Premenstrual syndrome (PMS) is one of the major health issues for childbearing-age women, as both physical and psychological symptoms can affect health and quality of life.1 Epidemiological studies show that 75% of fertile women have mild to moderate symptoms of PMS; 3-8% may experience severe symptoms.1 Hormonal dysfunction can impact mood, sleep, and appetite and lead to symptoms such as anxiety, pain, hot flashes, and even memory impairment. How can Functional Medicine practitioners help patients with these concerns?
There’s no ‘one’ hormone involved in [PMS]—this is a complex dance and interaction between hormones.
– IFM Educator Margaret Christensen, MD
“What we want to do from a functional standpoint is address the actual underlying hormonal imbalances and triggers. Is it high stress hormones? That’s one of the number one contributors to PMS, and it is lack of things like sleep, lack of adequate nutrients like B vitamins and magnesium, which are critically important in hormonal balancing pathways,” says Dr. Christensen.
There are many treatments for PMS capable of bringing some physical relief, but most come with side effects. The Functional Medicine approach is to look first at lifestyle factors, including nutrition. Both calcium and magnesium have been shown to help by decreasing pain and alleviating the severity of PMS symptoms.1,2 Studies suggest that magnesium can attenuate anxiety, which is also associated with PMS.2 A 2017 systematic review of the effects of magnesium supplementation on anxiety and stress showed a positive role for magnesium supplementation in women reporting PMS symptoms, both in isolation and when combined with vitamin B6.2
Vitamin D is another nutrient reported to have beneficial effects on PMS. A 2018 study found that vitamin D supplementation was associated with a reduction in the incidence of several symptoms of PMS in adolescent women, such as backaches and fluctuations in mood, as well as a decrement in pain severity.3 A meta-analysis concluded that vitamin D supplementation “was effective in ameliorating PMS symptoms.”4 Another study focused on adolescents who were known to be low in vitamin D, and supplementation over four months led to improvements in PMS-related symptoms like irritability, crying easily, and disturbed relationships.5 However, not all studies have found significant results.6
Vitex agnus-castus, or chaste tree berry, has also been shown to be beneficial for many women with PMS.7,8,9 Vitex helps the body to produce more progesterone, often balancing estrogen to progesterone ratios and decreasing PMS symptoms. Vitex also may decrease release of prolactin from the pituitary, helping with breast tenderness and other PMS symptoms. Randomized controlled trials have shown significant results when comparing vitex to placebo treatment for women with PMS,10 although results are preliminary and bias may contribute to the findings.11
Nutrient Combinations and Diet
One study found that the combination of a calcium supplement plus vitamin D, together with cognitive behavioral therapy, was beneficial for PMS,12 and a systematic review agreed.13 A 1987 study found that a multivitamin/multimineral supplement alleviated many symptoms.14
Overall, at least in adolescent girls, a healthier eating pattern may be protective against PMS.15 Nutrient deficiencies may also explain the correlation between adolescent IBS and increased risk of PMS.16 Dietary consumption of the B vitamins thiamine and riboflavin are also correlated with decreased risk of PMS, although supplementing with those same vitamins did not show the same effect.17 Supporting the notion of dietary patterns mattering for PMS symptoms, a conventional Western diet has been associated with increased risk of PMS,18 as has consumption of junk food and dysmenorrhea.19 Dietary modifications can make a difference. For instance, over a three-month period, replacing four servings a day of refined grains with whole grains reduced PMS symptoms significantly in a cohort of adult women.20
A full Functional Medicine workup for a patient with PMS should include other lifestyle factors beyond nutrition, such as exercise and stress. This approach to PMS looks at the whole patient through the lens of systems biology and examines the underlying cause of hormonal dysregulation. Addressing lifestyle factors first, including nutrition, can often help to alleviate symptoms without the need for further treatment.
