Premenstrual syndrome (PMS) is a collection of physical and emotional symptoms that are related to a woman's menstrual cycle. Approximately 70–90% of women experience PMS in their reproductive period. For approximately 20% of women, these symptoms may immensely affect their quality of life and daily functioning. Supplements are being explored as an option to alleviate PMS symptoms. Let’s explore the scientific evidence of their role in PMS management.
PMS is a range of symptoms associated with menstrual hormonal fluctuations, and the severity of symptoms may affect one’s life and daily activities.
In addition to hormonal changes, nutritional deficiencies of vitamin B6, calcium and magnesium are among potential causes of PMS.
The research results supporting the effects of foods and nutrients are insufficient and inconclusive.
Some studies show the effectiveness of vitamins B and D and micronutrients such as calcium and magnesium for PMS symptoms.
Understanding premenstrual syndrome
Hormonal fluctuations during the menstrual cycle, especially in the second half, cause physical and psychological symptoms. These symptoms are cyclic and start a few days before menstruation begins.
One or more of the following symptoms with differing severities are characteristic of PMS.
Combined oral contraceptives and antidepressants (SSRIs) effectively treat PMS, especially emotional symptoms. However, due to the potential side effects of antidepressants and oral contraceptives, other alternatives, such as nutritional, herbal, and vitamin supplements, are being investigated as a potential treatment.
Why do we expect supplements to help with PMS symptoms?
The exact causes of PMS are not clear. However, several factors have been linked to the condition. Deficiencies of specific vitamins and minerals, such as vitamin B, vitamin D, antioxidant vitamins (C, A, and E), calcium, and magnesium are among these factors. For example, vitamin B is involved in serotonin metabolism, magnesium is essential for brain dopamine synthesis, and calcium-regulating hormones are associated with ovarian steroid hormones.
A large study with over 1000 women experiencing PMS shows that consumption of vitamin B1 and B2 rich-food decreased the risk of developing PMS. The same study found no preventative effect of vitamin B6, B12, folate, and niacin.
Several studies researching the possible protective effect of antioxidant vitamins, such as vitamins C, E, and A, also failed to find an association between serum vitamin levels and PMS symptoms.
Scientific findings on the supplements in PMS
Despite the years-long study efforts investigating the therapeutic effects of supplements in PMS, the topic is still open to new research.
Zinc has antioxidant, anti-inflammatory, and antidepressant effects. Serum zinc levels decrease during menstruation, and they are significantly lower in women with PMS. According to a randomized controlled study, 30-mg zinc gluconate supplementation for three months significantly reduced physical and psychological symptoms of PMS. However, more research is required for more conclusive evidence.
The majority of studies suggest that women with low serum calcium levels and reduced dietary calcium intake experience PMS symptoms more than those with normal values. Also, serum calcium levels show cyclic differences in PMS-experiencing women. Additionally, research supports the knowledge that calcium supplementation could significantly improve PMS symptoms. However, more studies are required to establish the dose and treatment details.
Magnesium deficiency has been proposed as a cause of PMS. The neuromuscular stimulatory effects of magnesium relax muscles and reduce menstruation-related contraction pain. Magnesium supplementation alone and in combination with vitamin B6 showed improvement in PMS symptoms.
Vitamin D is a calcium-regulating hormone and shows importance in female reproduction. It affects cyclic hormone fluctuations and reduces menstruation-related pain. Although some studies show the therapeutic effect of vitamin D, there are also studies that found no significant impact on PMS symptoms.
For example, a randomized study treating vitamin D-deficient women with 25-hydroxyvitamin D found that after four months of treatment, their serum inflammation markers reduced, and the score evaluating PMS symptoms was improved. On the other hand, another randomized study assessing the effect of three months of vitamin D treatment did not find a difference from the untreated participants.
The majority of B vitamins, including thiamine (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), folic acid (B9), and cobalamin (B12), play an important role in the synthesis of neurotransmitters, which participate in emotional and pain pathways of PMS. Although the consumption of vitamin B1 and B2-rich food was found to lower PMS risk, studies could not show the protective effect of vitamin B supplementation on PMS risk or symptoms. However, vitamin B6 was found to be effective in broad-spectrum formulas.
Vitex agnus-castus (VAC, chaste tree, or chasteberry) originates from the Mediterranean and western Asia. It has been used and researched for decades. Several studies showed it reduces hormones regulating ovarian hormone secretion (FSH and LH), leading to a decrease in estrogen, progesterone, and prolactin levels. A meta-analysis combining results of studies on more than 500 women found that women taking VAC preparations experienced PMS symptoms 2.5 times less often than those who did not.
The effects of several other herbal supplements have been researched, and some of them have shown PMS symptom-reducing results. However, the number of these studies is too limited for conclusive evidence.
|Herbal supplement||Effect on PMS|
|Ginkgo biloba||Significant reduction in PMS symptoms|
|M. chamomile extract||Effective relief of symptoms|
|Ginger||Reduced physical, mood, and behavioral symptoms|
|Lemon balm||Effective reduction in symptoms|
|Bread wheat||Significant reduction in physical and psychological symptoms|
|Primrose||Relief of symptoms|
It should be remembered that the natural origin of supplements does not make them safe for unlimited or uncontrolled use. The limited knowledge of other plant components might lead to a conflicting reaction between different reagents and supplements. Additionally, it might be challenging to adjust the dose of the desired component while using dried herbs or plants. Therefore, it is recommended to speak with a healthcare professional if you plan to use supplements to reduce your PMS-related symptoms.
Things to consider before using PMS supplements
It is common to assume that supplements are harmless and safe to use. However, it must be remembered that supplements should be used if the beneficial effect is proven and if it doesn't harm other organs, systems, or disease symptoms. Therefore, talking to your doctor before adding supplements to your diet is always recommended. But what should you consider?
First, you should think about if you really need the supplement. Many hear about supplements from influencers who have minimal if any, medical or scientific education. Be careful before implementing these supplements, as they may not be necessary for you and, in fact, may cause harm. Do your own research into the evidence of each supplement and discuss the supplements with your healthcare provider before incorporating them.
Some supplements may interact with other medications that you take. These interactions may reduce the effectiveness of your medication, , or cause new symptoms. Additionally, most plant-based supplements have not been studied in large clinical trials, so their effects and interactions may be unknown.
As supplements are largely unregulated, it is hard to determine the exact concentration of each component. The origin of the plant and the steps involved in processing it may impact the concentration, and you may receive unhealthy levels of certain ingredients. If you do choose to take supplements, it is recommended to talk to a healthcare provider to choose the most suitable option for you.
Adding supplements to your diet is not as simple as it sounds. Some studies support the idea that Vitamin B6, D, calcium, and magnesium may provide relief for PMS, but more research is needed. Please keep in mind that vitamins and supplements might be associated with adverse effects, such as nausea, constipation, dizziness, headache, and abdominal discomfort.
- Cochrane Database Systematic Reviews. Vitex agnus castus for premenstrual syndrome.
- The American Journal of Clinical Nutrition. Dietary B vitamin intake and incident premenstrual syndrome.
- Fertility and Sterility. Association between antioxidant vitamins and symptoms of premenstrual syndrome.
- Frontiers in Nutrition. Impact of nutritional diet therapy on premenstrual syndrome.
- Biology Trace Element Research. Effect of Zinc Supplementation on Physical and Psychological Symptoms, Biomarkers of Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Young Women with Premenstrual Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial.