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Premenstrual Syndrome Pms

PMS (Premenstrual Syndrome) Introduction

:pms.jpg Premenstrual syndrome is a condition marked by mood changes and specific physical symptoms, those of which occur 7-14 days before the onset of menses. Symptoms often resolve at the beginning of menses. PMS is a monthly recurring condition. Although the exact cause of PMS is not fully understood, it appears to be related to hormone fluctuations. [1] There are four subtypes of PMS. Each subtype is represented by a particular symptom that is exaggerated.

  • PMS-A is characterized by anxiety. It is the most common of all subtypes, and is linked to excess estrogen and deficient progesterone.
  • PMS-C is characterized by carbohydrate cravings.
  • PMS-D is the least common subtype and depression is the main symptom.
  • PMS-H. This subtype is the result of increased aldosterone, the hormone that makes one retain water and salt. Water gain is typical. [2]

PMS affects women of all races. It primarily occurs in the 20’s and 30’s. PMS does not occur after menopause.

PMS Symptoms

PMS can have a multitude of symptoms, or just one. Symptoms can last from 1 hour to several days. The intensity of symptoms are different and dependant upon the individual. Most women are able to carry on their normal daily routine, but a small percentage of women who suffer from PMS have such severe symptoms that they interrupt their daily schedule and associated activities. [3]

The most common symptoms affecting mood are nervousness, anxiety, and irritability. Women may also suffer from mood swings and personality changes. Fatigue and depression commonly occur as well. PMS can manifest in the GI system with bloating, diarrhea or constipation, and changes in appetite. Because of the association with estrogen, PMS can also manifest as tender, enlarged breasts, cramps, and changes in libido. General symptoms of PMS include headache, backache, acne, and edema of hands and feet. [4]

PMS Statistics

  • It is believed that 70-90% of women experience some adverse symptom of PMS.
  • 2 out of 5 women age 14-50 suffer from PMS.
  • In 30-40% of women, the symptoms are so severe that they affect their activities of daily living (ADL).
  • An underlying psychiatric disorder can be identified in approximately 50% of all PMS sufferers. [5]

PMS Treatment

Conventional treatment focuses on relieving the symptoms of PMS. However, most prescription medications do not affect all symptoms. If the most pressing complaint is water retention and bloating, a diuretic may be prescribed. Some women will respond to hormone therapy, either estrogen or progesterone. For women who suffer from depression and severe mood changes, sedatives or anti-depressants may be prescribed. [6]

Natural based therapies have been effective for PMS. The treatment is usually aimed at correcting the problem that causes the symptoms, and not by solely targeting on adverse symptom in particular.

Supplements helpful for PMS


Calcium is regulated by estrogen. Estrogen also affects the absorption of calcium in the gut. Calcium is an effective treatment for PMS. It has been shown to improve hormone patterns and to positively alter smooth muscle reactivity. Calcium supplementation has also been proven to effectively alleviate mood swings and physical symptoms in women suffering from PMS. [7]


Magnesium has been proven an effective treatment for PMS, as this mineral is often deficient in women who suffer from PMS. It is a necessary mineral for proper cell function throughout the body. Magnesium is involved in energy metabolism in smooth muscle cells such as in the uterus.

In one particular study, supplementation with magnesium was shown to improve mood symptoms after a 2 month period. [8] In another study, magnesium was equally effective at reducing fluid retention, breast tenderness, and bloating that is commonly associated with PMS. [9]


Zinc is involved in prolactin secretion. When zinc levels are low, prolactin secretion is promoted. Higher levels of prolactin are thought to contribute to some of the symptoms of PMS, such as bloating and breast tenderness. Zinc was found, in clinical trial, to be low in women suffering from PMS compared to controls. [10]

Vitamin B6

Vitamin B6 is a well-studied therapy for women who suffer from PMS. It can be effective on its own, but is better when combined with magnesium. In one study, B6 supplementation caused a 45% reduction in symptoms, results that were comparable to prescription medications. [11] In another large retrospective study of supplemental B6, 65-88% of patients had improvements in PMS symptoms. Improvement were dose related. There were also no adverse effects noted from taking the B6. [12]

Vitamin E

Vitamin E is a proven treatment for PMS symptoms. It is postulated that vitamin E causes a decrease in the inflammatory prostaglandins that contribute to cramps and breast tenderness.