- Saeedian KA, Amani R, Cheraghian B. The association between the risk of premenstrual syndrome and vitamin D, calcium, and magnesium status among university students: a case control study. Health Promot Perspect. 2015;5(3):225-230. doi:15171/hpp.2015.027
- Boyle NB, Lawton C, Dye L. The effects of magnesium supplementation on subjective anxiety and stress – a systematic review. Nutrients. 2017;9(5):E429. doi:3390/nu9050429
- Bahrami A, Avan A, Sadeghnia HR, et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecol Endocrinol. 2018;34(8):659-663. doi:1080/09513590.2017.1423466
- Arab A, Golpour-Hamedani S, Rafie N. The association between vitamin D and premenstrual syndrome: a systematic review and meta-analysis of current literature. J Am Coll Nutr. Published online May 10, 2019. doi:1080/07315724.2019.1566036
- Tartagni M, Cicinelli MV, Tartagni MV, et al. Vitamin D supplementation for premenstrual syndrome-related mood disorders in adolescents with severe hypovitaminosis D. J Pediatr Adolesc Gynecol. 2016;29(4):357-361. doi:1016/j.jpag.2015.12.006
- Abdollahi R, Abiri B, Sarbakhsh P, Kashanian M, Vafa M. The effect of vitamin D supplement consumption on premenstrual syndrome in vitamin D-deficient young girls: a randomized, double-blind, placebo-controlled clinical trial. Complement Med Res. Published online May 17, 2019. doi:1159/000500016
- Dante G, Facchinetti F. Herbal treatments for alleviating premenstrual symptoms: a systematic review. J Psychosom Obstet Gynaecol. 2011;32(1):42-51. doi:3109/0167482X.2010.538102
- Cerqueira RO, Frey BN, Leclerc E, Brietzke E. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2017;20(6):713-719. doi:1007/s00737-017-0791-0
- Rafieian-Kopaei M, Movahedi M. Systematic review of premenstrual, postmenstrual and infertility disorders of Vitex agnus castus. Electron Physician. 2017;9(1):3685-3689. doi:19082/3685
- van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 2013;79(7):562-575. doi:1055/s-0032-1327831
- Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(2):150-166. doi:1016/j.ajog.2017.02.028
- Karimi Z, Dehkordi MA, Alipour A, Mohtashami T. Treatment of premenstrual syndrome: appraising the effectiveness of cognitive behavioral therapy in addition to calcium supplement plus vitamin D. Psych J. 2018;7(1):41-50. doi:1002/pchj.206
- Abdi F, Ozgoli G, Rahnemaie FS. A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstet Gynecol Sci. 2019;62(2):73-86. doi:5468/ogs.2019.62.2.73
- Stewart A. Clinical and biochemical effects of nutritional supplementation on the premenstrual syndrome. J Reprod Med. 1987;32(6):435-441.
- Isgin-Atici K, Kanbur N, Akgül S, Buyuktuncer Z. Diet quality in adolescents with premenstrual syndrome: a cross-sectional study. Nutr Diet. Published online February 6, 2019. doi:1111/1747-0080.12515
- Bahrami A, Gonoodi K, Khayyatzadeh SS, et al. The association of trace elements with premenstrual syndrome, dysmenorrhea and irritable bowel syndrome in adolescents. Eur J Obstet Gynecol Reprod Biol. 2019;233:114-119. doi:1016/j.ejogrb.2018.12.017
- Chocano-Bedoya PO, Manson JE, Hankinson SE, et al. Dietary B vitamin intake and incident premenstrual syndrome. Am J Clin Nutr. 2011;93(5):1080-1086. doi:3945/ajcn.110.009530
- Farasati N, Siassi F, Koohdani F, Qorbani M, Abashzadeh K, Sotoudeh G. Western dietary pattern is related to premenstrual syndrome: a case-control study. Br J Nutr. 2015;114(12):2016-2021. doi:1017/S0007114515003943
- Negi P, Mishra A, Lakhera P. Menstrual abnormalities and their association with lifestyle pattern in adolescent girls of Garhwal, India. J Family Med Prim Care. 2018;7(4):804-808. doi:4103/jfmpc.jfmpc_159_17
- Esmaeilpour M, Ghasemian S, Alizadeh M. Diets enriched with whole grains reduce premenstrual syndrome scores in nurses: an open-label parallel randomised controlled trial. Br J Nutr. 2019;121(9):992-1001. doi:1017/S0007114519000333
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