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Don't Let PMS Symptoms Slow You Down

Know your body and find your balance despite PMS. Because every woman is different, no single treatment effectively relieves all symptoms in all women. According to research or other evidence, the following self-care steps may be helpful:

  • Check out calcium and magnesium. A daily supplement of 1,000 to 1,200 mg of calcium and 200 to 400 mg of magnesium may reduce the risk of mood swings, bloating, headaches, and other symptoms.
  • Eat right. Emphasize low-fat, high-fiber foods and plenty of fruits and vegetables to improve hormone metabolism.
  • Stay active. Aim for regular aerobic exercise to help reduce symptoms.
  • Balance your body chemistry with vitex. 20 mg a day of a concentrated herbal extract for up to three months may help balance hormones.
  • Try vitamin B6. Take 100 to 200 mg per day regularly to help reduce symptoms

About premenstrual syndrome
Premenstrual syndrome (PMS) is a poorly understood complex of symptoms occurring a week to ten days before the start of each menstrual cycle. PMS is believed to be triggered by changes in progesterone and estrogen levels.

What are the symptoms?
Many premenopausal women suffer from symptoms of PMS at different points in their menstrual cycle. Symptoms include cramping, bloating, mood changes, and breast tenderness tied to the menstrual cycle.

Dietary changes that may be helpful
Women who eat more sugary foods have been reported to have an increased risk of PMS. Some doctors recommend that women with PMS cut back on sugar consumption for several months to see if it reduces their symptoms. However, no trials have yet to study the isolated effects of sugar restriction in women with PMS.

Alcohol can affect hormone metabolism, and alcoholic women are more likely to suffer PMS than are nonalcoholic women. Some doctors recommend that women with PMS avoid alcohol for several months to evaluate whether such a change will reduce symptoms.

In a study of Chinese women, increasing tea consumption was associated with increasing prevalence of PMS. Among a group of college students in the United States, consumption of caffeine-containing beverages was associated with increases in both the prevalence and severity of PMS. Moreover, the more caffeine women consumed, the more likely they were to suffer from PMS. A preliminary study showed that women with heavy caffeine consumption were more likely to have shorter menstrual periods and shorter cycle length compared with women who did not consume caffeine. Some doctors recommend that women with PMS avoid caffeine.

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

Lifestyle changes that may be helpful
Women with PMS who jogged an average of about 12 miles a week for six months were reported to experience a reduction in breast tenderness, fluid retention, depression, and stress. Doctors frequently recommend regular exercise as a way to reduce symptoms of PMS.

Vitamins that may be helpful
Many, though not all, clinical trials show that taking 50–400 mg of vitamin B6 per day for several months helps relieve symptoms of PMS. A composite analysis of the best designed controlled trials shows that vitamin B6 is more than twice as likely to reduce symptoms of PMS as is placebo. Many doctors suggest 100–400 mg per day for at least three months. However, intakes greater than 200 mg per day can cause side effects and should never be taken without the supervision of a healthcare professional.

Women who consume more calcium from their diets are less likely to suffer severe PMS. A large double-blind trial found that women who took 1,200 mg per day of calcium for three menstrual cycles had a 48% reduction in PMS symptoms, compared to a 30% reduction in the placebo group. Other double-blind trials have shown that supplementing with 1,000 mg of calcium per day relieves premenstrual symptoms.

Women with PMS have been shown to have impaired conversion of linoleic acid (an essential fatty acid) to gamma linolenic acid (GLA). Because a deficiency of GLA might, in theory, be a factor in PMS and because evening primrose oil (EPO) contains significant amounts of GLA, researchers have studied EPO as a potential way to reduce symptoms of PMS. In several double-blind trials, EPO was found to be beneficial, whereas in other trials it was no more effective than placebo. Despite these conflicting results, some doctors consider EPO to be worth a try; the amount usually recommended is 3–4 grams per day. EPO may work best when used over several menstrual cycles and may be more helpful in women with PMS who also experience breast tenderness or fibrocystic breast disease.

Women with PMS have been reported to be at increased risk of magnesium deficiency. Supplementing with magnesium may help reduce symptoms. In one double-blind trial using only 200 mg per day for two months, a significant reduction was reported for several symptoms related to PMS (fluid retention, weight gain, swelling of extremities, breast tenderness, and abdominal bloating). Magnesium has also been reported to be effective in reducing the symptoms of menstrual migraine headaches. While the ideal amount of magnesium has yet to be determined, some doctors recommend 400 mg per day. Effects of magnesium may begin to appear after two to three months.

A preliminary, uncontrolled trial found that women with severe PMS who took potassium supplements had complete resolution of PMS symptoms within four menstrual cycles. Most participants took 400 mg of potassium per day as potassium gluconate plus 200 mg of potassium per day as potassium chloride for the first two cycles, then switched to solely the gluconate form (600 mg potassium per day) for the remainder of the year-long trial. Without exception, all of the women found their symptoms (i.e., bloating, fatigue, irritability, etc.) decreasing gradually over three cycles and disappearing completely by the fourth cycle. Controlled trials are needed to confirm these preliminary observations.

Although women with PMS do not appear to be deficient in vitamin E, a double-blind trial reported that 300 IU of vitamin E per day may decrease symptoms of PMS.

Krill oil from Antarctic krill (a zooplankton crustacean) has been shown in a double-blind trial to be an effective treatment for premenstrual syndrome. Krill oil was significantly more effective than regular fish oil in relieving emotional symptoms and breast tenderness related to premenstrual syndrome. The amount of krill oil used in this study was 2 grams per day for the first month. In the second and third months the women took two grams per day beginning eight days prior to menstruation and continuing for two days after the start of menstruation.

Some of the nutrients mentioned above appear together in multivitamin-mineral supplements. One double-blind trial used a multivitamin-mineral supplement containing vitamin B6 (600 mg per day), magnesium (500 mg per day), vitamin E (200 IU per day), vitamin A (25,000 IU per day), B-complex vitamins, and various other vitamins and minerals. This supplement was found to relieve each of four different categories of PMS symptoms. Related results have been reported in other clinical trials.

Herbs that may be helpful
Vitex has been shown to help re-establish normal balance of estrogen and progesterone during the menstrual cycle. Vitex also blocks prolactin secretion in women with excessive levels of this hormone; excessive levels of prolactin can lead to breast tenderness and failure to ovulate. A double-blind trial has confirmed that vitex reduces mildly elevated levels of prolactin before a woman's period. Studies have shown that using vitex once in the morning over a period of several months helps normalize hormone balance and thus alleviate the symptoms of PMS. A preliminary trial and a double-blind trial have found that women taking 20 mg per day of a concentrated vitex extract for three menstrual cycles experience a significant reduction in symptoms of PMS.

Vitex has been shown to be as effective as 200 mg vitamin B6 in a double-blind trial of women with PMS. Two surveys examined 1,542 women with PMS who had taken a German liquid extract of vitex for their PMS symptoms for as long as 16 years. With an average intake of 42 drops per day, 92% of the women surveyed reported the effectiveness of vitex as "very good," "good," or "satisfactory."

Some healthcare practitioners recommend 40 drops of a liquid, concentrated vitex extract or one capsule of the equivalent dried, powdered extract once per day in the morning with some liquid. Vitex should be taken for at least four cycles to determine efficacy.


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