Premenstrual Syndrome (PMS)
Many women experience a variety of unpleasant symptoms in the week or two before menstruating. These include irritability, anger, headaches, anxiety, depression, fatigue, fluid retention, and breast tenderness. When emotional symptoms related to depression predominate in PMS, the condition is sometimes called premenstrual dysphoric disorder (PMDD). These symptoms undoubtedly result from hormonal changes of the menstrual cycle, but apart from that general statement, medical researchers do not know the cause of PMS or how to treat it.
Conventional treatments for PMS and PMDD include antidepressants, beta-blockers, diuretics, oral contraceptives, and other hormonally active formulations. Of all these, antidepressants in the SSRI family (such as Prozac) are perhaps the most effective.
Principal Proposed Natural Treatments
There is fairly good evidence that calcium supplements can significantly reduce all the major symptoms of PMS. There is also some evidence for the herbs chasteberry and ginkgo. Vitamin B6 is widely recommended as well, but its scientific record is mixed at best.
A large double-blind, placebo-controlled study found positive results using calcium for the treatment of PMS symptoms.1 Participants took 300 mg of calcium (as calcium carbonate) four times daily. Compared to placebo, calcium significantly reduced mood swings, pain, bloating, depression, back pain, and food cravings.
Similar findings were also seen in earlier preliminary studies of calcium for PMS.2,3
For more information, including dosage and safety issues, see the full Calcium article.
The herb chasteberry is widely used in Europe as a treatment for PMS symptoms. More than most herbs, chasteberry is frequently called by its Latin names: Vitex or Vitex agnus-castus.
A double-blind, placebo-controlled study of 178 women found that treatment with chasteberry over 3 menstrual cycles significantly reduced PMS symptoms.8 The dose used was one tablet 3 times daily of a chasteberry dry extract. Women in the treatment group experienced significant improvements in symptoms, including irritability, depression, headache, and breast tenderness.
A double-blind randomized trial of 162 women with PMS compared 8, 20, and 30 mg doses of chasteberry and placebo over the course of three menstrual cycles. Women who took 20mg or 30mg of chasteberry had significantly greater reduction in symptom scores compared to placebo with the greatest reduction in 20 mg dose. There was no significant difference when comparing 8mg to placebo.45
Unfortunately, there is little corroborating evidence as yet for this one well-designed study. A previous double-blind trial compared chasteberry to vitamin B6 (pyridoxine) instead of placebo.9 The two treatments proved equally effective. However, because vitamin B 6 itself has not been shown effective for PMS ( see below), these results mean little.10
Even better evidence indicates that chasteberry can help the cyclic breast tenderness often, but not necessarily, connected with PMS.
For more information, including dosage and safety issues, see the full Chasteberry article.
Vitamin B 6
Vitamin B 6 has been used for PMS for many decades, by both European and US physicians. However, the results of scientific studies are mixed at best. The most recent and best-designed double-blind study, enrolling 120 women, found no benefit.16 In this trial, three prescription drugs were compared against vitamin B 6 (pyridoxine, at 300 mg daily) and placebo. All study participants received 3 months of treatment and 3 months of placebo. Vitamin B 6 proved to be no better than placebo.
Approximately a dozen other double-blind studies have investigated the effectiveness of vitamin B 6 for PMS, but none were well designed, and the results were mixed.17,18 Some books on natural medicine report that the negative results in some of these studies were due to insufficient B 6 dosage, but in reality there was no clear link between dosage and effectiveness.
For more information, including dosage and safety issues, see the full Vitamin B6 article.
Other Proposed Treatments for PMS
One double-blind, placebo-controlled study evaluated the benefits of Ginkgo biloba extract for women with PMS symptoms.20 This trial enrolled 143 women, 18 to 45 years of age, and followed them for two menstrual cycles. Each woman received either the ginkgo extract (80 mg twice daily) or placebo on day 16 of the first cycle. Treatment was continued until day 5 of the next cycle, and resumed again on day 16 of that cycle. As compared to placebo, ginkgo significantly relieved major symptoms of PMS, especially breast pain and emotional disturbance. In another similarly designed trial involving 85 university students, Ginkgo biloba L. significantly reduced PMS symptom severity compared to placebo.43
For more information, including dosage and safety issues, see the full Ginkgo article.
Preliminary studies suggest that magnesium may also be helpful in PMS. A double-blind, placebo-controlled study of 32 women found that magnesium taken from day 15 of the menstrual cycle to the onset of menstrual flow could significantly improve premenstrual mood changes.21
Another small double-blind preliminary study found that regular use of magnesium could reduce symptoms of PMS-related fluid retention.22 In this study, 38 women were given magnesium or placebo for 2 months. The results showed no effect after one cycle, but by the end of two cycles, magnesium significantly reduced weight gain, swelling of extremities, breast tenderness, and abdominal bloating.
For more information, including dosage and safety issues, see the full Magnesium article.
