Premenstrual syndrome (PMS) affects a significant portion of menstruating women, manifesting in a range of physical and emotional symptoms. While lifestyle changes like diet and exercise can offer some relief, many women turn to supplements to manage their PMS symptoms. This article explores some of the most common supplements used for PMS relief, their potential benefits, and important considerations.

1. Calcium and Vitamin D:

Studies suggest that calcium and vitamin D can alleviate PMS symptoms, particularly mood swings, bloating, and cramping. Calcium plays a role in muscle function and nerve transmission, while vitamin D aids in calcium absorption and may influence serotonin levels. Consult a healthcare professional to determine the appropriate dosage. Combining calcium with vitamin D can enhance its effectiveness.

2. Magnesium:

Magnesium is known for its muscle-relaxing properties and may help reduce cramps, headaches, and mood swings associated with PMS. It also plays a role in regulating neurotransmitters. Magnesium citrate or glycinate are often recommended for better absorption.

3. Vitamin B6:

Vitamin B6 is involved in serotonin production and may help alleviate mood swings, irritability, and anxiety. It can also help with bloating and breast tenderness. It is often found in B-complex vitamins.

4. Omega-3 Fatty Acids:

Omega-3s, found in fish oil or flaxseed oil, have anti-inflammatory properties and may reduce cramps, mood swings, and breast tenderness. Look for high-quality supplements with adequate EPA and DHA content.

5. Chasteberry (Vitex agnus-castus):

Chasteberry has been traditionally used to regulate hormonal imbalances and may help alleviate PMS symptoms like mood swings, breast tenderness, and headaches. It is thought to effect the pituitary gland.

6. Dong Quai:

Dong Quai, known as "female ginseng," is a traditional Chinese herb with a long history of use in addressing PMS symptoms. Its reputed mechanisms of action center around hormonal balance and improved blood circulation. Available in capsule, tablet, and liquid extract forms, Dong Quai is believed to contain compounds that can influence estrogen and progesterone levels, potentially easing symptoms like mood swings, cramps, and irregular periods.

Before starting any new supplement, consulting a doctor or registered dietitian is crucial to assess individual needs, determine appropriate dosages, and identify potential interactions with existing medications. Prioritize reputable brands with third-party testing to ensure supplement quality and purity. Remember that individual responses to supplements vary, so finding the right combination and dosage may require some experimentation. ¹ Supplements are not a replacement for a healthy lifestyle; a balanced diet, regular exercise, and stress management are essential for overall well-being and PMS management. Crucially, some supplements are not intended for long-term use, so always consult a healthcare professional regarding duration of use.

Premenstrual syndrome (PMS) is a common condition affecting millions of women during their reproductive years. While physical symptoms like bloating and cramping are well-known, the emotional rollercoaster of PMS mood swings can be equally, if not more, disruptive. These fluctuations in mood, often characterized by irritability, anxiety, and sadness, can significantly impact daily life, relationships, and overall well-being.

The Hormonal Culprit

The primary driver behind PMS mood swings lies in the complex interplay of hormones, particularly estrogen and progesterone, which fluctuate throughout the menstrual cycle. In the luteal phase, the period after ovulation and before menstruation, progesterone levels rise and then fall sharply. This rapid hormonal shift is believed to disrupt the delicate balance of neurotransmitters in the brain, including serotonin, which plays a crucial role in mood regulation.

A Spectrum of Emotions

Experiencing a range of emotional and psychological symptoms can significantly impact daily life. These symptoms may include heightened irritability and anger, manifesting as easy frustration, short temper, or even outbursts. Anxiety and tension often accompany these feelings, leading to heightened worry, nervousness, or restlessness. Furthermore, individuals may struggle with depression and sadness, characterized by feelings of being down, hopeless, or tearful. Rapid and unpredictable shifts in emotions, known as mood swings, can further complicate emotional stability. Cognitive functions may also be affected, resulting in difficulty concentrating and struggling with focus and decision-making. Physical changes, such as changes in appetite, including cravings or loss of appetite, and sleep disturbances, such as trouble falling asleep or staying asleep, can also manifest.

