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The first step in helping women with PMS is to determine which subgroup most accurately fits their symptom picture. If it is not obvious from reading this or other information, selected laboratory tests can be called upon.
Diagnosis & Tests
Abnormal thyroid function and intestinal candidiasis should also be ruled out since these may produce, during the mid-luteal phase, a symptom picture similar to PMS. If you are affected by one or more types of PMS (A, C, D, or H) they will be listed separately. PMS type A is the most common.
Treatment & Prevention
General Dietary Guidelines:- Limit consumption of refined carbohydrates and other concentrated carbohydrates, such as, honey, dried fruit, and fruit juice
- Increase protein intake, particularly from vegetable sources such as legumes
- Increase green leafy vegetables consumption, except brassica family foods (cabbage, brussels sprouts, and cauliflower)
- Decrease milk and dairy product consumption
- Decrease intake of fats, especially saturated fats, while increasing intake of linoleic and linolenic acid. Use only non-estrogen-supplemented red meat and fowl
- Decrease salt intake. Restrict alcohol and tobacco use. Restrict intake of methyl-xanthines (coffee, tea, chocolate, and caffeine-containing foods and beverages).
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Conditions that suggest Premenstrual Syndrome:
Risk factors for Premenstrual Syndrome: | | | | | Hormones |  Progesterone Low or Estrogen Dominance
Low Melatonin Level | Melatonin can exhibit strong effects on the reproductive system, and the activity of the female hormones estrogen and progesterone is closely tied with its regulation of the sleep-wake cycle. Abnormal biological rhythms and sleep-wake cycle disturbances are often a primary feature of periodic depression, another common characteristic of PMS. Melatonin imbalances have been specifically linked to PMS.
A study reported finding that women with PMS had an earlier decline in melatonin secretion, resulting in a shorter overall secretion time. "The data demonstrate that women with premenstrual syndrome have chronobiological abnormalities of melatonin secretion... The fact that these patients respond to treatments that affect circadian physiology, such as sleep deprivation and phototherapy, suggests that circadian abnormalities may contribute to the pathogenesis of premenstrual syndrome." [Arch Gen Psychiatr 1990;47(12): pp.1139-46] |
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Nutrients |
Magnesium Requirement| | Magnesium deficiency is strongly implicated as a causative factor in PMS. Red Blood Cell magnesium levels in PMS patients have been shown to be significantly lower than in normal subjects. The deficiency is characterized by a generalized hyperesthesia syndrome (with generalized aches and pains), and a lower premenstrual pain threshold. One clinical trial of magnesium in PMS showed a reduction of nervousness in 89%, mastalgia in 96%, and weight gain in 95%. |
Manganese Requirement| | In a double blind study of women with normal menstrual cycles, lower dietary manganese (1.0mg versus 5.6mg) was found to increase mood and pain symptoms during the premenstrual phase. [Am J ObstetGynecol. 1993 May; 168(5): pp.1417-23] |
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Recommendations and treatments for Premenstrual Syndrome: | | | | | Animal-based |  Lactobacillus Acidophilus |
Botanical |
 Vitex / Chasteberry| | Clinical studies using vitex extract show a reduction in headaches, breast tenderness, bloating, fatigue, cravings for sweets, and also feelings of anxiety, irritability, depression and mood swings, after only one month.
One study compared vitex to vitamin B6 for treatment of PMS. In all, 85 women were given one capsule of vitex that contained up to 4.2mg of vitex agnus castus dried fruit, daily for three consecutive menstrual cycles. At the same time, another 90 women were given a placebo on the first 15 days of their menstrual cycle and 2 capsules of vitamin B6 (100mg per capsule) for the rest of the cycle. At the end of the study premenstrual tension syndrome (PMTS) scores were reduced nearly equally with vitex and vitamin B6. The investigators rated vitex as excellent for 24.6% of the patients compared to 12.1% for vitamin B6. Some 36% of the women reported that they became virtually symptom-free with vitex compared to only 21.1% of the vitamin B6 group. |
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Diet |
 Caffeine/Coffee Avoidance| | Several studies have linked caffeine consumption to a higher incidence of PMS symptoms including tension, irritability, anxiety, fatigue, sleep disturbance and breast tenderness. Some of coffee's components have a mild estrogen-like effect on the body. Since estrogen is responsible for premenstrual syndrome and breast tenderness, this may be one reason why coffee aggravates these conditions. |
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Hormone |
Natural Progesterone |
Mineral |
Magnesium| | Menstrual cramps, irritability, fatigue, depression and water retention have been lessened by taking supplemental magnesium, usually given along with calcium and often with vitamin B6. Magnesium is often at its lowest level during menstruation, and many symptoms of premenstrual syndrome (PMS) are relieved when this mineral is replenished. Supplementing magnesium in the same amount (or more) as calcium (about 500-1,000mg daily) is currently recommended for premenstrual problems.
