Premenstrual syndrome (PMS) is a recurrent condition in women, characterized by troublesome symptoms 7-14 days before menstruation. Typical symptoms include decreased energy levels, tension, irritability, depression, headache, altered sex drive, breast pain, backache, abdominal bloating, and edema of the fingers and ankles. Severe PMS, with depression, irritability and extreme mood swings, is referred to as premenstrual dysphoric disorder.

For many years it was commonly believed that elevated estrogen levels and reduced progesterone levels 5-10 days before the menses were responsible for PMS. However, this finding is no longer consistent. The dominant thought now is that rather than alterations in estrogen and progesterone levels in the blood, PMS is the result of alterations in brain chemistry that influences many factors, including the sensitivity of the brain to hormones. The chief factor that is most often promoted as the underlying issue in PMS is lower levels of the neurotransmitter serotonin. Because of this, recent research is showing that many natural antidepressant agents can also have benefits for PMS.

Natural relief with diet and dietary supplements
Here are a few ways to help ease PMS symptoms naturally.

Eat less meat, more veggies
Reduce or eliminate the amount of animal products in the diet, and increase consumption of fiber-rich plant foods, including fruits, vegetables, grains and legumes. Vegetarian women have been shown to excrete 2-3 times more estrogen in their feces and have 50 percent lower levels of free estrogen in their blood than omnivores. These differences are thought to be a result of the lower fat and higher fiber intake of vegetarians.

Reduce or eliminate caffeine consumption
Considerable evidence suggests that caffeine consumption is strongly related to the presence and severity of PMS. The effect of caffeine is particularly significant in the psychological symptoms associated with PMS, such as anxiety, irritability, insomnia and depression. It can also increase breast tenderness and fibrocystic breast disease, as caffeine has an adverse effect on the way estrogen stimulates breast tissue.

Eat more soy
There is evidence that phytoestrogens may exert a balancing effect when estrogen levels are high as is commonly seen in PMS. The consumption of soy foods is the most economical, and possibly the most beneficial, way to increase the intake of phytoestrogens.

Cut back on salt
Excessive salt consumption, coupled with diminished dietary potassium, greatly stresses the kidneys’ ability to maintain proper fluid volume. As a result, some people are “salt-sensitive,” in that high salt intake causes high blood pressure or, in other cases, water retention. In general, it’s a good idea to avoid salt if you experience PMS.

Supplement the diet with these key nutrients
Vitamin B6 supplementation has been shown to exert positive effects on all PMS symptoms (particularly depression) in many women. Vitamin B6 also has an effect on the metabolism of estrogen. Yams, leafy green vegetables and legumes are all high in vitamin B6. In most situations, the therapeutic dosage of 50 to 100 mg per day is generally regarded as safe, even for long-term use.
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Magnesium deficiency is strongly implicated as a causative factor in PMS. Red blood cell magnesium levels in PMS patients have been shown to be significantly lower than in normal subjects. Since magnesium plays such an integral part in normal cell function, magnesium deficiency may account for the wide range of symptoms attributed to PMS. Several studies have shown that when PMS patients are given a multivitamin-and-mineral supplement containing high doses of magnesium and pyridoxine, they experience a tremendous reduction in PMS symptoms. The recommended range of magnesium is 300 to 450 mg daily.

supplementation has produced significant improvements in PMS symptoms in double-blind studies. It is theorized that calcium improves the altered hormonal patterns, neurotransmitter levels and smooth muscle responsiveness noted in PMS. Further support for the importance of calcium supplementation in treating PMS was the finding that women with PMS have reduced bone mineral density. The recommended dosage for calcium in PMS cases is 1,000 to 1,500 mg daily.
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Zinc levels have been shown to be lower in women who have PMS. Zinc is required for proper action of many body hormones, including sex hormones, as well as in the control of the secretion of hormones. The suggested range for zinc supplementation is 15 to 20 mg.
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Chasteberry (Vitex agnus-castus) extract appears quite helpful in relieving PMS. In two surveys of gynecological practices in Germany, physicians graded chasteberry extract as good or very good in the treatment of PMS. More than 1,500 women participated in studies of chasteberry; one-third of them experienced complete resolution of their symptoms, while another 57 percent reported significant improvement and 90 percent reported improvement or resolution. Chasteberry extract appears to be particularly useful in cases of corpus luteum insufficiency, or prolactin excess. The usual amount of chasteberry extract to take (often standardized to contain 0.5 percent agnuside) in tablet or capsule form is 175 to 225 mg per day. If you are using the liquid extract, the typical amount is 2 ml per day.
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Ginkgo biloba extract (GBE) is well known for its effects in improving blood flow to the brain, and has also been shown to be of great benefit in PMS in several clinical trials. It not only improves psychological complaints of PMS, it also improves some of the physical issues. In the August 2009 issue of the Journal of Alternative and Complementary Medicine, results from a double-blind study of 165 women with PMS showed that those who took GBE at 80 mg twice daily on certain days of their cycles showed considerable benefit. Symptom diaries kept by patients and physician evaluation of symptoms demonstrated that GBE was particularly effective in relieving the breast pain and tenderness that some women with PMS experience.
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What about serotonin?
While it is becoming increasingly popular for doctors to prescribe antidepressant serotonin reuptake inhibitor drugs like Prozac, Zoloft, Paxil and their generic forms to raise serotonin levels, these drugs carry with them significant concerns about side effects (including weight gain). Several natural alternatives have been shown to offer comparable benefits with a better side effects profile. For example, the amino acid 5-hydroxytryptophan (5-HTP) is available as a dietary supplement and is converted in the brain to 5-HTP, as 5-HTP is a step closer to serotonin. My recommendation for PMS sufferers is to take 50 to 100 mg of 5-HTP 20 minutes before meals from day 17 of their cycle to day 3 of menses. If they suffer from low mood or sugar cravings throughout the month, then I recommend it throughout the month as well.
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Michael T. Murray, N.D., is chair of Pharmaca’s Integrative Health Advisory Board. Dr. Murray is widely regarded as one of the world’s leading authorities on natural medicine. He has written more than 30 books and numerous articles for major publications; appeared on 100s of radio and TV programs; and lectured to hundreds of thousands of people nationwide. He is a graduate and faculty member of Bastyr University and now serves on their Board of Regents.