What are natural treatments for premenstrual syndrome (PMS)?

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Treatment of symptoms related to the onset of menstruation.
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Introduction

Many women experience a variety of unpleasant symptoms, commonly called premenstrual syndrome (PMS), in the week or two before menstruating. These symptoms include irritability, anger, headaches, anxiety, depression, fatigue, fluid retention, breast tenderness, and cramps. 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 medical researchers do not know the exact 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 these, antidepressants such as selective serotonin reuptake inhibitors (Prozac, for example) 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 too, but its scientific record is mixed at best.

Calcium. A large double-blind, placebo-controlled study found positive results using calcium for the treatment of PMS symptoms. Participants took 300 milligrams (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.

Chasteberry. 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 name, Vitex or Vitex agnus-castus.

A double-blind, placebo-controlled study of 178 women found that treatment with chasteberry during three menstrual cycles significantly reduced PMS symptoms. The dose used was one tablet three times daily of a chasteberry dry extract. Women in the treatment group experienced significant improvements in symptoms, including irritability, depression, headache, and breast tenderness.

There is little corroborating evidence for this one well-designed study. An earlier double-blind trial compared chasteberry to vitamin B6 (pyridoxine) instead of placebo. The two treatments proved equally effective. However, because vitamin B6 itself has not been shown effective for PMS, these results mean little. Even better evidence indicates that chasteberry can help the cyclic breast tenderness that is often, but not necessarily, connected with PMS.

Vitamin B 6 . Vitamin B6 has been used for PMS for many decades, by both European and American physicians. However, the results of scientific studies are mixed at best. The latest and best-designed double-blind study, enrolling 120 women, found no benefit. In this trial, three prescription drugs were compared with vitamin B6 (pyridoxine, at 300 mg daily) and placebo. All study participants received three months of treatment and three months of placebo. vitamin B6 proved to be no better than placebo.

Approximately one dozen other double-blind studies have investigated the effectiveness of vitamin B6 for PMS, but none were well designed, and the results were mixed. Some books on natural medicine report that the negative results in some of these studies were caused by insufficient vitamin B6 dosage, but in reality there was no clear link between dosage and effectiveness. It has been suggested too that the combination of vitamin B6 and magnesium might be more effective than either treatment alone, but this remains to be proven.

Other Proposed Natural Treatments

Ginkgo. One double-blind, placebo-controlled study evaluated the benefits of Ginkgo biloba extract for women with PMS symptoms. This trial enrolled 143 women, eighteen to forty-five years of age, and monitored them for two menstrual cycles. Each woman received either the ginkgo extract (80 mg twice daily) or placebo on day sixteen of the first cycle. Treatment was continued until day five of the next cycle and resumed again on day sixteen of that cycle. Compared to placebo, ginkgo significantly relieved major symptoms of PMS, especially breast pain and emotional disturbance. In another, similarly designed trial involving eighty-five university students, Ginkgo biloba L. significantly reduced PMS symptom severity compared with placebo.

Magnesium. Preliminary studies suggest that magnesium may also be helpful for PMS. A double-blind, placebo-controlled study of thirty-two women found that magnesium taken from day fifteen of the menstrual cycle to the onset of menstrual flow could significantly improve premenstrual mood changes.

Another small, double-blind, preliminary study found that the regular use of magnesium could reduce symptoms of PMS-related fluid retention. In this study, thirty-eight women were given magnesium or placebo for two 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.

In addition, one small double-blind study (twenty participants) found that magnesium supplementation might help prevent menstrual migraines. Preliminary evidence suggests that combining vitamin B6 with magnesium might improve the results.

Additional treatments. Several double-blind, placebo-controlled studies, enrolling about 400 women, found evidence that multivitamin-multimineral supplements may be helpful for PMS. It is not clear what ingredients in these supplements played a role. Preliminary double-blind trials also suggest that vitamin E may be helpful for PMS.

A product containing grass pollen, royal jelly (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 thirty-two women, the use of the product for two menstrual cycles appeared to significantly improve PMS symptoms compared to the use of placebo.

A double-blind, placebo-controlled study of thirty women with premenstrual fluid retention found that the use of oligomeric proanthocyanidins 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. One poorly designed human trial hints that krill oil may be helpful for some PMS symptoms.

In a twenty-four-week double-blind study, forty-nine women with menstrual migraines received either placebo or a combination supplement containing soy isoflavones, dong quai, and black cohosh extracts. The treatment proved at least somewhat more effective than placebo. Soy isoflavones alone have also shown some potential benefit.

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. Preliminary evidence suggests that St. John’s wort might be helpful for mood changes in PMS.

One study often cited as evidence that massage therapy is helpful for PMS was fatally flawed by the absence of a control group. However, a better-designed trial compared reflexology (a special form of massage involving primarily the foot) with fake reflexology in thirty-eight women with PMS symptoms and found evidence that real reflexology was more effective. A small crossover trial of chiropractic manipulation for PMS symptoms found equivocal results at best. In a 2010 review of nine clinical trials, researchers could not conclusively determine the effectiveness of acupuncture for premenstrual syndrome because of the poor quality of the studies.

Progesterone cream is sometimes recommended for PMS, but there is no meaningful evidence that it is effective. One study failed to find the supplement inositol helpful for PMS.

Bibliography

Bryant, M., et al. “Effect of Consumption of Soy Isoflavones on Behavioural, Somatic, and Affective Symptoms in Women with Premenstrual Syndrome.” British Journal of Nutrition 93 (2005): 731-739.

Burke, B. E., R. D. Olson, and B. J. Cusack. “Randomized, Controlled Trial of Phytoestrogen in the Prophylactic Treatment of Menstrual Migraine.” Biomedicine and Pharmacotherapy 56 (2002): 283-288.

Cho, S. H., and J. Kim. “Efficacy of Acupuncture in Management of Premenstrual Syndrome.” Complementary Therapies in Medicine 18 (2010): 104-111.

Christie, S., et al. “Flavonoid Supplement Improves Leg Health and Reduces Fluid Retention in Pre-menopausal Women in a Double-Blind, Placebo-Controlled Study.” Phytomedicine 11 (2004): 11-17.

Hernandez-Reif, M., et al. “Premenstrual Symptoms Are Relieved by Massage Therapy.” Journal of Psychosomatic Obstetrics and Gynaecology 21 (2000): 9-15.

Ozgoli, G., et al. “A Randomized, Placebo-Controlled Trial of Ginkgo biloba L. in Treatment of Premenstrual Syndrome.” Journal of Alternative and Complementary Medicine 15 (2009): 845-851.

Sampalis, F., et al. “Evaluation of the Effects of Neptune Krill Oil on the Management of Premenstrual Syndrome and Dysmenorrhea.” Alternative Medicine Review 8 (2003): 171-179.