PMS

Many women experience a variety of unpleasant symptoms in the week or two before menstruating. These include irritability, anger, headaches, anxiety, depression, fatigue, fluid retention, and breast tenderness. These symptoms undoubtedly result from hormonal changes of the menstrual cycle, but we dont know the cause of PMS or exactly how to treat it.
Conventional treatments include antidepressants, antianxiety drugs, beta-blockers, diuretics, oral contraceptives, and other hormonally active formulations. None of these treatments is entirely effective except for those that take the drastic step of inducing artificial menopause.

Principal Proposed Treatments for PMS

There is fairly good evidence that calcium supplements can significantly reduce all the major symptoms of PMS. There is also some evidence that the herbs chasteberry and ginkgo can lessen the symptoms of PMS. Vitamin B6 is widely recommended as well, but its scientific record is mixed at best.

Calcium: May Improve All Symptoms of PMS

A recent study found surprisingly positive results using calcium (1,200 mg daily) for the treatment of PMS symptoms. These results have made a big impact because the study was large (about 500 women) and was performed at a prestigious medical center, Columbia University.1

Participants took 300 mg of calcium (as calcium carbonate) 4 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.

For more information, including dosage and safety issues, see the full calcium article.

Chasteberry: Especially Effective for Breast Tenderness

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 names: Vitex or Vitexagnus-castus. A shrub in the verbena family, chasteberry is commonly found on riverbanks and nearby foothills in central Asia and around the Mediterranean Sea. After its violet flowers have bloomed, a dark brown, peppercorn-size fruit develops, with a pleasant odor reminiscent of peppermint. It is the fruit that is used medicinally.

The modern use of chasteberry dates back to the 1950s, when the German pharmaceutical firm Madaus Company first produced a standardized extract. It has become a standard European treatment for PMS, cyclical breast tenderness, and menstrual irregularities.

Chasteberry is believed to work by suppressing the release of prolactin from the pituitary gland. Prolactin is a hormone that naturally rises during pregnancy to stimulate milk production and other physiological changes. Prolactin may also play a role in cyclic breast pain.

What Is the Scientific Evidence for Chasteberry?

A double-blind placebo-controlled study of 178 women found that treatment with chasteberry over three menstrual cycles significantly reduced PMS symptoms. The dose used was one tablet 3 times daily of a chasteberry dry extract. Women in the treatment group experienced significant improvements in symptoms, including irritability, depression, headache, and breast tenderness.

Unfortunately, there is little corroborating evidence as yet for this one well-designed study. A previous 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 (see the following discussion under the heading Vitamin B6: May Not Be Effective).

Two other studies are often cited in support of chasteberry as a treatment for PMS. These were rather informal reports of a total of about 3,000 women with PMS given chasteberry by their physicians. The physicians rated chasteberry as effective about 90% of the time, but in the absence of a control group, these reports are not very meaningful.

There is good evidence that chasteberry can help the cyclic breast tenderness often, but not necessarily, connected with PMS. For more information, see the article on cyclic mastalgia.

For more information, including dosage and safety issues, see the full chasteberry article.

Vitamin B6: May Not Be Effective

Vitamin B6 has been used for PMS for many decades, by both European and U.S. physicians. However, the results of scientific studies are mixed at best. A recent, properly designed, double-blind study of 120 women found no benefit. In this study, three prescription drugs were compared against vitamin B6 (pyridoxine, at 300 mg daily) and placebo. All study participants received 3 months of treatment and 3 months of placebo. Vitamin B6 proved to be no better than placebo.

Approximately a dozen other double-blind studies have investigated the effectiveness of vitamin B6 for PMS, but none were well designed. Overall, the evidence for any benefit is weak at most. Some books on natural medicine report that the negative results in some of these studies were due to insufficient B6 dosage, but in reality there was no clear link between dosage and effectiveness.

For more information, including dosage and safety issues, see the full vitamin B6 article.

Preliminary evidence suggests that the combination of B6 and magnesium might be more effective than either treatment alone.

Other Proposed Treatments for PMS

Ginkgo: For Breast Tenderness and Other PMS Symptoms

One double-blind placebo-controlled study evaluated the benefits of Ginkgo biloba extract for women with PMS symptoms. This trial enrolled 143 women, 18 to 45 years of age, and followed them for two menstrual cycles. Each woman received either the ginkgo extract (80 mg twice daily) or placebo on day 16 of the first cycle. Treatment was continued until day 5 of the next cycle, and resumed again on day 16 of that cycle.

As compared to placebo, ginkgo significantly relieved major symptoms of PMS, especially breast pain and emotional disturbance.

For more information, including dosage and safety issues, see the full ginkgo article.

Magnesium

Preliminary studies suggest that magnesium may also be helpful in PMS. A double-blind placebo-controlled study of 32 women found that magnesium taken from day 15 of the menstrual cycle to the onset of menstrual flow could significantly improve premenstrual mood changes.

Another small double-blind preliminary study found that regular use of magnesium could reduce symptoms of PMS-related fluid retention. In this study, 38 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 (20 participants) found that magnesium supplementation might help prevent menstrual migraines.

For more information, including dosage and safety issues, see the full magnesium article.

As mentioned earlier, preliminary evidence suggests that combining vitamin B6 with magnesium might improve the results.

Vitamin E

Weak evidence suggests that vitamin E may be helpful for PMS. For more information, including dosage and safety issues, see the full vitamin E article.

Multivitamin and Mineral Supplements

Preliminary evidence suggests that combined treatment with a multivitamin and mineral supplement high in B6 and magnesium may be helpful in PMS.

GLA: Primarily for Cyclic Breast Tenderness

Evening primrose oil, a source of GLA, is used for the breast pain that often occurs with premenstrual syndrome called cyclic mastalgia. It may be helpful with other PMS symptoms as well, but the scientific evidence is weak.

For more information, including dosage and safety issues, see the full GLA article.

Additional Treatments

Progesterone cream is another method widely recommended for PMS, but there is little evidence that it is effective.31 Highly preliminary evidence suggests that St. Johns wort might be helpful for PMS.