Premenstrual Syndrome

Premenstrual Syndrome: Overview

Alternative names: Premenstrual Syndrome is often abbreviated to PMS.

Premenstrual Syndrome (PMS) a very common condition that affects women during specific days of their menstrual cycle, usually just before their menses.  Symptoms can start 5 to 11 days before menstruation and usually go away once menstruation begins.  Higher levels of estrogen and progesterone during this time can cause mood swings, anxiety, irritability and physical changes.

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Many Holistic doctors categorize PMS under four subgroups or types – A, C, D and H – which were originally identified by Dr. Guy Abraham, M.D. Those doctors will first determine which subgroup most accurately fits the patient's symptom picture before trying to help.  If it is not obvious, specific laboratory testing can be performed.  Links to further information about these PMS subgroups can be found below.

Incidence; Causes and Development; Contributing Risk Factors

Around 85-90% of women experience Premenstrual Syndrome symptoms at some point in their lives.  However, it is estimated that medically significant Premenstrual Syndrome only occurs in 20-30% of women and just 3-8% are actually diagnosed with this condition.

Despite Premenstrual Syndrome being so common, doctors are still unable to say exactly what causes it.  A woman's menstrual cycle is controlled by several hormones at varying levels which determine the rhythm and length of a cycle and send a signal for menopause.  These hormonal controls involve the ovaries, brain and pituitary glands.  It is these hormonal fluctuations that are thought to be what causes Premenstrual Syndrome; specifically changes in serotonin, progesterone and estrogen.  Various hormonal and metabolic changes may contribute and are current research topics.

Other factors that have been associated with Premenstrual Syndrome include:

  • Lack of specific vitamins and minerals
  • Consuming high amounts of salt
  • Alcohol or caffeine
  • Cyclical changes in hormones
  • Depression
  • Chemical changes in the brain

There are several risk factors for Premenstrual Syndrome, including:

  • A family history of Premenstrual Syndrome or depression
  • A history of mood disorders
  • Domestic violence
  • Substance abuse
  • Physical or emotional trauma

Signs and Symptoms

Most women will suffer from at least one symptom of Premenstrual Syndrome each month and this can vary with each cycle.  In order to be classed as clinical Premenstrual Syndrome, symptoms need to be severe enough to affect everyday functioning.  These symptoms, which generally occur 5 to 11 days before menstruation, can be broken down into physical, emotional and behavioral.

Some physical symptoms of PMS include:

Some emotional symptoms of PMS include:

Some behavioral signs of PMS include:

  • Loss of mental focus
  • Forgetting things
  • Tired

Diagnosis and Tests

There are no specific tests available to diagnose Premenstrual Syndrome.  Doctors will often identify symptoms and look into menstrual regularity, ovulation and hormonal fluctuations to form a diagnosis.  Premenstrual Syndrome is usually self-diagnosed as the nature of the symptoms are very repetitive and become easy to identify over time.

Abnormal thyroid function and intestinal candidiasis should be ruled out since these can produce a symptom picture similar to PMS during the mid-luteal phase.

Treatment and Prevention

Treatments and their success will vary greatly between different women.  Some of the more regularly prescribed medications include:

General dietary guidelines for controlling PMS symptoms include:

  • 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 but AVOID members of the brassica family (cruciferous vegetables) such as cabbage, brussels sprouts, and cauliflower if estrogen levels are low to normal
  • 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 methylxanthines (coffee, tea, chocolate, and caffeine-containing foods and beverages)

Adding regular exercise into your daily routine (30 minutes a day) and ensuring you get enough sleep has also been proven to help manage Premenstrual Syndrome.  Other vitamins and minerals may also be advised to help alleviate symptoms such as magnesium, B6, B12, folic acid, calcium, vitamin E.

Prognosis; Complications; Seek medical attention if...

Although there is no cure, understanding Premenstrual Syndrome and knowing how to deal with the symptoms can help an individual to plan a coping strategy.  Often there are many measures a woman can take to help herself before medical assistance is needed.  Appropriate diet, exercise and lifestyle changes can help reduce symptoms in the long run and lead to healthy lives.

There are several conditions associated with PMS, including:

It is important to seek medical attention if you are unable to control your Premenstrual Syndrome and the symptoms are affecting your daily life.

References and Further Information

See also:

PMS-A (Anxiety)
PMS-C (Craving)
PMS-D (Depression)
PMS-H (Headache)

Signs, symptoms & indicators of Premenstrual Syndrome:

Symptoms - Abdomen

Symptoms - Metabolic

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Risk factors for Premenstrual Syndrome:

Environment / Toxicity

Copper Toxicity

Estrogen results in increased copper absorption.  Copper is closely related to estrogen metabolism, so an imbalance can cause many female health problems such as premenstrual syndrome.  Taking extra zinc and vitamin B6 before the menstrual period can reduce copper levels and thus the symptoms of PMS.


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]


Magnesium Requirement

Magnesium deficiency is strongly implicated as a causative factor in PMSRed 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]

Recommendations for Premenstrual Syndrome:

Botanical / Herbal

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.


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.

Digestive Aids

Lactobacillus Acidophilus

Lactobacillus acidophilus has been shown to inhibit the fecal bacterial enzyme, beta-glucuronidase, which is responsible for deconjugating liver conjugated estrogen.





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.



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 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.

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