Premenstrual Syndrome

For 3 weeks out of every month, you’re energetic, upbeat and even-tempered. Then it happens. A week before your period begins, your mood swings from depression to irritability to downright anger. Your breasts become tender, your abdomen swells and your pants fit like sausage casings. You feel lethargic, have trouble concentrating and crave junk food.

For millions of women, these symptoms subside just as menstruation begins. They are the symptoms of premenstrual syndrome (PMS).

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But you don’t have to succumb to these symptoms. A great deal has been learned in recent years about PMS and doctors can recommend an array of traditional and complementary remedies to help reduce your symptoms.

Exact cause unknown

Doctors once thought that PMS was “all in your head.” They now know that symptoms are real, not imagined. In fact, it’s estimated that 30 percent to 40 percent of women have symptoms severe enough to impair their daily activities. About 7 percent have a form of PMS so disabling that it has its own psychiatric designation — premenstrual dysphoric disorder.

No one knows for sure what causes PMS. Some believe it’s caused by chemical changes in the brain. Fluctuating hormones also may play a role. Low levels of vitamins and minerals have been associated with some symptoms. So has eating a lot of salty foods, which may cause fluid retention, and drinking alcohol, which may cause mood and energy level disturbances. It’s possible all these factors contribute to some degree.

There is no diagnostic test for PMS. To help determine whether you have it, your doctor may ask you to keep a daily chart for several menstrual cycles and record which symptoms you have, their severity, when they occur during your cycle and when they subside.

Nondrug treatments

Treatment depends on identifying which symptoms are most distressing and working to eliminate them. That usually requires a combination of therapies. Here’s a start.

  • Diet modification — Choose foods that are high in complex carbohydrates (fruits, vegetables and whole grains). Eat several small meals a day instead of three large ones. Limit caffeine, alcohol and salty foods.
  • Exercise — Try moderate aerobic exercise (brisk walking, cycling) for 20 to 30 minutes at least three times a week — more during your PMS days.
  • Stress-reduction techniques — Practice progressive muscle relaxation or deep breathing exercises.

Medications

If lifestyle strategies don’t reduce your symptoms within 2 to 3 months, your doctor may suggest one or more of these medications.

  • Oral contraceptives — These stop ovulation, so PMS symptoms usually are relieved. The newest oral contraceptives are very low-dose, so there are few side effects.
  • Antidepressants — Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Paxil and Zoloft, may reduce PMS symptoms by more than half in 60 percent to 70 percent of women who take them.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — NSAIDs, such as ibuprofen (Advil) or naproxen sodium (Aleve), taken before your period can lessen cramping and discomfort during your period.

Complementary remedies

How can you possibly sort through all the hype about complementary treatments when research is minimal at best? To make sense of it all, we sorted through some treatments and arranged them into three categories based on available information and their potential to help.

What works

  • Calcium supplements — A study of 500 women, reported in the August 1998 issue of the American Journal of Obstetrics and Gynecology, found that 1,200 milligrams (mg) a day of chewable calcium carbonate reduced the physical and psychological symptoms of PMS by almost 50 percent. Improvements were noticed during the third cycle of treatment.
  • Magnesium supplements — A 1998 study in the Journal of Women’s Health found that 200 mg a day of magnesium reduced fluid retention, breast tenderness and bloating by 40 percent. Improvements were noticed during the second cycle of treatment.

What may work

  • Vitamin E — This vitamin is thought to help reduce PMS symptoms through regulation of prostaglandin production — hormone-like substances that reduce cramps and breast tenderness. Some studies found that vitamin E significantly reduced symptoms, but others showed only marginal or no benefit. Doctors recommend 400 international units a day for PMS symptoms.
  • Natural progesterone creams — These creams are derived from wild yams and soybeans. Some women report symptom relief, although there are no scientific studies to prove their effectiveness.
  • Herbal remedies — Although there are few, if any, scientific studies to back up the claims, some women report relief of symptoms with certain herbs. These include: black cohosh (joint pain, headaches, depression), ginger (nausea), red raspberry leaf (cramps), dandelion tea (bloating), chaste tree berry (anxiety, insomnia and mood swings) and evening primrose oil (cramps, breast tenderness). Be aware, however, that the U.S. Food and Drug Administration doesn’t regulate herbs, so the safety and effectiveness of these substances haven’t been proven. Likewise, you have no assurance that the product you buy contains the active ingredient listed on the label or that it isn’t contaminated with other, potentially harmful, substances. Check with your doctor before taking any herb.

What doesn’t work

  • Vitamin B6 — Daily supplementation commonly was recommended in the past, but studies failed to show its effectiveness. Plus, high daily doses may cause nerve damage.

This too shall pass

PMS symptoms range from mild to severe. If you find yourself on an emotional roller coaster one week every month, talk with your doctor about the array of traditional and complementary remedies now available.

Natural Treatments

Getting the right nutrients can make a big difference in whether you suffer monthly symptoms of premenstrual syndrome. Here’s what some experts recommend.

Nutrients, Daily Amounts, and Applications

Information IconDietary supplements related to PMS

Medical Alert

  • If you have heart or kidney problems, you should talk to your doctor before taking magnesium supplements.
  • High doses of vitamin B6 can cause side effects and should be used only under the supervision of your doctor.
  • If you are taking anticoagulant drugs, you should not take vitamin E supplements.