As mentioned earlier, preliminary evidence suggests that combining vitamin B 6 with magnesium might improve the results.24
Several double-blind, placebo-controlled studies, enrolling a total of about 400 women, found evidence that multivitamin and mineral supplements may be helpful for PMS.26-29 It is not clear which ingredients in these supplements played a role.
A product containing grass pollen, royal jelly (a product made by bees), and the pistils (seed-bearing parts) of grass has been proposed for use in PMS. In a double-blind, placebo-controlled crossover trial of 32 women, use of the product for two menstrual cycles appeared to significantly improve PMS symptoms as compared to use of placebo.34 Royal jelly alone was associated with reduced PMS symptoms (when compared to placebo) in a randomized trial of 110 women. The jelly was given daily on the first day of menstruation for 2 consecutive cycles.47
A double-blind, placebo-controlled study of 30 women with complaints of premenstrual fluid retention found that use of oligomeric proanthocyanidins (OPCs) at a dose of 320 mg daily significantly reduced the sensation of fluid retention in the leg; however, actual leg swelling as measured was not significantly improved.40
One poorly designed human trial hints that krill oil may be helpful for some PMS symptoms.41 However, regular use of fish oil resulted in symptom improvement. In a randomized trial of 139 women, 2 g of fish oil per day for 3 months reduced depression, lack of concentration, anxiety, and bloating severity when compared to placebo. Fish oil was also associated in reduced duration time of symptoms, in addition to headache and breast tenderness.46
In a 24-week, double-blind study, 49 women with menstrual migraines received either placebo or a combination supplement containing soy isoflavones, dong quai, and black cohosh extracts.35 The treatment proved at least somewhat more effective than placebo. Soy isoflavones alone have also shown some potential benefit.42
Evening primrose oil, a source of the omega-6 fatty acids, was once thought to be helpful for cyclic breast pain. However, it probably does not work for this purpose. It has also been proposed as a treatment for general PMS symptoms, but there is only minimal supporting evidence.30
One study often cited as evidence that massage therapy is helpful for PMS was fatally flawed by the absence of a control group.36 However, a better-designed trial compared reflexology (a special form of massage involving primarily the foot) against fake reflexology in 38 women with PMS symptoms and found evidence that real reflexology was more effective.37 A small crossover trial of chiropractic manipulation for PMS symptoms found equivocal results at best.38
In a 2010 review of nine clinical trials, researchers could not conclusively determine the effectivenes of acupuncture for premenstrual syndrome due to the poor quality of the studies.44 However, acupressure to specific points near the liver and large intestine was associated with significant improvements in symptoms and quality of life. A randomized trial of 97 women with moderate to severe PMS symptoms compared acupressure to sham acupressure. Sessions were coordinated with the timing of menstrual cycles and done daily for 20 minutes at a time.48
For a discussion of homeopathic approaches to PMS, see the Homeopathy Database.
1. Thys-Jacobs S, Starkey P, Bernstein D, et al. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 1998;179:444-452.
2. Alvir JM, Thys-Jacobs S. Premenstrual and menstrual symptom clusters and response to calcium treatment. Psychopharmacol Bull. 1991;27:145-148.
3. Thys-Jacobs S, Ceccarelli S, Bierman A, et al. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med. 1989;4:183-189.
4. Milewicz A, Gejdel E, Sworen H, et al. Vitex agnus-castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study [translated from German]. Arzneimittelforschung. 1993;43:752-756.
5. Jarry H, Leonhardt S, Gorkow C, et al. In vitro prolactin but not LH and FSH release is inhibited by compounds in extracts of Agnus castus: direct evidence for a dopaminergic principle by the dopamine receptor assay. Exp Clin Endocrinol. 1994;102:448-454.
6. Sliutz G, Speiser P, Schultz AM, et al. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res. 1993;25:253-255.
7. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:241-242.
8. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. 2001;322:134-137.
9. Lauritzen C, Reuter HD, Repges R, et al. Treatment of premenstrual tension syndrome with Vitex agnus castus. Controlled, double-blind study versus pyridoxine. Phytomedicine. 1997;4:183-189.
10. Kleijnen J, Ter Riet G, Knipschild P. Vitamin B6 in the treatment of premenstrual syndrome—a review. Br J Obstet Gynaecol. 1990;97:847-852.
11. Dittmar FW, Bohnert KJ, Peeters M, et al. Premenstrual syndrome: treatment with a phytopharmaceutical [translated from German]. Therapie Woche Gynakol. 1992;5:60-68.
12. Peters-Welte C, Albrecht M. Menstrual abnormalities and PMS: Vitex agnus castus [translated from German]. Therapie Woche Gynakol. 1994;7:49-52.
16. Diegoli MSC, da Fonseca AM, Diegoli CA, et al. A double-blind trial of four medications to treat severe premenstrual syndrome. Int J Gynaecol Obstet. 1998;62:63-67.
17. Kleijnen J, Ter Riet G, Knipschild P. Vitamin B6 in the treatment of premenstrual syndrome—a review. Br J Obstet Gynaecol. 1990;97:847-852.
