Definition

Premenstrual syndrome or PMS is a syndrome, or constellation of symptoms that occurs in the days and weeks before the onset of the menstrual flow. It is characterized by one or more of the following symptoms: irritability, emotional tension, anxiety, mood changes, breast tenderness with or without swelling, water retention, which may cause edema (swelling), depression, and headaches.

Premenstrual symptoms are common. Up to 40 percent (40%) of women in their reproductive years are affected. Daily life and relationships can be affected. Severe impairment occurs in only 5 percent (5%) of women. Progesterone levels fall dramatically at around day 21, while estrogen levels rise. Other contributing causes and factors, including low levels of calcium, B6 and other nutrients, food allergies and thyroid disorders have been suggested. Many women find that PMS worsens with age.

Women most often affected by premenstrual syndrome are those who have experienced a major hormonal change, as may happen after childbirth, miscarriage, abortion, or tubal ligation. Women who discontinue birth-control pills may also notice an increase in PMS symptoms until their hormone balance returns.

To be considered symptoms of PMS, symptoms must occur in the second half of the menstrual cycle. There must be least a 7-day period without these symptoms in the first half of the cycle. This will rule out psychiatric problems that last all month. The symptoms must occur in three consecutive cycles and must be severe enough to require medical advice or treatment. Women are asked to keep a daily log of symptoms for a period of 3 months, to assist their physician in diagnosing PMS.

Different views exist about the validity of PMS as a diagnosis and the proper methods to diagnose. These views reflect diverse ethnic and cultural norms and values. Nonetheless, to women with PMS, the symptoms are very real and distressing. They can be disruptive, debilitating and require professional treatment. However, optimizing the nutritional component of PMS can offer relief to women with mild to moderate symptoms. By incorporating the common sense, use of nutritional supplements, including natural herbal remedies, with a healthy diet and exercise, many women have a natural healthy option.

What are the symptoms?

More than 150 symptoms (physical and psychological) have been attributed to PMS. Some of the most common include:

Physical Symptoms
. Abdominal discomfort and bloating
. Acne, cold sores, or susceptibility to herpes outbreaks
. Breast swelling and pain
. Backaches
. Clumsiness
. Constipation, diarrhea, or urinary disorders
. Drowsiness and fatigue, or conversely, extra energy
. Food cravings, especially for sugary or salty foods
. Headaches, sometimes migraine
. Joint and muscle aches
. Hot flashes or nausea
. Insomnia
. Weight Gain
. Fluid Retention

Emotional Symptoms
. Mood Swings
. Anxiety
. Depression
. Irritability
. Nervousness
. Tension
. Mental confusion

A very small number of women with premenstrual syndrome may experience more intense symptoms:
· Fits of crying
· Panic attacks
· Suicidal thoughts
· Aggressive or violent behavior

Dietary & Natural Solutions

Avoid Sugar, alcohol, and caffeine all increase the risk of PMS. It is known that women who eat more food with high sugar tend to have an increased risk of PMS. Alcohol can affect hormone metabolism, and alcoholic women are more likely to suffer PMS than are non-alcoholic women. Caffeine also increases the risk of PMS.

In a study of Chinese women, increased tea consumption was associated with increased prevalence of PMS. Another study done on a group of college students in the United States came up with the conclusion that consumption of caffeine-containing beverages was associated with increases in both the prevalence and the severity of PMS. One last study showed that the more caffeine women consumed, the more likely they were to suffer from PMS. Due to this, many nutritionally oriented doctors recommend that women with PMS avoid sugar (including honey, syrup, and "-ose" additives like fructose or sucrose), alcohol, and caffeine (in coffee, chocolate, and cola drinks).

Several studies suggest that diets low in fat or high in fiber may help to reduce symptoms of PMS. Many nutritionally oriented doctors recommend diets very low in meat and dairy fat and high in fruit, vegetables, and whole grains.

Think Water
Keeping well hydrated during the hot summer months is a simple and effective self-help method for women with PMS according to Clinical Pharmacist, Marla Ahlgrimm, R.Ph, and founder of PMS Access a national PMS resource center. "When the weather heats up, we water our lawns and gardens regularly. Replenishing our own bodies water supply is just as important," Ahlgrimm explained. "Often women with PMS avoid drinking an abundance of water because water retention is such a common PMS symptom. Drinking lots of water (at least six to eight glasses a day) helps flush the body out and actually reduces premenstrual bloating .

Exercise
Women with PMS who jogged an average of about twelve miles a week for six months experienced a reduction in breast tenderness, fluid retention, depression, and stress. Some nutritionally oriented doctors suggest 20 to 30 minutes of sustained aerobic activity five days a week. Besides giving a sense of strength, well-being, and increasing the flow of oxygen to all organs, exercise helps to regulate hormone levels.

Nutritional Supplements That May Help

Calcium
Calcium supplementation of 1200-1600 mg/day, unless contraindicated, is considered a sound treatment option in women who experience premenstrual syndrome. Evidence suggests that PMS represents the clinical manifestation of a calcium deficiency state that is unmasked following the rise of ovarian steroid hormone concentrations during the menstrual cycle.

