General Description
Premenstrual syndrome (PMS), also known as premenstrual tension
syndrome, is a condition characterized by physical and psychological
abnormalities experienced by some women during the one to two week
period preceding menstruation. The condition involves a wide range
of symptoms, which vary in prevalence and severity. The most common
symptoms include water retention (bloating), depression, irritability,
breast tenderness, backache, cramps, food cravings (especially chocolate
and other sweets), headache, fatigue, and gastrointestinal disturbances
such as diarrhea or constipation. The cause of PMS remains controversial;
for decades, many doctors denied that the syndrome even existed,
believing the symptoms were imaginary, or "all in the head." Recent
research indicates that PMS results from a complex interaction of
hormonal and other biochemical factors, best described as an abnormal
reaction to normal hormonal changes during the menstrual cycle.1,2
Contributing factors
During the phase of the menstrual cycle that precedes menstruation,
natural changes occur in the production of certain hormones. Plasma
estrogen levels rise, and plasma progesterone levels decrease.
In most women, these hormonal fluctuations take place unnoticed,
but in some women they trigger a series of physical and psychological
symptoms known as PMS. Researchers are currently trying to determine
what makes some women but not others susceptible to PMS. Possibilities
include genetic differences in hormone sensitivity at the cellular
level, differences in history of other mood disorders, and individual
differences in serotonin function.2
Conventional Treatment
Because the underlying cause of PMS is unknown, treatments have
focused on alleviating individual symptoms: oral contraceptives
may be used to alter the hormonal profile; diuretics may help
reduce water retention, analgesics can relieve headaches and cramps;
and antidepressants can improve mood disturbances. Some women
experience relief with progesterone supplements,3-5
but some studies indicate that supplemental progesterone may be
no more effective than a placebo.6
Nutritional/lifestyle considerations
Several dietary and lifestyle factors can contribute to PMS or
influence the severity of symptoms. In some women, more severe
symptoms have been associated with consumption of alcohol, caffeine,
sugar, and chocolate.7-9 Reducing salt intake
can help control fluid retention. In some studies, consumption
of a low-fat diet reduced PMS symptoms.10,11
Other research suggests that PMS may be linked to deficiencies
in certain nutrients like magnesium,12-16
calcium,17 and vitamin B-6.15,16
Exercise can also have an influence on PMS. Studies have shown
that regular aerobic exercise can significantly reduce PMS symptoms
in some women.18-20
There are several herbs that have traditionally been used for
PMS, including dong quai, wild yam, evening primrose, chasteberry,
black cohosh, and many others. While most of these herbs lack
scientific research to support their use, some studies suggest
that evening primrose oil and chasteberry may be helpful for some
people.21,22 In three double-blind studies,
evening primrose oil (EPO) was shown to be superior to placebo
in improving symptoms such as depression and irritability, breast
tenderness, and fluid retention.23 However,
the results of another study conflict with these findings, showing
no significant difference between EPO and placebo.24
Germany's Commission E Monographs lists black cohosh as an approved
herb for treatment of premenstrual discomfort,25 and
the herb is used for this purpose throughout much of Europe. Some
herbalists also recommend "calming" herbs such as valerian and
chamomile to ease anxiety and promote relaxation. St.
John's wort is often recommended to promote emotional stability.
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