Introduction to PMS

Premenstrual syndrome (PMS) was first described by Frank and Horney in 1931. It is a common cause of physical, behavioural and social dysfunction in women of reproductive age that occurs cyclically and recurrently, starting 1-2 weeks before the menstrual period (the luteal phase of the cycle).  Often the symptoms of PMS manifest themselves as irritability, hence why the condition used to be called premenstrual tension (PMT).  A characteristic of the syndrome is that all symptoms are relieved by the onset of, or during menstruation.

The precise cause of PMS is still unknown, and relatively little research has been conducted on this condition.  Most women experience mild emotional or physical premenstrual symptoms, but for some 8-20% it can severely disrupt their lives to the extent that they seek medical treatment .  The most severe form of the syndrome affects between 3% to 5% of women of reproductive age and under the Diagnostics and Statistical Manual of Mental Disorders is known as premenstrual dysphoric disorder (PMDD)

It is thought that PMS may be caused by an increased sensitivity to circulating progesterone and its metabolites rather than abnormal concentrations of hormones .  Sex steroids produced by the corpus luteum of the ovary are thought to be symptom provoking, as the cyclicity disappears in anovulatory cycles when a corpus luteum is not formed.  The response systems within the brain known to be involved in PMS symptoms are the serotonin and gamma-amino butyric acid (GABA) systems. Progesterone metabolites, especially allopregnanolone, are neuroactive, acting via the GABA system in the brain. Drugs such as SSRIs and substances inhibiting ovulation, such as gonadotrophin-releasing hormone (GnRH) agonists, have proven to be effective treatments.   Differences in leptin levels between PMS subjects and controls have also been observed which could point to a role of leptin in the pathophysiology of the disease .

An older theory, but one which still re-emerges, is that PMS can be caused by a lack of production of prostaglandin E1 (PGE1) which is derived from omega 6 fatty acids.  It is believed that in PMS there is insufficient delta 6 desaturase enzyme around to convert the Linoleic acid to Gamma linolenic acid and therefore insufficient PGE1 is formed.  Insufficient PGE1 is believed to cause undue sensitivity to the luteal phase rise in ovarian hormones.

Various vitamins and minerals and fatty acids, including B Vitamins and Magnesium are involved as co-enzymes in the production of these neurotransmitters and hence why some believe supplementing the diet with them helps to reduce PMS symptoms although, except for magnesium, a true deficiency in any particular nutrient has been hard to show.


Symptoms of PMS vary from woman to woman and each month women can individually experience different symptoms.  These include mood swings, irritability, increased appetite, carbohydrate and alcohol cravings, breast tenderness, headaches and bloating.

It is believed that having other underlying chronic diseases such as diabetes, IBS, allergies etc can also lower the threshold for developing PMS.  This also ties in with the finding that women with higher levels of C reactive protein (CRP) have more severe premenstrual symptomsal. Making sure that any other chronic medical condition is controlled as best as possible can help reduce the chance of more severe PMS symptoms emerging .


PMS can be hard to diagnose, as many conditions can worsen during the premenstrual phase, such as allergies and even conditions such as migraine and asthma, but this in itself is not an indication that PMS is present.  The only real way of identifying PMS is to keep a symptom diary.  Symptoms of PMS will appear in the luteal phase (up to two weeks before the period start) and disappear as soon as a period is fully underway .

There is no single treatment universally recognised for PMS and so women often turn to diet, supplements and alternative approaches to relieve their symptoms.  For women with mild to moderate symptoms, lifestyle changes and eating a healthy diet can substantially reduce if not alleviate the symptoms.  For those who need to go on to receive further treatment such as drugs, having a baseline healthy diet and keeping physically active can mean the treatment is more successful .

Thursday, April 26th, 2018

PMS may be linked to drinking alcohol

Over 10 percent of PMS cases linked to drinking habits

If you are a woman, you may be acquainted with the confusing hell of premenstrual syndrome. Nobody knows exactly what factors raise the risk, but data point the finger at alcohol.
woman enjoying a glass of red wine

If you use red wine as a home remedy for cramps, or if you enjoy having a drink with your meals, you may be exacerbating your risk of PMS.

Do you experience mood swings and changes in appetite before your period?

Do your breasts get so sensitive that you start to wear loose-fitting tops and bralettes just so you don’t hurt yourself?

Do these and other premenstrual symptoms — changes in your sleeping pattern, sporadic nausea, and headaches, for example — interfere with your normal lifestyle to a lesser or greater degree?

If so, you may have premenstrual syndrome (PMS), which many women commonly experience.

Though the exact causes and risk factors for PMS are unknown, several studies have suggested that women who regularly drink alcohol are more likely to experience the symptoms.

A new systematic review and meta-analysis of the relevant literature now confirms that there may be more than a little merit to the claim that alcohol influences PMS.

The researchers who conducted the analysis hail from: the University of Santiago de Compostela in Spain, the Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública in Madrid, also in Spain, and the University of Southampton, in the United Kingdom.

An article detailing the findings of this research, whose first author is María del Mar Fernández, was published yesterday in BMJ Open.

Risk heightened by 45 percent

The researchers extracted and analyzed the data from 19 studies conducted across eight countries and, combined, worked with more than 47,000 participants. They found a “moderate association” between alcohol and an increased risk of PMS.

The estimated percentages, however, are far from negligible: drinkers are estimated to have a 45 percent higher risk of PMS, and heavy drinkers have an even higher risk, at 79 percent.

Thus, del Mar Fernández and colleagues think that 11 percent — or approximately 1 in 10 — of PMS cases may have to do with the women’s drinking habits.

However, as it often goes with studies that observe relationships without looking at the possible underlying mechanisms, there is a caveat: the researchers are unsure as to the direction of the causal relationship.

After all, popular knowledge has it that drinking certain types of alcohol — usually red wine — can help to ease cramps related to the menstrual period.

Still, the study authors believe that the high numbers and the consistency of the links revealed by studies looking at the relationship between alcohol and PMS suggest that alcohol is the probable culprit in this equation.

Many women may drink too much

“Worldwide, the proportion of current female drinkers is 28.9 percent, while that of heavy female drinkers is 5.7 percent,” the study authors write.

“In Europe and America,” they add, “these figures are much higher and reach 59.9 percent for current drinking and 12.6 percent for heavy drinking in Europe.”

According to data from the National Institute on Alcohol Abuse and Alcoholism, 5.3 million adult women in the United States have alcohol use disorder. Also, among the women who drink, 13 percent indulge in more than seven drinks per week.

“If [the] association [between alcohol consumption and PMS] is of [a] causal nature,” write the researchers, “eliminating heavy drinking in women would then prevent 1 in every 12 cases of PMS in Europe.”

As to how alcohol may raise the risk of premenstrual symptoms, several biological mechanisms could be at play. Among these, the study authors mention the fact that alcohol could create hormonal imbalances by influencing the levels of certain sex hormones.

Another effect of alcohol, they say, may be that it alters levels of serotonin — which is a hormone largely held responsible for mood alterations and disorders such as anxiety and depression — in the brain.

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Monday, August 29th, 2016

Key points from the evidence on diet & activity for PMS

Dietary advice for PMS


  • 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.


  • 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,


  • 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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Sunday, May 12th, 2013

New book on #PMS published on kindle

Coping with PMS in Four Steps


May 2013: ‘The four step Approach to PMS’ by Gaynor Bussell. Kindle book. ISBN: 978-1-909795-00-6.


Coping with PMS in four steps using a lifestyle and diet approach. A balanced diet, low glycaemic index diets, useful supplements and controlling stress and chronic conditions by encouraging weight-loss and physical activity.


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