One study of vitamin E supplementation showed a significant improvement in both mental and physical symptoms associated with PMS. [13] Another study compared vitamin E treatment across the four subtypes, and found that it was effective in 3 of the 4, significantly more than placebo. This study also showed that vitamin E was effective for the treatment of the severest of PMS symptoms. [14]

Vitex agnus-castus (Chaste Tree Berry)

Vitex has historically been used as an herb for complaints of the female reproductive system. It is believed to regulate the associated hormonal changes which occur monthly in PMS. Vitex’s primary site of action is in the brain, thereby allowing its chemical constituents to effect many different hormones in the body.

In one study, Vitex was shown to suppress prolactin and was useful for the treatment of breast tenderness. [15] In addition, 93% of women reported a decrease in symptoms in all four subtypes of PMS after treatments with vitex. [16] Other studies found that symptoms decreased with Vitex supplementation, but after discontinuing treatment, symptoms quickly returned. [17]


[1] Beers M and Berkow R. The Merck Manual 17th Ed. 1997. Pages: 1932-1933.

[2] Pizzorno J, Murray M and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 1999 Churchill Livingstone New York. Pages: 411-421.

[3] Beers M and Berkow R. The Merck Manual 17th Ed. 1997. Pages: 1932-1933.

[4] Pizzorno J, Murray M and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 1999 Churchill Livingstone New York. Pages: 411-421.

[5] November 2004.

[6] Beers M and Berkow R. The Merck Manual 17th Ed. 1997. Pages: 1932-1933.

[7] Thys-Jacobs S. Micronutrients and premenstrual syndrome: the case for calcium. J Am Cell Nutr. 2000 Apr; 19(2): 220-227.

[8] Facchinetti et al. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991; 78(2): 177-181.

[9] November 2004.

[10] Chuong CJ and Dawson EB. Zinc and copper levels in premenstrual syndrome. Fertil Steril. 1994 Aug; 62(2): 313-320.

[11] Diegoli MS da Fonseca AM, Diegoli CA, Pinotti JA. A double blind trial of four medications to treat severe PMS. Int J Gynaecol Obstet. 1998 Jul; 62(1): 63-67.

[12] Brush MG, Bennett T, and Hansen K. Pyridoxine in the treatment of premenstrual syndrome: a retrospective survey in 630 patients. Br J Clin Pract. 1998 Nov; 42(11): 448-452.

[13] London RS, Murphy L, Kitlowski KE, and Reynolds MA. Efficacy of alpha-tocopherol in the treatment of premenstrual syndrome. J Reprod Med. 1987 Jun; 32(6): 400-404.

[14] London RS, Sundaram GS, Murphy L, and Goldstein PJ. J Am Coll Nutr. 1983; 2(2): 115-122.

[15] Wuttke W, Jarry H, Christoffel V, Spengler B, Siedlova-Wuttke D. Chaste tree (vitex agnus-castus)-pharmacology and clinical indications. Phytomedicine 2003 May; 10(4): 348-357.

[16] Loch EG, Selle H, and Boblitz N. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing vitex agnus-castus. J Womens Health Gend Based Med. 2000 Apr; 9(3): 315-320.

[17] Berger D, Schaffner W, Schrader E, Meier B, and Brattstrom A. Efficacy of vitex agnus castus l. extract Ze 440 in patients with premenstrual syndrome. Arch Gynecol Obstet. 2000 Nov; 264(3): 150-153.