PMS and supplements – exploring the facts and benefits

PMS – also known as premenstrual syndrome – is the group of symptoms most people experience in the weeks before they start their period. This is a very common syndrome, with as many as three in four females getting PMS symptoms at some point in their lifetime. However, on average, people in their 30s are most likely to have PMS.Symptoms include mood swings, feeling upset or anxious, breast tenderness, and changes in appetite and sex drive, bloating, confusion and generally just not feeling right. You might have joint pain, constipation or diarrhoea.

Medically-approved treatments

For people with PMS, symptoms can be mild. However, they can also be so severe that people have to take time off work, university/college or school. If this is the case, it’s important to consult with your doctor, as they’ll be able to help you find treatments to manage the symptoms.

Your doctor may prescribe treatments for PMS such as combined oral contraceptives, antidepressants, or talking therapy (CBT). They may also suggest lifestyle changes or over-the-counter painkillers.

Complementary and alternative therapy

These two types of therapies fall outside of mainstream healthcare. These therapies include acupuncture, aromatherapy, chiropractic, reflexology and taking supplements, vitamins, or traditional Chinese medicine (TCM). When these are used alongside conventional medicine, it's considered "complementary". When they’re used instead of conventional medicine, it's considered "alternative".

Clinical trials and evidence supporting each method for treating PMS symptoms are sparse and conflicting in their results. However, different people find different treatments effective, so it’s worth speaking with a healthcare professional about what might work best for you.

There’s a range of supplements available for people who experience PMS, some of which have been widely researched. These include vitamins for PMS, such as vitamin B6 – which is a very popular option – minerals, including magnesium and calcium, and herbs and berries, such as chasteberry, Evening Primrose Oil, and St John’s Wort. It’s important to note that you should consult a medical professional before adding certain supplements to your diet. Excessively high levels of vitamins and minerals can have adverse health effects. Supplements should also be approached with caution if you are pregnant, breastfeeding, have any health conditions or are taking medications such as antidepressants or hormonal contraceptives, as they can interfere with the function of such.

This vitamin is known for relieving PMS symptoms because it plays an important role in making neurotransmitters (chemicals that send signals between nerves, muscles, glands, etc.) – especially the mood-regulating hormone serotonin (the happy hormone). One study found that up to 100 mg of vitamin B6 might relieve PMS symptoms, especially when it comes to improving low moods or depression. Another study confirmed that vitamin B6 relieved PMS symptoms such as pain (abdominal, breast, back), anxiety, drowsiness, feelings of depression, and oily skin.

You can try to increase vitamin B6 intake through your diet - try foods such as starchy vegetables, chickpeas, tuna, salmon, animal liver, dark leafy vegetables, bananas, papaya, and oranges - or add a supplement containing 50 to 100 mg of vitamin B6 into your diet each day.

Interactions and warnings

Vitamin B6 can interfere with certain epilepsy, asthma, chemotherapy, central nervous system depressants, Parkinson’s and antibiotic medications, so if taking these check with your doctor before taking vitamin B6 supplements.

This is an essential mineral for many aspects of health and comes with many calming and relaxing properties. According to a recent review, magnesium can help ease the symptoms of PMS for many people, with research suggesting that it may work by normalising (aka, balancing) the action of certain hormones (such as progesterone) on the central nervous system. One study shows that a combination of magnesium and vitamin B6 can be very effective at alleviating feelings of anxiety, depression, water retention, feeling cold, nausea, pain (headache, back, and muscle), and acne. You can increase your magnesium intake through your diet – by eating more green, leafy veg, wholegrains, nuts, seeds and legumes – or by taking supplements of approximately 200-250 mg of magnesium per day. However, research also shows that it may take up to three cycles to feel the effects of magnesium on symptom relief.

Interactions and warnings

Magnesium can interfere with a number of medications, including (but not limited to) diuretics, antibiotics, bisphosphonates and proton pump inhibitors, so check with your doctor before adding it to your diet.

People with PMS have been found to have lower calcium levels during the luteal phase of their cycle, which exacerbates symptoms. Therefore, it’s also been shown that supplementation with calcium can reduce PMS symptoms in these people. In 2017, a clinical trial concluded that using calcium supplements is an effective method for easing mood disorders such as anxiety, sadness and fluctuating moods. Another study concluded that, after taking it for three menstrual cycles, calcium supplementation reduced core premenstrual symptoms, helping water retention, food cravings, and pain during the luteal phase of the cycle. In fact, some herbal remedies, like raspberry leaf tea, that have traditionally been used for easing PMS, are high in calcium. If you want to increase your calcium intake, you can do this through your diet or supplements. Foods high in calcium include dairy, bone-in fish (such as sardines) or fortified plant-based milks. People often take vitamin D with calcium, as it helps the body maximise calcium absorption.  

Interactions and warnings

Although rare, excessive calcium intake can be potentially harmful, so it’s important to keep within recommended daily intake levels. Calcium can interfere with medications taken for bipolar disorder, HIV, osteoporosis, beta-blockers, heart rhythm irregularities, diuretics, infections and thyroid disorders, so speak with your doctor before adding them to your diet.

People with PMS have been found to have lower levels of vitamin D during the luteal phase compared to people who don’t have PMS. Vitamin D plays a crucial role in regulating mood and encouraging hormonal balance in the body, and also impacts our metabolism of calcium (see above).