Women who suffer mood swings and discomfort from premenstrual syndrome (PMS) may find relief simply by taking a few calcium supplements each day, according to a study published in the American Journal of Obstetrics and Gynecology.

Dr. Susan Thys-Jacobs and her team of researchers from St. Luke's Roosevelt Hospital in New York conducted a study in which 466 women ages 18 to 45 participated. All experienced symptoms of PMS before the study. For three menstrual cycles, about half the women took two Tums E-X chewable tablets twice each day, which gave them 1,200 mg of calcium a day. The others took dummy pills. Starting with the second menstrual cycle, those who took the calcium supplements experienced progressively less moodiness, water retention, food cravings, headaches, and low back pain. By the end of the study, the calcium supplements had cut these PMS symptoms by almost half, compared with a 30 percent reduction in the women taking dummy pills. Antidepressants, like Prozac, are used to treat severe mood swings of PMS, but don't help the physical symptoms .

The optimum dose of calcium for reducing PMS symptoms is not completely clear, but the study by Thys-Jacobs suggests that 1,200 mg daily is appropriate. Since the body can't absorb more than about 500 mg at a time, divide your daily calcium into several doses.

Calcium comes in many forms, each with its own pros and cons. Calcium citrate is the best absorbed but is the most expensive. Calcium carbonate, the form used in the Thys-Jacob's study is one of the most inexpensive and convenient forms. However, some women have trouble absorbing it. Taking it with meals should help. Calcium supplements from bone meal and oyster shell are also inexpensive, but may contain lead.

Taking vitamin D supplements at 400 IU daily, with your daily calcium, has been shown to enhance absorption.

Magnesium, Zinc and Vitamin C
Magnesium is a critical mineral that regulates muscle and nerve function. Supplementation of magnesium has been shown to improve the management of PMS. Dr. G. Abraham, a Los Angeles physician, measured the level of magnesium in the blood of women with PMS and found that low levels are associated with symptoms. , He found that many drugs deplete the body of magnesium and zinc, including oral contraceptives and diuretics. Excess copper, calcium and iron intake can also cause a depletion of these essential nutrients. Vitamin C is critical to stress adaptation. Dr. Abraham demonstrated that women with symptoms of headaches, dizziness, and craving for sweets responded to magnesium, zinc, niacin, and vitamin C supplementation. ,

A study of 40 women from the University of Reading in the U.K. found that those suffering from PMS-related symptoms of fluid retention (bloating, weight gain, breast tenderness) might benefit from 200 mg of of magnesium oxide daily. After two menstrual cycles, those taking magnesium had a significant reduction of symptoms compared with those taking a placebo .

Preliminary double-blind trials also suggest that magnesium may be useful for dysmenorrhea (menstrual cramps) , and other symptoms of PMS, including menstrual migraines.

Vitamin B6
Dr Katrina Wyatt and colleagues from North Staffordshire Hospital along with Keele University reviewed nine published trials representing 940 women with premenstrual syndrome and found evidence to suggest that 100mg of vitamin B-6 daily was more than two times more effective than a placebo treatment.

Research suggests that magnesium works synergistically with Vitamin B6 to relieve anxiety related PMS symptoms. In a cross over double-blind study combining magnesium with B6, 44 women were given 200 mg of magnesium and 50 mg of B6. After one month most of the women had relief from anxiety related premenstrual symptoms. De Souza MC, et al. leader of the study says " a synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 can be used for the relief of anxiety-related premenstrual symptoms" .

Vitamin E
Three double-blind studies performed by the same researcher suggest that vitamin E may improve many symptoms of PMS, though the evidence is conflicting. The largest of these studies was a double-blind trial that followed 75 women between ages 18 and 45. Participants were randomly assigned to either a placebo or doses of vitamin E at 150, 300, or 600 IU per day. The study found that vitamin E (at all doses) was more effective than the placebo in relieving mood swings, irritability, nervous tension, anxiety, headaches, fatigue, appetite disturbances, dizziness, depression, crying, and insomnia.

Herbal Formulations

St. John's Wort/Hypericum perforatum
St. John's Wort is best known as an herbal remedy used to alleviate the symptoms of depression. Now, British researchers report that it may also help symptoms of premenstrual syndrome (PMS), such as nervous tension, anxiety, "feeling out of control" and insomnia.

"Our study was a pilot study aimed at finding out whether St. John's Wort might reduce the symptoms of PMS and whether a larger, more rigorous, controlled trial is worth doing," said Dr. Edzard Ernst of the University of Exeter, UK, in an interview with Reuters Health. "This question can now be answered with "Yes."

In a 4-month study of 19 women diagnosed with PMS symptoms, the women were required to fill out a daily symptoms report and complete various standardized psychological tests to rate their emotional and physical state. The study participants were then given a 2-month supply of St. John's Wort tablets. The daily dose was 300 milligrams of hypericin, the active ingredient in the dietary supplement. During months three and four of the study, the women continued to fill out the daily symptoms reports and returned to the clinic for a follow-up examination, which included retaking the psychological tests. Treatment with St. John's Wort for two menstrual cycles resulted in a 50% reduction in severity of symptoms. Some of the individual symptoms, such as nervous tension, insomnia, crying and depression, showed large reductions in severity.

