Pre-menstrual syndrome (PMS) is a common and distressing problem affecting as many as one in two women. More than 150 symptoms have been described as forming part of the PMS complex which, for diagnosis, should start within the two weeks before a period and cease promptly when bleeding occurs.
Symptoms of PMS tend to fall into one of four main groups, although symptoms often overlap. These are: PMS-A, whose main symptoms are: Anxiety, irritability and insomnia PMS-C, with sugar Cravings, increased appetite, headache and fatigue PMS-D, with Depression, forgetfulness and confusion PMS-H (for Hyper-hydration), with fluid retention, weight gain, bloating and breast tenderness.
PMS-A and PMS-H are the most common types.
Diet
The exact cause of PMS is unknown, but it seems to be linked to an imbalance between the two female hormones, oestrogen and progesterone. Some researchers believe that the progesterone hormone cannot bind properly to cell receptors when blood glucose levels are low.
Nibbling regular carbohydrate snacks raises blood glucose levels and helps progesterone bind to cells so it can work properly. In one trial, in which women with PMS ate starchy foods (eg bread, rice cakes, digestive biscuits, wholegrain cereals) every three hours from waking up until going to bed, more than 50 per cent gained relief from symptoms, while a further 20 per cent experienced some improvement. Dietary changes alone, with no additional medication, gave full relief of severe PMS symptoms in 19 per cent of sufferers. Other dietary changes that can help include:
Following a wholefood – and preferably organic – diet with as little pre-packaged, convenience foods and additives as possible Eating more nuts, seeds and fish – especially oily fish (eg mackerel, salmon, herrings, sardines, pilchards), which include the essential fatty acids required for optimum hormone balance Cutting down on salt intake to reduce fluid retention Cutting back on alcohol and caffeine to reduce irritability and depression
Supplements
A variety of supplements can help relieve symptoms of PMS, but none are consistently helpful for all women. Most seem to provide benefit for two out of three women with PMS and need to be taken for three months to assess the full benefits.
Magnesium is a mineral needed to help stabilise blood sugar levels. It interacts with vitamin B6 to help reduce the effects of excess oestrogen, and with zinc to regulate the way sex hormones activate certain genes. Magnesium supplements can reduce symptoms of irritability, depression, anxiety/tension, bloating, tiredness and headaches. Magnesium also acts as a muscle relaxant and can reduce the painful periods associated with PMS.
Vitamin B6 helps to reduce the effects of excess oestrogen and seems to be most beneficial for the fatigue and emotional symptoms of PMS such as depression and irritability.
Vitamin D and calcium appear to reduce headaches, negative emotions, fluid retention and pain. Each supplement tends to help around two out of three women, but must be taken for at least three months to assess the effect.
Evening primrose oil is especially helpful in reducing low mood, sugar cravings and breast pain linked with PMS. It contains hormone building blocks that help to even out hormonal imbalances, but needs to be taken at doses of up to 3g a day for at least three months before an effect may be noticed.
Agnus castus is one of the most popular herbal remedies for PMS as it is believed to have a progesterone-like action in the body. Although it is slow-acting, it can relieve a variety of physical and emotional PMS symptoms. A recent randomised, placebo controlled trial of 170 women found that Agnus castus extracts significantly reduced irritability, mood changes, headache and breast fullness.
A pilot study involving 25 women with severe PMS found St John's Wort effective in reducing the incidence of crying, low mood and nervous tension.
Extracts from the herbs horsetail (Equisetum arvense) and dandelion (Taraxacum officinale) have a diuretic action to improve pre-menstrual bloating and fluid retention.
Wild yam cream is another popular treatment, but it is important to know that those described as containing "natural progesterone" contain a progesterone hormone that has been synthesised in the laboratory from building blocks found in wild yam. It is therefore a form of hormone replacement therapy rather than a herbal product. The word “natural” on the label refers to the fact that the progesterone is “nature identical” to that found in the human body.
If symptoms of PMS are severe, always seek medical advice.
