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| Premenstrual Syndrome / PMDD |
Last updated: May 12, 2008 |
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Premenstrual Syndrome / PMDD |
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Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations
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The first step in helping women with PMS is to determine which subgroup most accurately fits their symptom picture. If it is not obvious from reading this or other information, selected laboratory tests can be called upon.
Abnormal thyroid function and intestinal candidiasis should also be ruled out since these may produce, during the mid-luteal phase, a symptom picture similar to PMS. If you are affected by one or more types of PMS (A, C, D, or H) they will be listed separately. PMS type A is the most common.
General Dietary Guidelines - Limit consumption of refined carbohydrates and other concentrated carbohydrates, such as, honey, dried fruit, and fruit juice
- Increase protein intake, particularly from vegetable sources such as legumes
- Increase green leafy vegetables consumption, except brassica family foods (cabbage, brussels sprouts, and cauliflower)
- Decrease milk and dairy product consumption
- Decrease intake of fats, especially saturated fats, while increasing intake of linoleic and linolenic acid. Use only non-estrogen-supplemented red meat and fowl
- Decrease salt intake. Restrict alcohol and tobacco use. Restrict intake of methyl-xanthines (coffee, tea, chocolate, and caffeine-containing foods and beverages).
Premenstrual dysphoric disorder, or PMDD, is a debilitating set of symptoms associated with the part of a woman's cycle that precedes her menstrual period. PMDD is also a psychiatric term for a major mood disturbance. "Dysphoria" is used by the psychiatric and medical community as a diagnostic term, generally referring to a type of depression.
Unlike PMS, PMDD symptoms are so severe that a woman's day-to-day activities are completely disrupted. PMDD is relatively rare, affecting perhaps 3 - 5% of women.
There are 3 conventional approaches to treating PMDD. While most experts recommend a combination of all 3, there have been no scientific studies to determine if combination treatment is really the best approach. It is likely that the best approach or combination of approaches will vary from woman to woman based on things like symptom severity and which symptoms are most troublesome. These three include:
Medications - including antidepressants, antianxiety drugs, analgesics, hormones and diuretics.
Psychobehavioral - including exercise and psychotherapies (cognitive-behavioral, coping skills training, relaxation).
Nutritional - including diet modification, vitamins, minerals and herbal preparations.
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 Conditions that suggest Premenstrual Syndrome / PMDD:
Risk factors for Premenstrual Syndrome / PMDD: | | | | | | Hormones |  Low Progesterone or Estrogen Dominance
Low Melatonin Level | Melatonin can exhibit strong effects on the reproductive system, and the activity of the female hormones estrogen and progesterone is closely tied with its regulation of the sleep-wake cycle. Abnormal biological rhythms and sleep-wake cycle disturbances are often a primary feature of periodic depression, another common characteristic of PMS. Melatonin imbalances have been specifically linked to PMS.
A study reported finding that women with PMS had an earlier decline in melatonin secretion, resulting in a shorter overall secretion time. "The data demonstrate that women with premenstrual syndrome have chronobiological abnormalities of melatonin secretion... The fact that these patients respond to treatments that affect circadian physiology, such as sleep deprivation and phototherapy, suggests that circadian abnormalities may contribute to the pathogenesis of premenstrual syndrome." [Arch Gen Psychiatr 1990;47(12): pp.1139-46] |
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Nutrients |
Magnesium Requirement| | Magnesium deficiency is strongly implicated as a causative factor in PMS. Red Blood Cell magnesium levels in PMS patients have been shown to be significantly lower than in normal subjects. The deficiency is characterized by a generalized hyperesthesia syndrome (with generalized aches and pains), and a lower premenstrual pain threshold. One clinical trial of magnesium in PMS showed a reduction of nervousness in 89%, mastalgia in 96%, and weight gain in 95%. |
Manganese Requirement| | In a double blind study of women with normal menstrual cycles, lower dietary manganese (1.0mg versus 5.6mg) was found to increase mood and pain symptoms during the premenstrual phase. [Am J ObstetGynecol. 1993 May; 168(5): pp.1417-23] |
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Premenstrual Syndrome / PMDD suggests the following may be present:
Recommendations for Premenstrual Syndrome / PMDD: | | | | | | Amino Acid / Protein |  Theanine (L-Theanine)| | Japanese researchers have discovered that theanine works for PMS. Using a distress questionnaire, they tracked the reactions of 20 women taking the new supplement for 2 months. 100mg of theanine bid caused documented reductions in mental, social and physical symptoms when taken during symptomatic periods. |
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Animal-based |
Lactobacillus Acidophilus| | Lactobacillus acidophilus has been shown to inhibit the fecal bacterial enzyme, beta-glucuronidase, which is responsible for deconjugating liver conjugated estrogen. |
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Botanical |
 Vitex| | Clinical studies using vitex extract show a reduction in headaches, breast tenderness, bloating, fatigue, cravings for sweets, and also feelings of anxiety, irritability, depression and mood swings, after only one month. Whether this would be effective for the more severe symptoms of PMDD is not known. |
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Diet |
 Caffeine/Coffee Avoidance| | Several studies have linked caffeine consumption to a higher incidence of PMS symptoms including tension, irritability, anxiety, fatigue, sleep disturbance and breast tenderness. Some of coffee's components have a mild estrogen-like effect on the body. Since estrogen is responsible for premenstrual syndrome and breast tenderness, this may be one reason why coffee aggravates these conditions. |
Sugars Avoidance / Reduction| | Reducing or eliminating alcohol, caffeine, nicotine and sugar are all diet recommendations that can improve PMS symptoms. |
Alcohol Avoidance| | See the link between PMS and Sugar Avoidance. |
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Drug |
Conventional Drugs / Information| | In the October 2006 issue of the Journal of Clinical Psychiatry, researchers reported that low doses of sertraline taken for two weeks before the onset of the menstrual period may be an effective and well-tolerated treatment for some women who experience moderate-to-severe premenstrual syndrome, or PMS.