Managing the Emotional Turbulence

Managing PMS mood swings involves a diverse approach, starting with lifestyle modifications such as regular exercise, a balanced diet, and sufficient sleep, also try to limit caffeine, alcohol, and processed foods. Stress management techniques, including yoga, meditation, deep breathing, and mindfulness, can effectively regulate emotions and reduce anxiety. Cognitive Behavioral Therapy (CBT) offers a pathway to identify and change negative thought patterns, and in more severe cases, medical interventions like SSRIs or hormonal birth control can stabilize neurotransmitter and hormone levels. Some women find relief through supplements like calcium, magnesium, and vitamin B6, though consulting a healthcare professional is essential before starting any new supplement. Finally, tracking symptoms through journaling can help identify patterns and triggers, enabling more proactive management.

When to Seek Professional Help

While PMS is common, severe mood swings can significantly impact quality of life. If you experience debilitating emotional symptoms, it's essential to seek professional help. A healthcare provider can accurately diagnose your condition, rule out other potential causes, and recommend appropriate treatment options. In some cases, severe PMS might be indicative of Premenstrual Dysphoric Disorder (PMDD), a more severe form of PMS that requires specialized care.

Understanding the hormonal basis of PMS mood swings and implementing effective management strategies can empower women to navigate this challenging phase with greater ease and resilience. By prioritizing self-care, seeking support, and working with healthcare professionals, women can regain control over their emotional well-being and live fulfilling lives.

1. Are menstrual cramps common in women?
   • Yes, they occur in 50-90% of women of reproductive age, particularly in young women. Usually menstrual cramps become less painful as you get older.
2. What causes menstrual cramps?
   • Menstrual cramps are caused by prostaglandins which regulate the process of inflammation, blood flow, blood clot formation and childbirth labor. Prostaglandins are secreted by the inner lining of the uterus during menstruation.
3. What are the pain qualities of menstrual cramps?
   • The pain qualities of menstrual cramps, arisen from uterine contraction, are characterized by:
     • Irregular pain pattern
     • Frequent uterine contraction at 4-5 times every 10-minutes
     • Progressive pain from mild to intense
     • Similar to labor pain but less severe
4. What are the risk factors for severe menstrual cramps?
   • Smoking
   • Stress
   • Drink alcohol during period (alcohol tends to prolong menstrual pain)
   • Overweight
5. How many types of menstrual cramps are there?
   • Medically, menstrual cramps or dysmenorrhea are categorized into 2 types.
   • Primary dysmenorrhea:
     • Occurs during the menstrual period only
     • Occurs briefly and resolves within 12-72 hours
   • Secondary dysmenorrhea:
     • Starts before menstruation or persists afterwards
     • Pain progressively more severe when you get older.
     • Often accompanied by other symptoms such as irregular menstruation, pain
   • Outside of menstrual period, nausea, vomiting, headache and infertility.
     • This type of pain often has an underlying condition such as endometriosis. In this case, please seek medical attention.
6. Do menstrual cramps signify any underlying diseases?
   • If the pain is primary dysmenorrhea, no medical attention is required. But if it is secondary dysmenorrhea or you never experience the pain before and you start to feel the pain as you get older and the pain worsens, there may be underlying conditions such as:
     • Endometriosis of the ovaries, also known as chocolate cyst
     • Endometriosis of the uterine muscle
     • Uterine fibroid
     • Pelvic Inflammatory Disease (PID), etc.
7. What kind of pain killer is suitable for menstrual cramps? Are there any side effects from long-term use?
   • Common medications for menstrual cramps are:
     • Paracetamol: It is a universal pain killer for any types of pain, including menstrual pain. It can relieve 50 % of the pain. If not overdosed, there rarely are side effects. The recommended dosage is 500 mg (1-2 pills, depending on your weight), every 6 hours.
     • Non-steroidal anti-inflammatory drugs (NSAIDs): There are many types of NSIADs, but the recommended one is mefanamic acid. The recommended initial dosage is 500 mg, followed by 250 mg every 6 hours if needed. Take Ponstan during your menstruation but not longer than 3 days. Possible side effect is inflammation of the stomach; hence, it should be taken after meal.
8. When menstruation cramps are severe, what should I do?
   • Please see a doctor for proper diagnosis to ensure that there are no underlying conditions.