18. Wyatt KM, Dimmock PW, Jones PW, et al. Efficacy of vitamin B6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999;318:1375-1381.
19. De Souza MC, Walker AF, Robinson PA, et al. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med. 2000;9:131-139.
20. Tamborini A, Taurelle R. Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome [translated from French]. Rev Fr Gynecol Obstet. 1993;88:447-457.
21. Facchinetti F, Bolrella P, Sances G, et al. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991;78:177-181.
22. Walker AF, De Souza MC, Vickers MF, et al. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998;7:1157-1165.
23. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991;31:298-301.
24. De Souza MC, Walker AF, Robinson PA, et al. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med. 2000;9:131-139.
25. London RS, Murphy L, Kitlowski KE, et al. Efficacy of alpha-tocopherol in the treatment of the premenstrual syndrome. J Reprod Med. 1987;32:400-404.
26. London RS, Bradley L, Chiamori NY. Effect of a nutritional supplement on premenstrual symptomatology in women with premenstrual syndrome: a double-blind longitudinal study. J Am Coll Nutr. 1991;10:494-499.
27. Reynolds MA, London RS. Efficacy of a multivitamin/mineral supplement in the treatment of the premenstrual syndrome [abstract]. J Am Coll Nutr. 1988;7:416.
28. Stewart A. Clinical and biochemical effects of nutritional supplementation on the premenstrual syndrome. J Reprod Med. 1987;32:435-441.
29. Chakmakjian ZH, Higgins CE, Abraham GE. The effect of a nutritional supplement, Optivite® for women, on premenstrual tension syndromes: II. Effect on symptomatology, using a double-blind, cross-over design. J Appl Nutr. 1985;37:12-17.
30. Puolakka J, Makarainen L, Viinikka L, et al. Biochemical and clinical effects of treating the premenstrual syndrome with prostaglandin synthesis precursors. J Reprod Med. 1985;30:149-153.
31. Dittmar FW, Bohnert KJ, Peeters M, et al. Premenstrual syndrome: treatment with a phytopharmaceutical [translated from German]. Therapie Woche Gynakol. 1992;5:60-68.
32. Stevinson C, Ernst E. A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome. BJOG. 2000;107:870-876.
33. London RS, Sundaram GS, Murphy L, et al. The effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. J Am Coll Nutr. 1983;2:115-122.
34. Winther K, Hedman C. Assessment of the effects of the herbal remedy Femal on the symptoms of premenstrual syndrome: a randomized, double-blind, placebo-controlled study. Curr Ther Res Clin Exp. 2002;63:344-353.
35. Burke BE, Olson RD, Cusack BJ. Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother. 2002;56:283-288.
36. Hernandez-Reif M, Martinez A, Field T, et al. Premenstrual symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol. 2000;21:9-15.
37. Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol. 1993;82:906-911.
38. Walsh MJ, Polus BI. A randomized, placebo-controlled clinical trial on the efficacy of chiropractic therapy on premenstrual syndrome. J Manipulative Physiol Ther. 1999;22:582-585.
39. Nemets B, Talesnick B, Belmaker RH, et al. Myo-inositol has no beneficial effect on premenstrual dysphoric disorder. World J Biol Psychiatry. 2002;3:147-149.
40. Christie S, Walker AF, Hicks SM, et al. Flavonoid supplement improves leg health and reduces fluid retention in pre-menopausal women in a double-blind, placebo-controlled study. Phytomedicine. 2004;11:11-7.
41. Sampalis F, Bunea R, Pelland MF, et al. Evaluation of the effects of Neptune Krill Oil on the management of premenstrual syndrome and dysmenorrhea. Altern Med Rev. 2003;8:171-179.
42. Bryant M, Cassidy A, Hill C, et al. Effect of consumption of soy isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome. Br J Nutr. 2005;93:731-739.
43. Ozgoli G, Selselei EA, Mojab F, et al. A randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of premenstrual syndrome. J Altern Complement Med. 2009;15:845-51.
44. Cho SH, Kim J. Efficacy of acupuncture in management of premenstrual syndrome: a systematic review. Complement Ther Med. 2010 Apr;18(2):104.
45. Schellenberg R, Zimmermann C, et al. Dose-dependent efficacy of the Vitex agnus castus extract Ze 440 in patients suffering from premenstrual syndrome. Phytomedicine. 2012;19(14):1325-1331.
46. Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: "a pilot trial". Complement Ther Med. 2013;21(3):141-146.
47. Taavoni S, Barkhordari F, Goushegir A, Haghani. Effect of Royal Jelly on premenstrual syndrome among Iranian medical sciences students: a randomized, triple-blind, placebo-controlled study. Complement Ther Med. 2014;22(4):601-606.
48. Bazarganipour F, Taghavi SA, Allan H, et al. The effect of applying pressure to the LIV3 and LI4 on the symptoms of premenstrual syndrome: A randomized clinical trial. Complement Ther Med. 2017;31:65-70.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 1/11/2018
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