The researchers also tested and found two other anti-depressant dosing strategies to be effective. One of those dosing strategies was taking medication daily throughout the menstrual cycle. The other was waiting until PMS symptoms begin to start medication each cycle, which is known as 'symptom-onset' dosing. Sertraline is a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression and anxiety, as well as for premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome.
"Our study is the first to evaluate the use of low-dose antidepressant medication for women who have moderate-to-severe PMS, and the first placebo-controlled study to include the novel dosing strategy of 'symptom-onset dosing,'" said Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU's School of Medicine and lead author on the study.
"Our findings suggest that women with less severe forms of PMS than PMDD may also benefit from treatment with antidepressant medication, and they may be able to take medication only on the days that they are symptomatic," she said. |
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Habits |
Tobacco Avoidance| | See the link between PMS and Sugar Avoidance. |
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Hormone |
Progesterone| | Progesterone continues to be widely prescribed by clinicians and widely used by patients, but remains a controversial subject. Some doctors have observed that progesterone administered vaginally, rectally, or topically (to the skin) can relieve the symptoms of premenstrual syndrome (PMS), BUT most well-controlled studies have not found natural progesterone to be effective against PMS. |
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Mineral |
Magnesium| | Menstrual cramps, irritability, fatigue, depression and water retention have been lessened by taking supplemental magnesium, usually given along with calcium and often with vitamin B6. Magnesium is often at its lowest level during menstruation, and many symptoms of premenstrual syndrome (PMS) are relieved when this mineral is replenished. Supplementing magnesium in the same amount (or more) as calcium (about 500-1,000mg daily) is currently recommended for premenstrual problems. Women with PMS have been reported to be at increased risk of magnesium deficiency.
A 1998 study in The Journal of Women's Health found that 200mg a day of magnesium reduced PMS fluid retention, breast tenderness and bloating by 40%. Magnesium is important to regulate muscle relaxation, blood sugar, and to promote sound sleep - all particularly important during PMS. |
Zinc| | A study was conducted at the Department of Obstetrics and Gynecology, Baylor College of Medicine in Houston, Texas to determine whether changes in peripheral zinc and copper levels are associated with symptoms of PMS. Ten PMS patients and ten controls gave blood at 2 to 3 day intervals through three menstrual cycles. Lower levels of zinc were noted during the luteal phase in PMS patients compared with the controls. Copper levels were noted to be higher during the luteal phase in PMS patients compared with the controls. The researchers concluded that zinc deficiency occurs in PMS patients during the luteal phase, and the elevated copper further reduces the availability of zinc in PMS patients during the luteal phase . The recommended dose of elemental zinc is 30 mg daily to help relieve PMS symptoms. [Chuong and Dawson, 1994] |
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Nutrient |
Beta-Carotene |
Vitamins |
Vitamin B6 (Pyridoxine)| | Numerous clinical studies have demonstrated the efficacy of vitamin B6 supplementation in treating PMS. In one double blind crossover trial, 84% of the subjects had a lower symptomatology score during the B6 treatment period. Although PMS is of multifactorial origin, B6 supplementation alone appears to benefit most patients. In another study, premenstrual acne flare-up was reduced in 72% of 106 affected young women taking 50mg of pyridoxine daily for one week prior and during the menstrual period. Pyridoxine acts as a mild diuretic, reducing the symptoms of premenstrual syndrome. |
Vitamin A| | Vitamin A has been shown to be beneficial in reducing PMS symptoms when given in doses of 100,000 to 300,000iu per day in the second half of the menstrual cycle. These levels should only be achieved by a water-soluble form of vitamin A and supervised by a Natural Doctor. Beta-carotenes may be better indicated since they are less toxic and endogenous regulation of conversion to retinol helps maintain more appropriate levels. The enzymatic conversion of beta-carotene to vitamin A is increased twofold during mid-ovulation. It is believed that there is a storage capacity for beta-carotene, which is converted to retinol as needed by the corpus luteum. |
Vitamin B Complex
Vitamin E| | Although vitamin E research concerning PMS has focused primarily on mastalgia, significant reduction of other PMS symptomatology has been demonstrated in double-blind studies. Nervous tension, headache, fatigue, depression, and insomnia were all significantly reduced. |
Vitamin C (Ascorbic Acid) |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Strongly counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
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