TABLE OF CONTENTS

• What is PMS?
• What are the symptoms of PMS?
• Why do you get PMS?
• Managing PMS
• Final thoughts

What is PMS?

Premenstrual syndrome (PMS) is a combination of symptoms that many women get about a week or two before their period. According to the Office on Women Health (https://womenshealth.gov/), as many as three in four women say they get PMS symptoms at some point in their lifetime. Most women, over 90%, say they get some premenstrual symptoms, such as bloating, headaches, and moodiness. For some women, these symptoms may be so severe that they miss work or school, but other women are not bothered by milder symptoms. On average, women in their 30s are most likely to have PMS.¹

What are the symptoms of PMS?

PMS symptoms are different for every woman. Your symptoms may also change throughout your life. PMS can be both emotional and/or physical, but some common symptoms include:¹

• Cramps: Painful muscle contractions in the uterus, often felt in the lower abdomen, which can range from mild to severe.
• Mood swings: Rapid and unpredictable shifts in emotional state, including irritability, sadness, or sudden outbursts.
• Swollen or tender breasts: Increased breast tissue sensitivity and swelling due to hormonal fluctuations.
• Tension or anxiety: Feelings of unease, worry, or nervousness, sometimes accompanied by physical symptoms like restlessness.
• Headache or backache: Pain in the head or lower back, often attributed to hormonal changes and muscle tension.
• Sleep problems (sleeping too much or too little): Disruptions in sleep patterns, leading to either excessive drowsiness or insomnia.
• Changes in appetite: Fluctuations in hunger, including increased cravings or a decreased desire to eat.
• Less interest in sex: A reduced libido or sexual desire, potentially linked to hormonal shifts and physical discomfort.

Why do you get PMS?

While the exact cause of PMS remains unclear, scientific research points to a few key theories. Many experts believe that the cyclical fluctuations of the hormones estrogen and progesterone throughout the menstrual cycle play a significant role. During the luteal phase after ovulation, these hormones peak and then rapidly decline.² This hormonal shift is thought to trigger various PMS symptoms, including anxiety and irritability, due to their influence on brain chemistry and other bodily functions

Additionally, changes in brain chemistry, specifically involving neurotransmitters like serotonin and norepinephrine, are considered a contributing factor. ² A drop in estrogen levels may lead to the release of norepinephrine, subsequently affecting the production of dopamine, acetylcholine, and serotonin. These neurochemical changes can manifest as sleep disturbances and a lowered mood. Furthermore, individuals with pre-existing mental health conditions like depression or anxiety may be more susceptible to experiencing PMS or its more severe form, PMDD.³ A family history of mood disorders can also increase this risk.⁴ Lifestyle factors such as smoking, a diet high in unhealthy fats, sugar, and salt, lack of exercise, and poor sleep quality are also believed to potentially worsen PMS symptoms.⁵

How is PMS diagnosed?

Diagnosing PMS isn't about a blood test or scan. It comes down to understanding your personal experience. Your doctor will really focus on the pattern of your symptoms – when they show up and how much they impact your daily life.

You'll likely be diagnosed with PMS if your symptoms consistently appear in the five days leading up to your period for at least three menstrual cycles in a row, and then ease up within about four days after your period begins. Importantly, these symptoms will be significant enough to interfere with your usual activities and enjoyment of life.

Keeping a detailed record of your PMS symptoms for a few months is super helpful for your doctor. Jotting down each day which symptoms you're experiencing and how intense they are, whether on a calendar or using an app on your phone, can reveal clear patterns. Bringing this log with you to your doctor's appointment will give them valuable insight to make an accurate assessment.

Managing PMS

Dietary Adjustments

Nourishing your body with whole foods like fruits, vegetables, and whole grains is a foundational step in easing PMS symptoms, as they provide essential nutrients and fiber that support overall well-being. Conversely, it can be beneficial to limit your intake of processed foods, caffeine, and alcohol, as these substances can sometimes worsen symptoms such as bloating, mood swings, and sleep disturbances. Staying well-hydrated by drinking plenty of water is also crucial, as it can help to reduce bloating and combat fatigue. Some research suggests that ensuring adequate intake of calcium and vitamin D may also play a role in alleviating PMS discomfort, although it's always wise to discuss supplementation with your doctor to determine what's right for you. Finally, incorporating magnesium-rich foods like leafy greens, nuts, and seeds into your diet may offer relief from muscle cramps and contribute to a more stable mood during your cycle.

