Premenstrual syndrome, or PMS, is more than just a signal that a woman’s period is approaching: it involves a range of recurring physical, behavioural, and emotional symptoms that occur cyclically before menstruation.[1] The symptoms can include, among others, bloating, fatigue, weight gain, headaches, irritability, nervousness, sadness, mood swings, and sleep disturbances. PMS symptoms begin after ovulation (which occurs approximately on day 14 of the cycle) and resolves within a few days of menstruation starting. PMS symptoms can last anywhere from a couple of days up to two weeks. The timing of PMS symptoms corresponds to hormonal fluctuations that occur in the luteal or postovulatory phase of the cycle. While 50 to 80% of women report experiencing mild PMS, 30 to 40% experience symptoms significant enough to require treatment. The exact cause of PMS is not fully understood, but it is believed that some women are more sensitive to normal hormonal changes, which may explain the variation in symptom severity.[2]

Lifestyle Tips for Relief

Various lifestyle strategies can help to manage these bothersome recurring symptoms. Regular exercise, regardless of the type, has been shown to reduce symptoms of pain, constipation, breast sensitivity, and emotional disturbances including anxiety and anger.[3] Exercise increases feel-good endorphins to support a healthy mood, stimulates circulation which can ease muscle cramping and stress, and supports hormonal balance including reducing estradiol and increasing progesterone.[4]

Diets high in fat, sugar, salt, processed foods, and soft drinks have been linked to an increased risk of PMS. In contrast, eating habits that emphasize fresh, unprocessed foods rich in essential micronutrients and omega‑3 fatty acids—and that limit alcohol, simple carbohydrates, saturated fats, and excess salt—are associated with a reduced risk of PMS symptoms.[5]

Supplement Smart

Many nutraceuticals, including herbs, vitamins, and minerals, can also help to manage PMS symptoms.

Vitex agnus-castus

Vitex agnus-castus, otherwise known as chasteberry or chaste tree berry, is an herb that may help reduce symptoms of PMS. Vitex has prolactin-lowering activity while also supporting midluteal progesterone levels.[6] Over a three-month period, Vitex has been found to significantly reduce self-rated PMS severity compared to placebo, including significantly reducing back pain, breast fullness, headaches, and irritability, while also improving sleep quality.[7]

Vitamin B6

Vitamin B6 has also been shown to be useful for PMS. Vitamin B6 plays a role in healthy mood balance by regulating production of serotonin and dopamine.[8] B6 also plays a role in water metabolism, with deficiencies of vitamin B6 contributing to increased water retention, another common premenstrual symptom. Low levels of B6 also contribute to elevated prolactin,[9] a hormone associated with premenstrual symptoms.[10] Daily supplementation with vitamin B6 has been found to significantly reduce the physical and psychological symptoms of PMS compared to placebo, with dosages ranging from 40 mg to 250 mg daily over the course of 2–3 menstrual cycles.[11]

Calcium

Calcium supplementation is also a promising potential therapeutic for PMS. Calcium levels have been found to fluctuate with the cycle and tend to be lower amongst those who experience PMS.[12] Supplementing with calcium carbonate, between 500 mg and 1,200 mg daily, contributes to significant reductions in PMS symptoms, including improvements in energy, mood, and water retention.[13] One study found that combining calcium with vitamin B6 was more effective at reducing PMS severity than calcium alone.[14]

Vitamin E

Vitamin E may also play a role in managing PMS symptoms. As a potent antioxidant, vitamin E supplementation can help reduce cyclical breast pain associated with PMS.[15] One study compared the supplementation of vitamin E dosed at 200 IU/d versus 40 mg/d of vitamin B6 versus placebo, for two months. Both vitamins E and B6 contributed to significant reductions in breast pain, and vitamin E was found to be as effective as vitamin B6.[16]

Ginger

Cramping can also be a component of PMS for some women. Various studies have found ginger supplementation to be effective in reducing menstrual cramping, in doses ranging from 750 mg/d to 2,000 mg/d during the first 3–4 days of menstruation.[17] Painful menstrual cramping without any underlying pathology is not entirely understood but is associated with an increased production of proinflammatory molecules which contribute to excessive uterine contractions. Ginger root contains various antioxidant and anti-inflammatory constituents which inhibit inflammatory molecules and disrupt pain signals.[18] Another study found ginger to significantly reduce overall PMS severity (encompassing mood, behavioural, and physical symptoms) in comparison to placebo.[19]

Palmitoylethanolamide

Palmitoylethanolamide (PEA), a fatty acid, is known for its anti-inflammatory and endocannabinoid-like effects. Palmitoylethanolamide has been studied in the context of pain control for various conditions, including menstrual pain. Used acutely with the onset of menstrual cramping, 300 mg of PEA can significantly reduce menstrual pain in comparison to placebo.[20]

Relief Is Within Reach

PMS is an incredibly common component of the menstrual cycle for many women. Various strategies, including lifestyle intervention and supplements, can help to reduce the severity of PMS symptoms. It is important to consult a physician if PMS symptoms change in their pattern or intensity, are present throughout a large portion of the cycle, or are accompanied by significant mood disruptions or pain.

Dr. Jill Northrup, ND

A Toronto-based naturopathic doctor with a passion for health and natural medicines, she values an evidence-based treatment approach and emphasizes patient education and preventative medicine in her practice.

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