A Functional Medicine Approach to PMS

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.

Margaret Christensen, MD, discusses the Functional Medicine approach to balancing female hormones to reduce PMS. A board-certified OB/GYN for 23 years, Dr. Christensen first became interested in Functional Medicine 13 years ago when trying to solve her own health challenges.
Individual Supplementation

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.

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  2. 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
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  4. 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
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  8. 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
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  10. 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
  11. 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
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  16. 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
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