Prone to PMS?

What do you recommend for PMS? I’m miserable every month, and nothing I do seems to help.

– March 7, 2006

Three out of four menstruating women experience some degree of premenstrual syndrome (PMS) in the week leading up to their periods. Symptoms can range from mood swings, fatigue, irritability and depression to tender breasts, abdominal bloating, anxiety, insomnia, headache, fluid retention, and increased appetite with cravings for sweet or salty foods. Of course, not all women have all the symptoms – and not all affected women have symptoms of the same intensity month after month. Still PMS can be so severe that some of those affected can’t go about their normal activities.

We don’t know what causes PMS, or why some women have it and others don’t. Clearly, hormonal fluctuations play a role, as PMS symptoms tend to disappear when hormone levels are stable, such as during pregnancy and after menopause.

Conventional medicine treats PMS with non-steroidal anti-inflammatory drugs (NSAIDS), which can ease cramps and relieve breast discomfort. (Taking these drugs before your period can help prevent cramps by lowering blood levels of prostaglandins, hormones that promote inflammation.) Oral contraceptives can help as well, because they prevent ovulation and its associated hormonal changes. In some cases, conventional physicians prescribe antidepressant drugs. These boost the levels of serotonin in the brain and have been shown to reduce fatigue, food cravings and sleeping problems. (Some doctors recommend taking them only during the two weeks prior to menstruation.) Another more drastic alternative is an injection of Depo-Provera, a hormone that stops ovulation temporarily but can also cause increased appetite, weight gain, headache and depressed mood.

I recommend trying the following lifestyle changes and supplements, which can go a long way toward relieving PMS symptoms:

  • Avoid alcohol and caffeine (including chocolate). Caffeine can worsen PMS symptoms by contributing to breast tenderness, nervous tension and anxiety.
  • Start eating an anti-inflammatory diet. Especially eliminate polyunsaturated and trans-fats. They promote inflammation that can worsen PMS symptoms.
  • Get plenty of omega-3s (from wild Alaskan salmon, sardines and other cold water fish, freshly ground flaxseed, and walnuts). They help ease cramps.
  • Limit your intake of salt, sugar, alcohol and fat throughout the month; they all contribute to the fluid retention and bloating that can occur with PMS.
  • Get at least 30 minutes a day of aerobic exercise such as walking, bicycling or swimming to improve mood, relieve stress and ease PMS symptoms in general.
  • Do my breathing exercises daily and practice a relaxation technique such as yoga or meditation. This can help reduce anxiety and improve your sleep.
  • Take 1,200 mg of calcium daily (you should notice effects on your PMS symptoms after three months). Use calcium citrate and take it with half as much magnesium, starting slowly at 200 mg and leveling off at 600 mg. Magnesium can reduce cramping by relaxing smooth muscle tissue in the uterus.
  • Take vitamin B6. The amount found in a good multivitamin or B-complex is sufficient.
  • Try evening primrose oil or black currant oil. These are good sources of gamma-linolenic acid (GLA), a natural anti-inflammatory agent that can help reduce breast tenderness. Take 500 mg of either twice a day. It may take up to three months for effects to become noticeable.
  • Drink raspberry leaf tea, an effective remedy for menstrual cramps.

Andrew Weil, M.D.

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