness of herbal remedies for PMS.
How long should I take a dietary supplement or herbal remedy before expecting to see improvements in my PMS symptoms?
The duration of treatment in the included studies ranged from one menstrual cycle to 12 months. However, the authors highlighted that calcium supplementation for at least three cycles may be beneficial. For other dietary supplements and herbal remedies, the optimal duration of treatment is unclear due to mixed findings or insufficient evidence. It is best to consult with a healthcare professional to determine an appropriate treatment duration based on your individual circumstances.
Are there any risks or side effects associated with taking dietary supplements or herbal remedies for PMS?
The review did not specifically address the risks or side effects of dietary supplements and herbal remedies for PMS. However, it is important to note that some supplements and herbs can interact with medications or have adverse effects, especially when taken in high doses. Before starting any new supplement or herbal remedy, it is advisable to consult with a healthcare professional to discuss potential risks and ensure safety.
What should I look for in a study to determine if a PMS treatment is effective and reliable?
When evaluating the effectiveness and reliability of a PMS treatment, look for studies that are well-designed, double-blind, placebo-controlled randomised controlled trials. These studies should use strict criteria to prospectively diagnose PMS, enrol representative populations, and standardise diagnostic methods, outcome measures, and assessment measures. Additionally, the study should have a sufficient sample size and report on both the benefits and any adverse effects of the treatment.
References
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