Stress Management Techniques

Incorporating gentle physical activities like yoga or stretching into your routine can be incredibly beneficial for easing the physical discomfort of PMS by releasing muscle tension and promoting overall relaxation. Beyond physical ease, making a conscious effort to spend time in nature has been shown in studies to have a positive influence on mood, offering a sense of calm and well-being. Furthermore, don't underestimate the power of engaging in hobbies and activities that bring you joy. Setting aside time for these enjoyable pursuits can serve as a welcome distraction from PMS symptoms and provide a significant boost to your emotional state during this time.

Track your cycle

Tracking your cycle can also really help you understand and manage your symptoms. Apps like Glow make this easy, offering mobile tracking, personalized PMS alerts, and the ability to log symptoms like pain and mood changes, which can help you spot patterns from cycle to cycle.

Medical treatments

Over-the-counter pain relievers, such as ibuprofen, naproxen, and aspirin, can alleviate physical PMS symptoms like cramps, headaches, backaches, and breast tenderness. Some women find that preemptive use, starting just before menstruation, can minimize pain and bleeding.¹

For those experiencing inadequate relief from over-the-counter options, prescription medications may be considered. Hormonal contraceptives, including birth control pills, can regulate hormone levels and reduce PMS symptoms. In severe cases of mood-related symptoms, selective serotonin reuptake inhibitors (SSRIs) may be prescribed. While some studies suggest potential benefits from calcium, magnesium, and vitamin B6 supplements, consultation with a healthcare professional is essential before initiating any supplement regimen.¹

Herbal supplements

Many women have found comfort from PMS symptoms through practices like yoga and meditation, which can help to soothe both the physical and emotional aspects of PMS. Additionally, some explore herbal supplements for relief. However, it's absolutely crucial to have a conversation with your doctor or nurse before starting any herbal supplement. This is because these supplements can potentially interact with other medications you might be taking, which could either reduce the effectiveness of your other medicines or even lead to dangerous side effects.¹ While some research studies suggest that certain herbal supplements may offer relief from PMS symptoms, the findings are not always consistent across different studies. It's also important to be aware that many herbal supplements should not be combined with other medications. Some of the herbal supplements that women sometimes use to ease PMS symptoms include black cohosh,⁶ often used for menopausal symptoms but also tried for PMS relief; chasteberry,⁷ which some women take in liquid extract or pill form for PMS, but it's important to note that it should not be used by those on hormonal birth control or hormone therapy; and evening primrose oil capsules, which some women find helpful, although research on its effectiveness for PMS has yielded mixed results. Prioritizing your safety by discussing any potential supplements with your healthcare provider is always the best approach.

Final thoughts

Medical advice should be sought when PMS symptoms significantly disrupt daily life. A healthcare provider can determine the most appropriate treatment plan and rule out underlying medical conditions.

Article sources:

1. Office on Women's Health. Premenstrual syndrome (PMS). Retrieved February 3, 2025.
2. Mayo Clinic. Premenstrual syndrome (PMS). Retrieved Feb 25, 2022
3. Cleveland Clinic. Premenstrual Dysphoric Disorder (PMDD). Retrieved February 02, 2023
4. University of Rochester Medical Centre. Premenstrual Dysphoric Disorder (PMDD) Retrieved February 25, 2022
5. Thiyagarajan DK, Basit H, Jeanmonod R. Physiology, Menstrual Cycle. Retrieved 2024 Sep 27
6. Dietz, B. M., Hajirahimkhan, A., Dunlap, T. L., Bolton, J. L. (2016). Botanicals and their bioactive phytochemicals for women’s health. Pharmacological Reviews, 68(4): 1026-1073
7. Cleveland Clinic. What Is Chasteberry, and What Can It Do? Retrieved November 22, 2022