A 1998 study in The Journal of Women's Health found that 200mg a day of magnesium reduced PMS fluid retention, breast tenderness and bloating by 40%. Magnesium is important to regulate muscle relaxation, blood sugar, and to promote sound sleep - all particularly important during PMS. |
Zinc |
Nutrient |
Beta-Carotene |
Vitamins |
Vitamin B6 (Pyridoxine)| | Vitamin B6 is effective for PMS symptoms because it reduces estrogen while raising progesterone levels. Numerous clinical studies have demonstrated the efficacy of vitamin B6 supplementation in treating PMS. In one double blind crossover trial, 84% of the subjects had a lower symptomatology score during the B6 treatment period. Although PMS is of multifactorial origin, B6 supplementation alone appears to benefit most patients. In another study, premenstrual acne flare-up was reduced in 72% of 106 affected young women taking 50mg of pyridoxine daily for one week prior and during the menstrual period. Pyridoxine acts as a mild diuretic, reducing the symptoms of premenstrual syndrome. |
Vitamin A| | Vitamin A has been shown to be beneficial in reducing PMS symptoms when given in doses of 100,000 to 300,000 IU per day in the second half of the menstrual cycle. These levels should only be achieved by a water-soluble form of vitamin A and supervised by a doctor.
Beta-carotenes may be better indicated since they are less toxic and endogenous regulation of conversion to retinol helps maintain more appropriate levels. The enzymatic conversion of beta-carotene to vitamin A is increased twofold during mid-ovulation. It is believed that there is a storage capacity for beta-carotene, which is converted to retinol as needed by the corpus luteum. |
Vitamin B-Complex
Vitamin E| | Although vitamin E research concerning PMS has focused primarily on mastalgia, significant reduction of other PMS symptomatology has been demonstrated in double-blind studies. Nervous tension, headache, fatigue, depression, and insomnia were all significantly reduced. |
Vitamin C (Ascorbic Acid) |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Acidophilus
A microflora (good bacteria) that acts as a digestive aid and lives in your intestines helping your body fight disease.
Acne
A chronic skin disorder due to inflammation of hair follicles and sebaceous glands (secretion glands in the skin).
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Beta-Carotene (Beta Carotene)
The most abundant of the carotenoids, beta-carotene has strong provitamin A activity and is a stronger antioxidant than vitamin A. It is widely accepted today as a cancer preventative. It is found in leafy green and yellow vegetables, often missing in children's diets. Beta-Carotene is believed to be a superior source of Vitamin A because it is readily converted into a more active form of the substance: your body converts it to Vitamin A as needed.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Candidiasis (Candida)
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge. Candidiasis is also known as: Candida; Candida albicans; Candida Related Complex; Chronic Candida Syndrome; (Chronic) Systemic Candidiasis; Monilia; Candidiasis Hypersensitivity Syndrome; Candidosis; (Chronic) Mucocutaneous Candidosis; Thrush (oral or vaginal); Moniliasis; Polysystematic Candidiasis.
Carbohydrates (Carbohydrate)
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Copper
An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.
Corpus Luteum
Yellow endocrine body formed in the ovary that secretes estrogen.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Crave (Craving, Cravings)
To have a strong desire for; to feel the need for.
Diuretic (Diuretics)
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
Endogenous
From within the body, either a native function or the product of the extended colony. Normal flora in the colon are considered endogenous.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hyperesthesia
An abnormal or pathological increase in sensitivity to sensory stimuli, as of the skin to touch or the ear to sound.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
Lactobacillus
A genus of gram-positive, acid-resistant bacteria in the Lactobacillaceae family. We know of lactobacillus because of its use in making yogurt and the conventional wisdom of taking it in one form or another after antibiotic therapy, but it is an integral part of the colon and mouth flora, and is the critical acidifying agent in vaginal flora. There is a growing body of rather ignored data showing the value of regular consumption of a lactobacillus-containing food in immunosuppression, slow virus, and candidiasis conditions.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Manganese
An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.
Melatonin
The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Mineral (Minerals)
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Premenstrual Syndrome (PMS)
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Pyridoxine
A B-complex vitamin that plays a role as a coenzyme in the breakdown and utilization of carbohydrates, fats and proteins. It facilitates the release of glycogen for energy from the liver and muscles. It also participates in the utilization of energy in the brain and nervous tissue and is essential for the regulation of the central nervous system.
Red Blood Cell (Erythrocyte, Erythrocytes, RBC, Red Blood Cells)
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Saturated Fat (Saturated Fats)
A type of fat that is readily converted to LDL cholesterol and is thought to encourage production of arterial disease. Saturated fats tend to be hard at room temperature. Among saturated fats are animal fats, dairy products, and such vegetable oils as coconut and palm oils.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Vitamin B6 (B6, B-6)
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
Vitex
Vitex agnus castus. Common name: chaste tree berry.
Last updated: Sep 28, 2008
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