It’s thought that taking vitamin D supplements can help alleviate symptoms such as mood swings, anxiety, depression, abdominal pain, and bloating. Studies testing the effect of vitamin D supplementation on reducing PMS symptoms show that a vitamin D intake of ~17.6 mcg/day can be associated with a 41% reduction in symptoms.

Interactions and warnings

Vitamin D shouldn’t be taken by people who have kidney disease or hypercalcaemia, or take corticosteroids, diuretics, or drugs for epilepsy.

Chasteberry, or Vitex agnus castus, is the fruit of the chaste tree. It’s one of the most common supplements taken to treat hormone-related gynaecological conditions. The German Commission E (the German version of the body responsible for regulating medicines in the UK (MHRA)) approves the use of chasteberry for PMS and is widely prescribed by GPs and gynaecologists in Germany. Scientists believe it may work by stimulating certain opioid receptors in the brain, mimicking the activity of endorphins - which make us feel good and reduce our perception of pain.

Another study suggests that chasteberry may prevent release of the hormone GnRH, which then allows luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels to rise, which ultimately leads to regulation of oestrogen and progesterone production (thus reducing the severity of PMS symptoms).

Interactions and warnings

Chasteberry is generally well tolerated, but side effects can include digestive issues, dizziness, and dry mouth. No herb-drug interactions have been reported, but this may be due to the lack of clinical studies on this treatment. If you’re pregnant, breastfeeding, taking oral contraceptives, dopamine agonists, dopamine antagonists, or have a hormone-sensitive condition such as some types of breast cancer, consult your doctor before taking chasteberry.

Evening primrose oil (EPO) is made from the seeds of flowering plants native to North America and is full of omega-6 fatty acids. Because some people with PMS have elevated levels of, or sensitivity to, prolactin, evening primrose oil helps reduce PMS symptoms, particularly water retention, low mood, and breast tenderness, by working to reduce the impact of prolactin on the body.

Interactions and warnings

Some people experience bloating and gastrointestinal problems after administration of evening primrose oil. Evening primrose oil may reduce blood pressure and interact with blood-thinning or clot-preventing drugs, as well as medication for HIV and epilepsy. People with schizophrenia should also avoid evening primrose oil. If you’re unsure whether evening primrose oil is right for you, consult a healthcare professional before adding it to your diet.

Ginkgo biloba (aka maidenhair) is a large tree native to China, the leaves of which are used to make extracts that are full of antioxidants. Ginkgo biloba can work to reduce the severity of physical and psychological PMS symptoms, particularly insomnia, fatigue, bloating, and breast tenderness. It’s thought to work by increasing blood circulation and altering neurotransmitter and inflammatory agent levels. The active ingredient in ginkgo biloba also works as a stress modulator and can reduce feelings of anxiety.

Interactions and warnings

GB is also well tolerated by most people. It can cause some minor side effects such as stomach upset, headache, dizziness, and allergic skin reactions. Note that the roasted seeds of the ginkgo biloba tree can cause serious effects such as seizure, and eating raw seeds can be fatal. People who have epilepsy shouldn’t take GB as it may cause seizures. GB can interact with blood-thinning or clot-preventing drugs, as well as medications taken for epilepsy, depression, and pain relief.

Dong quai (aka female ginseng) supplements are made from the root of a fragrant, perennial plant - a member of the celery family - grown in the mountains of China, Korea, and Japan. It’s thought that dong quai has anti-inflammatory effects, and improves blood circulation. There is conflicting evidence about whether it mimics oestrogen in the body. Although its method of action isn’t 100% confirmed, it has been shown to reduce PMS symptoms. It may also prevent uptake of serotonin (the happy hormone), which means there’s more of it present, making us feel better.

Interactions and warnings

Dong quai shouldn’t be taken if pregnant, breastfeeding or taking blood-thinning or clot-preventing medication. People with hormone-sensitive cancers should avoid taking dong quai.

This historic medication dates back to Ancient Greece. It’s one of the most commonly used herbal products in the United States and is widely used across Europe. St John’s Wort has been found to reduce symptoms in mild to moderate depression (therefore can be helpful for mood-related symptoms of PMS). Scientists don’t know exactly how St. John’s Wort works as an antidepressant; however, it may be because it increases the level of serotonin in the brain, which is what conventional antidepressants (like SSRIs) do. Many studies suggest St John’s Wort seems to work as well as SSRIs. Research also shows that it’s effective in reducing certain behavioural symptoms of PMS such as hostility, anger, impulsivity and emotional instability.

Interactions and warnings

St John’s Wort must be used with extreme caution as it interacts with a range of medications. Never take St John’s Wort alongside other antidepressant medication or hormonal contraceptives. Consult your doctor before starting it, especially if you’re pregnant, breastfeeding or taking other medication. It also can cause side effects, such as tiredness, skin rashes and oversensitivity towards the sun.

Ashwagandha, also known as Indian Ginseng, is a powerful adaptogen that is sometimes used to ease the psychological symptoms of PMS. Ashwagandha is thought to help balance the production of stress hormones, such as cortisol, and has been shown to have a beneficial effect on reducing perceived stress levels. Although there isn’t enough research out there to conclusively say that this herb can effectively ease PMS, it certainly may help to reduce cortisol levels and stress.

Interactions and warnings

Ashwagandha can cause uterine contractions, so don’t take it if you’re pregnant or trying to conceive. It can also, in rare cases, cause liver damage, alter blood sugar levels, and exacerbate hyperthyroidism. Side effects may include stomach upset and diarrhoea.