Premenstrual Syndrome (PMS) - we know it’s common, but that doesn’t make it normal. It pains me to know that as much as 85% of menstruating women report having one or more PMS symptoms and that 7% of those suffer from symptoms so bad that it affects their daily function.
What is PMS?
PMS is classified as the physical and psychological symptoms felt during the luteal (post ovulatory) phase of the menstrual cycle that are relieved within a few days of menstruation. The American College of Obstetricians and Gynaecologists (ACOG) provides specific criteria for PMS, including one physical or psychological symptom in the five days prior to menses, which interfere with some normal activities, for at least three menstrual cycles. These symptoms must subside within four days after the onset of menstruation.
There are up to 150 symptoms that have been associated with PMS, the underlying causes for these are multifaceted and likely differ from person to person. The most common symptoms include, but aren’t limited to:
The psychological such as irritability, anger, depression, anxiety, tension, decreased self-esteem and forgetfulness.
The physiological such as headaches, breast tenderness, cramping, abdominal pain and bloating, fluid retention, change in bowel motions and fatigue.
Of those women successfully combating their PMS symptoms, dietary and nutritional supplementation, alongside exercise are reported to be the most effective.
So here I share what helps my clients achieve the best results in clinic:
Real Food
This means limiting or entirely avoiding processed carbohydrates and instead prioritising non-starchy vegetables, healthy fats and proteins. Although carbohydrate cravings are commonly experienced pre-period, females aren’t as insulin sensitive in the luteal phase of the cycle which means carbohydrate tolerance is lower. While chocolate and cake may feel good in the moment, nourishing the body with plenty of fibre and satiating fats and proteins will help to get you off the blood sugar rollercoaster which by the way, is the cause of your cravings.
Magnesium
If there was a superhero whose job was to free the world of PMS, magnesium would have to be it. It has the power to influence cravings, mood, sleep quality, fluid retention, changes in bowel motions and anxiety.
Evidence shows that magnesium deficiency (which is relatively common) may contribute to PMS symptoms evidenced by women experiencing an improvement in symptoms, particularly low mood and anxiety, following supplementation with 250mg/day for two months.
It’s also very helpful for those who have trouble sleeping as a result of their PMS. At a slightly higher dose of 500mg/day, magnesium has been shown to significantly decrease serum cortisol levels within hours of sleep initiation, resulting in increased slow wave sleep.
The combination of magnesium and B6 appears to offer more benefit, which is why they can often be found together.
Taurine
If the superhero in this story was Batman, Taurine would be Robin. It’s an amino acid and it works beautifully alongside Magnesium to create a sense of calm, improve sleep, improve insulin sensitivity and boost haemoglobin. For many women it would be enough to free them of the hormonally driven cravings, irritability, headaches, low energy and poor-quality sleep.
Dietary sources of Taurine include meat, fish and dairy. It is not present in plant foods. Between 500 – 3000mg / day is considered a therapeutic dose. I typically look for a magnesium, B6 and taurine blend that offers 3000mg (3g) of taurine.
Omega-3 Fatty Acids
Essential fatty acids EPA and DHA are naturally found in oily fish including salmon, trout, sardines and mackerel. Research done on the administration of Omega-3 over a 6 month period has shown that it can create statistically significant reductions in PMS symptoms – while improvements do appear after 3 months they improve further with time. In another study, 1g of EPA/DHA daily was shown to be better at targeting PMS associated pain than ibuprofen. I recommend 1g/day of an EPA/DHA supplement that is either fish or algal oil based.
Zinc
Naturally found in many foods including oysters, meat, offal and seeds. Zinc is an essential cofactor for more than 200 enzymes which means it’s essential for many areas of women’s health and can be particularly helpful with certain PMS symptoms. It’s important for the metabolism of neurotransmitters, it has huge antioxidant capacity and levels do drop in the luteal phase of the menstrual cycle, hence why supplementation can be beneficial. I particularly like to use it when premenstrual break outs are a concern. Therapeutic doses of 25 – 50mg may be required for effect to be noticed.
As stated, the underlying causes for PMS are multifaceted which means while the above will help in many cases it may not help in all. When it doesn’t help, I recommend screening serum vitamin D, TSH, T3, T4, RT3, iron studies, CRP and fasting insulin to understand if these are the cause (or contributor) to PMS like symptoms.
If you need one on one support, in 2022 I am offering a 'Healthy Hormones' program. Please get in touch and you'll be the first to know when bookings are available. Ready to get started now? You can book a complimentary 15-minute consultation.
References:
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Held K, Antonijevic IA, Künzel H, et al. Oral Mg(2+) supplementation reverses age-related neuroendocrine and sleep EEG changes in humans. Pharmacopsychiatry. 2002;35(4):135-143. doi:10.1055/s-2002-33195
Campbell EM, Peterkin D, O'Grady K, Sanson-Fisher R. Premenstrual symptoms in general practice patients. Prevalence and treatment. J Reprod Med. 1997;42(10):637-646. doi: 10.1055/s-2002-33195
Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010;15(Suppl 1):401-405.
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H Osiecki: The nutrient bible. 6th ed 2004 Bioconcepts Publishing Eagle Farm, QLD
Fathizadeh S, Amani R, Haghighizadeh MH, Hormozi R. Comparison of serum zinc concentrations and body antioxidant status between young women with premenstrual syndrome and normal controls: A case-control study. Int J Reprod Biomed. 2016;14(11):699-704.