Premenstrual Stress: When ‘time of the month’ ruins the whole month

PMS is frequently dismissed as a flippant problem that is normal and natural and something women should just put up with. But whilst PMS is common (75% of women suffer from PMS) the symptoms and presentations can be very varied. Some women may not suffer at all, some women may suffer a number of symptoms (and that can add up to half their life of not feeling great!) and a much smaller number, about 2.5-5% have severe symptoms, to the point where work, relationships or home life are jeopardized. (Also take a look at my blog on reproductive depression, which is depression with a hormonal basis, and PMS is one possible cause of this.)

PMS has been characterised by a number of symptoms- over 150 have been identified!!

Common psychological symptoms are mood swings, depression, tiredness, fatigue or lethargy, anxiety, feeling out of control, irritability, aggression, anger, sleep disorders and food cravings.

Common physical symptoms are breast tenderness, bloating, weight gain, clumsiness and headaches. You may find that one symptom is dominant, or that each symptom varies in severity during a cycle and from one cycle to another.

Some women may also find that other medical problems (for example asthma, migraines or epilepsy) worsen cyclically.

What can make PMS worse?

In PMS, there is a school of thought that oestrogen levels increase and progesterone levels decrease either relatively or absolutely. Many factors might promote these imbalances in hormones, including a high- sugar, refined-carbohydrate diet, caffeine, stress, dairy, hormones in dairy products and meat, and endocrine disruptors from pesticides and pollution. Some women are offered the pill, although as this article by Alice Roberts for the Guardian points out, for some women with extreme cyclical moodswings, this does not work.

For mild PMS, the following dietary changes and supplements have also been studied and used in the management of PMS.


PMS sufferers typically have worse diets than non-sufferers, consuming more refined carbs and dairy and significantly more sugar. Moving away from refined carbs, sugar and too much dairy and towards a plant based diet will help. Many women with premenstrual breast pain benefit from avoiding caffeine in coffee, chocolate and coca-cola.


Exercise and PMS has been studied in several controlled trials: women who exercise regularly have less PMS symptoms.

1.   Aerobic exercise is best

2.   Frequent exercise is more important than intense exercise

3.   Regular exercisers show improvement in all PMS parameters

 Nutritional supplements may help:

A deficiency of prostaglandin E1 may contribute to PMS and the synthesis of PgE1 requires magnesium, linoleic acid, vitamin B6, zinc, vitamin C and vitamin B3 so make sure you have enough of these.

B vitamins: Women with the highest intake of B1 and B2 vitamins were less likely to suffer from PMS and vitamin B6 has shown benefits in treating PMS in most, but not all studies. Take vitamin B6 50-100mg per day.

Evening primrose oil: Four double-blind, crossover, controlled trials of evening primrose oil have demonstrated a significant effect over the placebo group. Take 1000mg per day.

Magnesium has shown some beneficial effect in the treatment of PMS at a dose of 400mg – 600mg at night of magnesium citrate or glycinate.

Based on the research, Vitex agnus castus (chaste tree berry), St. Johns wort and Ginkgo biloba appear to be the most effective botanical treatments for PMS.

Vitex agnus castus: Of them all, I find that vitex agnus castus often works the best, probably because it results in an increased secretion of luteinizing hormone which supports progesterone – and progesterone deficiency is so often a factor in PMS. Several placebo controlled studies have found that Vitex reduces a variety of PMS symptoms.[1]  Particularly it can help cyclical breast tenderness. The usual dose is 100 mg twice a day of a 10:1 extract taken all month long for three consecutive months.

St John’s Wort: A randomized, double-blind, placebo-controlled crossover trial using St. John’s Wort for PMS sufferers looked at 36 women with mild PMS and found that the St Johns Wort group had significant improvements in food cravings, swelling, poor coordination, insomnia, confusion, headaches, crying and fatigue as compared with placebo.[2]

Gingko biloba: A study of 85 women found that those given 40mg of gingko extract three times per day from day 16 of the cycle until day 5 had a significant decrease in PMS symptoms as compared with the placebo group.

Curcurmin: A randomized, double-blind, placebo controlled study in 21-35 yr old women with regular menstrual cycles found that  the group that received curcumin 100 mg from 7 days before and until 3 days after the onset of their period had significantly reduced PMS symptoms compared with the placebo group.[3]

[1] Treatment for premenstrual syndrome with Vitex agnus castus: A prospective, randomized, multi-center placebo controlled study in China. 

[2] The efficacy of Hypericum perforatum (ST John’s Wort) for the treatment of premenstrual syndrome. 

[3] Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial.