Pre-Menstrual Syndrome

Pre-menstrual syndrome is a group of symptoms associated with the days or weeks prior to the menstrual period.

Pre-Menstrual Syndrome

Pre-menstrual syndrome is a group of symptoms associated with the days or weeks prior to the menstrual period. Up to 90% of women in the UK experience some symptoms, ranging from mild to severe.1 Up to 10% experience symptoms so severe that they interfere with normal, day to day life. There are over 200 symptoms associated with PMS, and PMS can be classified into four types:

  • Emotional – PMS-A (Anxiety, associated with mood swings, anxiety and irritability) and PMS-D (Depression – associated with crying, insomnia, forgetfulness and confusion).
  • Physical – PMS-H (Hydration – associated with weight gain, fluid retention, bloating and breast tenderness) and PMS-C (Craving – associated with sweet cravings, increased appetite, headaches, fatigue, dizziness and fainting).

Causes of PMS

There is evidence to support the role of nutrition and diet for some PMS symptoms and the nutrients chosen will depend on the main symptoms experienced. Many signs of PMS are linked to changes in oestrogen and progesterone levels following ovulation. For example, high oestrogen and low progesterone can be linked to mood changes and cravings as well as an increase in prolactin which is linked to breast tenderness. Some studies also suggest a link between PMS and serotonin, which is strongly linked to mood, appetite and sleep.

Nutrition and Lifestyle

In terms of diet and lifestyle, there are some changes which could be considered to alleviate PMS symptoms. Some studies have shown a link between both caffeine and alcohol and period pain, as these are thought to be linked to an increase in muscle contractions.

One of the most well-known supplements recommended for PMS is Vitamin B6. Studies suggest that it may help to balance oestrogen and progesterone production by affecting detoxification and production, and support serotonin manufacture in the body.2 B6 supplementation significantly reduced PMS symptoms and was more effective and better tolerated than a conventional medication.3

Vitamin D plays several physiological roles in the body which may be relevant to PMS and the menstrual cycle, including maintaining calcium balance, production of sex hormones and the function of neurotransmitters.4 Low Vitamin D status is associated with an increased incidence of PMS symptoms and supplementation has been shown to reduce symptoms such as backache and crying.5

Gamma-Linoleic Acid (GLA), a fatty acid found in both starflower and evening primrose oils, is also commonly recommended for PMS,6,7,8 particularly breast tenderness. Studies suggest that GLA can increase production of compounds which reduce inflammation and decrease sensitivity to prolactin, and it has been shown to be more effective for breast discomfort than conventional painkillers.9

The omega 3 fatty acids EPA and DHA have also been indicated for both physical and psychological symptoms of PMS including irritability, anxiety, low mood and fatigue.10 These fatty acids have also been shown to reduce dysmenorrhoea (period pain).11

Several minerals can also be useful for a variety of PMS symptoms. Changes in calcium regulation have been hypothesised as a cause for some PMS symptoms and calcium, in doses of both 600mg and 1000mg a day, has been shown to reduce symptoms such as fluid retention, fatigue, depression, food cravings and pain,12,13 as well as being useful for dysmenorrhoea.

It is well known that magnesium intakes are low in most women, with up to 70% of the female population in the UK not consuming the recommended level of 375mg a day.14 Low magnesium levels have been associated with PMS and supplementation successfully reduced both mood changes and pain scores.15 Magnesium is also associated with a reduction in the symptoms associated with PMS-H, particularly fluid retention.

Plant compounds known as anthocyanidins are associated with improvements in collagen production. A supplement providing 160mg of anthocyanidins has been shown to alleviate fluid retention in pre-menopausal women at a dose of two tablets (320mg anthocyanidins) daily.16

References

  1. Office on Women's Health, U.S. Department of Health & Human Services. Premenstrual Syndrome (PMS). womenshealth.gov
  2. Spinneker A, Sola R, Lemmen V, et al. Vitamin B6 status, deficiency and its consequences – an overview. Nutr Hosp. 2007;22(1):7–24.
  3. Sharma P, Kulshreshtha S, Singh GM, Bhagoliwal A. Role of bromocriptine and pyridoxine in premenstrual tension syndrome. Indian J Physiol Pharmacol. 2007;51(4):368–74.
  4. Arab A, Golpour-Hamedani S, Rafie N. The Association Between Vitamin D and Premenstrual Syndrome: A Systematic Review and Meta-Analysis of Current Literature. J Am Coll Nutr. 2019;38(7):648–656.
  5. Bahrami A, Avan A, Sadeghnia HR, et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecol Endocrinol. 2018;34(8):659–663.
  6. Watanabe S, Sakurada M, Tsuji H, Matsumoto S, Kondo K. Efficacy of γ-linolenic acid for treatment of premenstrual syndrome, as assessed by a prospective daily rating system. J Oleo Sci. 2005;54:217–224.
  7. Saki M, Akbari S, Saki M, et al. The effect of primrose oil on the premenstrual syndrome among the female students in Lorestan University of Medical Sciences: a triple blind study. J Nurs Midwifery Sci. 2015;2:20–26.
  8. Mahboubi M. Evening Primrose (Oenothera biennis) Oil in Management of Female Ailments. J Menopausal Med. 2019;25(2):74–82.
  9. Balci FL, Uras C, Feldman S. Clinical Factors Affecting the Therapeutic Efficacy of Evening Primrose Oil on Mastalgia. Ann Surg Oncol. 2020;27(12):4844–4852.
  10. Behboudi-Gandevani S, Hariri FZ, Moghaddam-Banaem L. The effect of omega 3 fatty acid supplementation on premenstrual syndrome and health-related quality of life: a randomized clinical trial. J Psychosom Obstet Gynaecol. 2018;39(4):266–272.
  11. Rahbar N, Asgharzadeh N, Ghorbani R. Effect of omega-3 fatty acids on intensity of primary dysmenorrhea. Int J Gynaecol Obstet. 2012;117(1):45–7.
  12. Ghanbari Z, Haghollahi F, Shariat M, Foroshani AR, Ashrafi M. Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwan J Obstet Gynecol. 2009;48(2):124–9.
  13. Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med. 1989;4(3):183–9.
  14. Towards a Healthier Britain. 2010. PAGB.
  15. Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AR. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991;78(2):177–81.
  16. Christie S, Walker AF, Hicks SM, Abeyasekera S. Flavonoid supplement improves leg health and reduces fluid retention in pre-menopausal women in a double-blind, placebo-controlled study. Phytomedicine. 2004;11(1):11–7.
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