4 Self-Help Strategies for PMS

Perhaps some 90% of women have symptoms that indicate that their menstrual period is due to arrive. About 60% of those women will indicate that their premenstrual symptoms are troublesome. Nearly all cultures have a set of physical or mood symptoms which are attributed to being "premenstrual". Interestingly, this set of common symptoms varies from culture to culture. Studies done with the US subjects suggest that the "American Top Ten" of bothersome premenstrual symptoms include:

1. Irritability
2. Mood swings
3. Swelling of abdomen/breasts
4. Restlessness
5. Tension
6. Depression
7. Anxiety
8. painful breasts
9. Decreased concentration
10. Forgetfulness
    

The first approach to improving premenstrual symptoms is a trial of "lifestyle" and non-prescription treatments. Which of these is most likely to benefit you?

EXERCISE

Stanley (1989), in a study of exercise and PMS symptom relief, found that women should start to obtain some symptom improvement from as little as: 110 minutes/week of swimming, 70 minutes/week of aerobic dance, or 50 minutes/week of jogging. You will note that aerobic exercise seems to dominate the list. The effectiveness of aerobic exercise was confirmed in a study of women with documented PMS (Steege, 1993). The women were randomly assigned into either aerobic or weight training groups. The aerobic exercise group showed the best symptom relief.

SUPPLEMENTS

Several well designed studies have suggested that an increased daily intake of vitamin D to 800 IU/day, accompanied by an increased intake of dietary calcium to 1200 mg/day may prevent PMS symptoms (Bertone-Johnson, 2005). ThysJacobs (1998) treated women with documented PMS using 1200 mg of calcium carbonate daily to gain significant reductions in mood symptoms, pain, fluid retention, and food cravings.

Magnesium supplementation has also been studied (Facchineti, 1997). Taking up to 360 mg of magnesium daily from cycle day 15 until flow has been found to decrease negative moods when compared to a placebo/sugar pill (Facchineti, 1991).

Vitamin B6 is a cofactor in the formation of serotonin, a neurotransmitter that figures prominently in studies of severe mood swings and depression. Without adequate Vitamin B6 less serotonin can be converted from the essential amino acid tryptophan. The RDA for vitamin B6 is 2mg/day, yet PMS studies have used doses ranging from 50-800 mg/day. For treatment of premenstrual mood swings, irritability and depression doses should be no more than 300 mg/day. Reversible nerve injury has been reported at higher doses.

DIET

Studies have shown that women with PMS crave carbohydrates. In animal models increased carbohydrate intake causes increased release of serotonin, that neurotransmitter in the brain which prompts feelings of improved mood. It has been theorized that women with PMS may be attempting to self medicate for their down moods by increased cravings for starches and sweets. Yet simple sugars can cause the body to release additional insulin, so it is recommended that "complex carbohydrates" be consumed instead. The use of whole grain bread and cereal products can be part of a morning or lunch meal. Legumes in the form of lentils, split peas, or beans can help buffer blood sugar. Think bean burritos on a whole grain tortilla...or lentil soup with a whole wheat bagel plus low fat cheese.

The recommendations to decrease intake of caffeine, alcohol, and salt are based upon much less rigorous science. Early studies in the US (1985) and China (1989) found that increased PMS symptoms were linked to as little as one cup of caffeine beverage per day. Women given an intravenous dose of alcohol were noted to have decreased tolerance for alcohol effects in the premenstrual week, as opposed to their postmenstrual week. The average American diet can contain as many as 8,000-9,000 mg of sodium per day. For women with salt sensitive fluid retention, restricting salt intake to less than 2,000 mg per day may be helpful. Take a look at you favorite snack foods, even among the low fat variety there can be considerable sodium content.

COMPLEMENTARY & ALTERNATIVE TREATMENTS

With an increased interest in "alternative therapies" some researchers have chosen to study herbal, or body work therapies for common premenstrual symptoms.

• Soy isoflavones (68 mg/day) may be helpful for breast tenderness, abdominal bloating, cramps and headaches (Bryant, 2005).
  
• Chasteberry (in the form of Vitex agnus castus extract, 20 mg daily) was found to be more effective than placebo for the relief of mood swings, headache, breast tenderness, and bloating (Schellenberg, 2001).
  
• Ginko biloba (80 mg twice a day from cycle day 15) was most successful in treating breast pain. (Tamborini, 1993).
  
• The only study utilizing St. Johns Wort (900 mg/day in divided doses) for anxiety and depression showed benefit. However, it was evaluated in only 19 women—all of whom knew they were getting the real herb treatment.

Ear, hand, and foot reflexology demonstrated improvement in premenstrual symptoms (Oleson & Flocco, 1993), as did one which utilized nine sessions of Qi therapy (Jang, 2004). Acupuncture on the outer part of the ear decreased cramps, nervousness, food cravings and other premenstrual problems (Gerhard, 1992).

WHEN TO SEEK PROFESSIONAL INPUT

If your symptoms have not responded to self help measures then it is time to see your GYN, or clinic, for some additional evaluations. There may be an underlying medical disorder (e.g., thyroid disease, depression, anemia, atypical migraines, etc) which is responsible for low grade symptoms which are worsened during the premenstrual week.

When symptoms are determined to be PMDD (Premenstrual Dysphoric Disorder) there are numerous prescriptive medication options. While PMDD has a greater emphasis on the mood symptoms of "PMS", if a woman is having marked physical symptoms she might be tried on drugs to target her specific physical concerns such as bloating or severe headache.

The most important take home message: If premenstrual symptoms are bad enough to impair your relationships or quality of life then it is time to take action. Try the self help strategies first. If those do not provide enough relief then your GYN provider may be able to help.