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 .

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

Tags: , , ,

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.


Tags: , , ,

Monday, May 21st, 2012

The Four Stage Approach to Lessening #PMS

The 4 stage approach to PMS

Eating a healthy balanced diet and keeping fit and well will help to reduce and even alleviate PMS symptoms. If you need to go on and have other treatment, it will more likely to be successful if you have the foundation of a healthy diet and lifestyle. The ‘four stage approach’ is a tried and tested, healthy eating and lifestyle plan for the treatment of PMS based on scientific research. The first phase must always be followed before the other phases as it forms the foundation without which the other phases will not be effective. The other phases can then follow but do not have to be followed in strict order.

Phase 1: baseline healthy diet

Ensure you are eating a healthy balanced diet i.e. one that is low in saturated and trans fats, low in refined sugar, low in salt, high in fibre and each meal is based on a wholegrain starchy food such as rice, cereal, pasta, and multigrain bread. Make sure you have at least 3 portions of dairy daily and have at least two protein portions a day and at least five fruit and veg daily. Keep alcohol, tea, coffee and other caffeine containing drinks to moderate levels.

 Phase 2: controlling blood sugar swings and mood

Make sure each meal contains a good serving of a starchy food; wholegrain varieties of these are best and there is some evidence that foods with a low glycaemic index may be most helpful in alleviating some symptoms of PMS. Have three meals a day and, if there is a long gap between meals, then have a starchy snack too.

Phase 3: supplements

Not many supplements have been shown to work consistently in research studies, but calcium (1,000mg) and vitamin D (10 mcg) combined have shown some positive results, particularly if you don’t eat much dairy. An evening primrose oil supplement with vitamin E may also be helpful, especially if there is breast pain. You must take supplements continuously for 3-4 months before the full effect is achieved. However, stop taking them if they have no effect.

Phase 4: other lifestyle and health factors

Make sure you properly treat and control medical conditions such as allergies, IBS, anaemia or diabetes, which will otherwise aggravate PMS symptoms.  Carrying extra weight also aggrevates PMS symptoms Being fit and healthy will minimise PMS symptoms, so build in some exercise into your lifestyle and minimise stress.

Tags: ,