Key points from the evidence on diet & activity for PMS

Dietary advice for PMS

Introduction

  • Premenstrual syndrome (PMS) is cyclical and occurs during the luteal phase (1–2 weeks before menstruation) of a woman’s cycle; symptoms are relieved by the onset of or during menstruation.
  • Most women experience mild symptoms, but for 8–20% it can be severe; the severest form, affecting 3-8% of PMS sufferers, is known as premenstrual dysphoric disorder (PMD),
  • Symptoms of PMS vary between and within individuals and include mood swings, irritability, increased appetite, carbohydrate and alcohol cravings, breast tenderness, headaches and bloating
  • Women with chronic disease e g. diabetes, irritable bowel syndrome (IBS) or allergies, may have a low threshold for developing PMS so good control of chronic medical conditions may reduce the severity of symptoms.
  • Cause
  • Although not proved outright, PMS is thought to be due to an increased sensitivity to progesterone and its metabolites and/or neurotransmitter abnormalities.

Diagnosis

  • It is difficult to diagnose PMS; the most definitive method is a symptom diary as symptoms will start in the luteal phase and cease at the start of or during menstruation

Dietary treatment

  • There is no universally recognised single treatment for PMS
  • For mild to moderate symptoms, lifestyle changes and a healthy diet can substantially reduce, if not alleviate, the symptoms.
  • For PMS sufferers who need to be treated with medication, such as anti-depressants and oral contraceptives, the success rate is no greater than 60-70% but a healthy lifestyle may make the treatment more successful (Bussell, 1998).
  • A healthy diet, regular physical activity, good sleep patterns and stress reduction techniques can help to reduce symptoms
  • Sustained dietary change is necessary for symptom relief and not just premenstrually.

Vitamin D and calcium

  • A diet rich in calcium and vitamin D is associated with a lower incidence of PMS especially lower fat versions of dairy foods.
  • Calcium (1000 mg/day) and vitamin D (10 μg) may be useful in treating premenstrual pain and emotional symptoms associated with PMS
  • Dietary vitamin D on its own has been shown to reduce the risk of PMS specifically breast tenderness and depression
  • A calcium (500mg) supplement with vitamin B6 (40mg) has also been shown to exert an effective control of PMS symptoms.

Other vitamins and minerals

  • A diet containing adequate iron and magnesium may help reduce PMS symptoms
  • Upping intakes of thiamine and riboflavin may reduce the incidence of PMS
  • Vitamin E combined with evening primrose oil has been shown to be effective for premenstrual breast pain

Dietary factors

  • Fish oil (omega 3 ) may help reduce some symptoms of PMS, including depression
  • Increasing dietary fibre can help to alleviate the constipation that may occur premenstrually.
  • Alcoholics are prone to PMS and alcohol aggravates symptoms
  • Some PMS sufferers have alcohol cravings premenstrually but alcohol metabolism may also be impaired so it has more of an effect during this time.
  • Overweight and obesity is associated with PMS
  • Many women report an increase in appetite during the luteal (PMS) phase and this may be due to the fact that the metabolic rate can rise during this time, hence allowing a little more food to be eaten without causing weight gain,

Herbals

  • There is a little evidence for Jingqianping, Vitex agnus castus, Ginko biloba, ginger and Crocus sativus being effective, but more trials are needed

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