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While researching this article, I read that premenstrual syndrome, or PMS, affects up to 40% of menstruating women.  That number surprised me, as I’ve yet to meet a woman who claims she’s never experienced PMS.  Except for my mother, that is; but then she didn’t have any symptoms of menopause, either.  I should be so lucky – if PMS is any indicator, it’s not looking good.

PMS actually doesn’t come up that often in my patient interactions; patients usually only mention it if it’s particularly severe or affecting their relationships or work performance.  It’s not something I usually bring up in a periodic health examination or during a Pap test, though I probably should.  Especially given what I know now about the basic nutritional interventions that can help manage symptoms – this information could probably make a real difference to the lives of a significant number of women.

The classic symptoms of PMS include pre-menstrual depression and moodiness, irritability, breast tenderness, headaches, abdominal cramping, insomnia, bloating and food cravings.  It’s enough to make you want to drown yourself in a vat of ice cream, or bury yourself in chocolate cake.  Neither of these remedies, unfortunately, is particularly helpful in the long run.

In 2000 the American College of Obstetricians and Gynecologists published recommendations for the management of PMS.  Their Level B recommendations (based on “limited or inconsistent evidence”): 1) Carbohydrate-rich foods and beverages may improve mood symptoms and food cravings and are a reasonable first line approach; 2) Calcium supplements have been shown to be effective in treatment; and 3) Magnesium, Vitamin B6 and Vitamin E have minimal effectiveness in treatment of PMS.   Their Level C recommendations (based on consensus and expert opinion) recommend complex carbohydrates and calcium, magnesium and vitamin E supplements as first-line treatment, before considering “Step 2”, anti-depressant medications.

Several other sources stress the importance of eating regular (every 2-3 hours) small meals rich in complex carbohydrates, protein and fat, in order to keep blood sugar levels stable.  As much as you may crave simple sugars like baked goods, pop, or candy, stay away from them to prevent rapid fluctuations in blood sugar that contribute to moodiness and irritability.

Caffeine is another food to avoid, as it’s thought to contribute to irritability and breast tenderness.  I’m sorry, but this also includes chocolate.  Of course PMS is not the time for a regular coffee-drinker to go cold turkey – you’ll only feel worse.  Instead, decrease coffee intake gradually; green tea may make for a gentler substitute in the meantime.

The calcium recommendations grew out of a controlled trial from Columbia University in 1998, published in the American Journal of Obstetrics and Gynecology.  They studied over 400 women with PMS, giving them either 1200 mg of chewable Calcium carbonate or placebo daily for three months.  Those taking the supplements enjoyed a 48 percent decrease in symptom severity by the third cycle, compared to 30 percent taking placebo.  Apparently, calcium supplementation may replenish an underlying deficiency in calcium levels, which arises secondary to the hormone shifts of the menstrual cycle.  On top of that, most woman aren’t taking in enough calcium, period.  Try this regimen a few months, as it may take several cycles for them to notice the benefits (but check with your doctor, first, to make sure it’s ok for you to be taking this dose of calcium).

According to several review articles, magnesium in daily doses of 200-400 mg may provide a minimal benefit in reducing bloating and water retention.  Again, check with your doctor first – you might try this for at least two months or more.
Vitamin E, 400 IU daily, has been documented as a treatment for breast pain and swelling.  It may also help with some mood symptoms.  Of course, this advice should be weighed with the recent reports of increased risk of death with Vitamin E supplements over 400 IU.

A review in the 2003 American Family Physician reported that nine randomized trials of vitamin B6 have shown improvement of PMS symptoms, but the poor quality of the trials limit their usefulness.  Still, it might help, and doses of up to 100 mg daily are unlikely to be of any harm.

If you’re bothered by bloating and water retention, avoid sodium (salt).  Alcohol is also a bad idea; it’s a depressant and can make your mood symptoms worse.  Not to mention, a hangover is the last thing in the world an already cranky woman with PMS needs.  A study reported in the 1996 British Journal of Obstetrics and Gynecology also found that regular alcohol consumption increased length of and severity of cramps in those who experience cramping as part of PMS.  Yikes!

So there you have it: eat regular small meals which include complex carbohydrates (such as whole grains), try the above supplements, with permission from your doctor, for at least a few months, and avoid caffeine, salt, alcohol and simple sugars.  I’d also recommend lots of vegetables and low-sugar fruits like apples and berries, while minimizing red meat, saturated and trans fats.  And chocolate cake?  Only in emergency situations (trust me, you’ll regret it).


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