"At the moment, all I would say to PMS patients is that St. John's Wort is perhaps worth a try. If depression is an element of PMS in an individual case, this would be a stronger reason to try it," Ernst told Reuters Health. "Finally, it is important to know that St. John's Wort interacts with prescribed drugs. "If anyone takes other drugs, I would not take it concomitantly, that is, at the same time," Ernst added.

The typical dose is 300mg three times per day, standardized to contain 0.3-0.5% hypericin and/or 3-5% hyperforin per dose. A minimum of 4-6 weeks of therapy is necessary to see results.

Evening Primrose Oil
Evening primrose oil contains Gamma Linoic Acid or GLA. GLA is a hormone precursor and has been shown to improve the symptoms of some inflammatory conditions. It is used for a number of women's problems and has become a standard treatment for cyclic mastalgia and breast pain that cycles with the menstrual period. It is widely used for this purpose by conventional physicians in both Europe and North America, and as a mark of its acceptance it is even mentioned in the AMA's official Drug Evaluations textbook.

At the American Pharmaceutical Associations' (APHA) Annual Conference, Dr. Mary L. Hardy, medical director of the Cedars-Sinai Integrative Medicine Medical Group in Los Angeles, California said that physicians and pharmacists need to understand and utilize the medicinal power of herbs, especially for premenstrual syndrome. Hardy cited findings evaluating the efficacy of Evening Primrose Oil from a number of clinical studies.

Dr Hardy and her investigators reported that the level of GLA were low in PMS patients, and postulated that "PMS is associated with a defect in the conversion of linoleic acid to Gamma Linolenic Acid. "This problem that can be helped by taking Evening Primrose Oil." Many other studies have proved this too .

The standard dose is 500mg per day, standardized to contain 8-9% Gamma Linoic Acid and at least 72% linoic acid per dose.

Caution: Do not take this with anticonvulsants or if you have a seizure disorder. Do not take with antipsychotic medications, blood thinners. Discontinue use 2 weeks before surgery.

Vitex/Chaste Berry
Vitex is an herbal remedy used for a variety of women's problems including PMS. It has been shown to help reestablish normal balance of estrogen and progesterone levels during a woman's menstrual cycle. This is important because some women suffer from PMS and other menstrual irregularities due to the underproduction of the hormone progesterone during the second half of their cycle. Vitex stimulates the pituitary gland to produce more luteinizing hormone, which leads to greater a production of progesterone. Studies have shown that using Vitex once in the morning over a period of several months helps normalize hormone balance to alleviate the symptoms of PMS.

Dr. Mary Hardy, medical director of the Cedars-Sinai Integrative Medicine Medical Group in Los Angeles reported a study that revealed that Vitex may affect levels of hormones that influence the menstrual cycle, reducing the symptoms of PMS. "Chaste Tree Berry was cited by Hippocrates as being of benefit on the effects of female reproduction and now we are finding clinical evidence that he was right," .

In a double- blind study done on women with PMS. Vitex has been shown to be as effective as 200 mg of vitamin B6. The usual dose is 400mg standardized to contain 0.5% agnuside and 0.6% aucubin per dose, per day.

Caution: This herb may interact with hormone replacement therapy, oral contraceptives, and dopamine agonists.

Dong Quai
Dong Quai (Angelica sinensis) is often referred to as the "female ginseng." Dong Quai has been used for thousands of years to treat menstrual problems such as PMS and relieve menopausal symptoms such as hot flashes. Dong Quai helps promote normal hormone balance and is particularly useful for women experiencing premenstrual cramping and pain. Many women take 2-3 grams of Dong Quai capsules or tablets per day to help alleviate these cramps.

Modern herbalists commonly recommend Dong Quai as a uterine tonic to treat irregular menstrual flow and weakness during menstrual periods. As an antispasmodic it is considered a remedy for menstrual cramps and nervousness. It is also said to purify the blood and act as a mild laxative.

Dr. Mary Hardy, at the American Pharmaceutical Associations (APHA) annual conference also discussed Dong Quai, saying significant amounts of vitamin B12 are found in their roots, and are very beneficial for anemia and PMS. .

Standard dose is 200 mg. twice per day, standardized to contain 0.8% to 1.1% ligustilide per dose.

Caution: May interfere with blood thinners, hormone replacement therapy, oral contraceptives and antihypertensive medications. May cause photosensitivity

For more information about our PMS products click below:

Maxi Premium Primrose - Evening primrose with borage oil

Mag 6 - Magnesium with vitamin B6

Cal Max 1000 - Calcium citrate with magnesium, vitamin D and boron

Circu E 400 - Natural vitamin E (all succinate) with other enhancing nutrients

Maxi SJW - Standardized st johns wort with rosemary and spirulina

*The information provided is for educational purposes only. These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, prevent or cure any disease or condition.

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