Women who have premenstrual syndrome (PMS) experience a variety of physical
and emotional symptoms that occur each month from 2 to 14 days before their
menstrual cycle. The symptoms usually disappear once the cycle begins. PMS may
begin at any age and ends after menopause. Approximately 75 percent of women
experience PMS to some degree, with 20 to 50 percent finding that symptoms
disrupt their daily activities, and 3 to 5 percent becoming
|Signs and Symptoms|
PMS is often accompanied by the following signs and symptoms.
- Abnormal bloating and weight gain
- Breast swelling, tenderness
- Mood swings
- Depression and anxiety
- Skin disorders
- Changes in appetite, food cravings
- Changes in interest in sex
- Headaches, backaches, cramps
- Inability to concentrate, loss of interest in usual activities,
|What Causes It?|
While the exact cause of PMS is unknown, the most popular theories include
hormonal changes (estrogen excess or progesterone deficiency), hypoglycemia (low
blood sugar), vitamin B6 deficiency, abnormal metabolism of
prostaglandin (hormone-like substances), excessive fluid retention, and
endorphin (a substance in the brain that provides pain relief)
|Who's Most At Risk?|
Women with a history of the following conditions are at a higher-than-average
risk for having PMS.
- Dysmenorrhea (painful menstruation)
- Depressive, mood, anxiety, or bipolar disorders (family history,
- Postpartum depression or psychotic episodes
- High stress
|What to Expect at Your Provider's Office|
If you are experiencing symptoms associated with PMS, you should see your
health care provider. He or she can help make a diagnosis and guide you in
determining which treatment or combination of therapies will work best for
You'll need to chart your symptoms and their severity daily for one to two
months. Your provider will take a detailed history of symptoms, do a physical
and gynecologic examination to rule out other medical conditions, and conduct a
psychosocial evaluation. Certain laboratory and imaging studies may be used,
such as a Pap smear, complete blood count, chemistry screen, fasting blood
glucose test, and thyroid studies.
Reducing stress, increasing exercise, and making dietary changes around the
time of menstruation can prevent PMS symptoms from
Preventive measures and, in some cases, drug therapy, are most often used for
Your provider may prescribe the following medications.
- Diuretics, for bloating and water retention
- Analgesics, for headaches and cramps
- Beta-blockers and calcium-channel blockers, to prevent the onset of
- Prostaglandin inhibitors for painful menstruation
- Spironolactone for skin conditions
- Medications that block ovulation
- Bromocriptine for breast soreness
- Anti-anxiety medications
- Progesterone, for relief of symptoms
Women who are planning to become pregnant should avoid medications such as
prostaglandin inhibitors, diuretics, spironolactone, and
|Surgical and Other Procedures|
Women whose symptoms are severe and do not respond to treatment may need to
undergo a hysterectomy, including removal of the ovaries, followed by estrogen
|Complementary and Alternative Therapies|
A comprehensive treatment plan for PMS may include a range of complementary
and alternative therapies.
Decreasing or avoiding caffeine (including chocolate), saturated fats, sugar,
salt, dairy, meat, poultry, and alcohol can help reduce the intensity and
duration of symptoms. Nutritional deficiencies may be addressed with these
- Vitamin B6 (100 to 200 mg a day) with B-complex (50 to 100
mg a day)
- Magnesium (400 mg a day)
- Vitamin E (400 to 600 IU a day), especially with breast
- Essential fatty acids: omega-3 and omega-6 (3,000 to 4,000 mg a day
for three months, then decrease dose by 1,000 mg every two months)
- Chromium (250 mcg one to two times per day) to reduce sugar
Herbal remedies may be helpful in alleviating symptoms. The following herbs
should be used in combination, either as tincture (60 drops three times a day or
tea (1 cup three to four times a day):
- Chaste tree (Vitex agnus castus) (175 mg a day)
- Black cohosh (Cimicifuga racemosa) (100 to 600 mg a
- Valerian (Valeriana officinalis) (150 to 300 mg one to four
times a day, or before bed for insomnia) or kava kava (Piper methysticum)
(200 mg one to four times a day, or before bed). Reduce dose of either herb if
- Milk thistle (Silybum marianum) (200 to 600 mg a
- Dandelion (Taraxacum officinale) root and/or leaves as a tea or
tincture can be used as a diuretic. If you have liver problems, consult with an
experienced practitioner before using dandelion.
- St. John's wort (Hypericum perforatum) (300 mg two to three
times per day) for depression associated with PMS. Must be taken consistently
throughout the month; direct sun exposure may cause rashes in some
Herbs are generally available as dried extracts (pills, capsules, or
tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose
for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20
minutes). For PMS, teas or tinctures are preferred.
There have been few studies examining the effectiveness of specific
homeopathic remedies. Professional homeopaths, however, may recommend one or
more of the following treatments for PMS based on their knowledge and clinical
experience. Before prescribing a remedy, homeopaths take into account a person's
constitutional type. In homeopathic terms, a person's constitution is his or her
physical, emotional, and intellectual makeup. An experienced homeopath assesses
all of these factors when determining the most appropriate remedy for a
- Chamomilla — for intense menstrual
pain; this remedy is most appropriate for individuals who are extremely
irritable, angry, and have frequent mood swings
- Cimicifuga — for feelings of hysteria,
frustration, and being overwhelmed; this remedy is most appropriate for
individuals who have labor-type pains that migrate from one side of the body to
the other and may involve the back or even sciatic nerve (the largest nerve in
the body; extends from the lower back down through the legs and knees)
- Colocynthis — for cramps that are
relieved by bending forward, abdominal massage, and warmth (such as a heating
pad); this remedy is most appropriate for individuals who are extremely
irritable and restless
- Ignatia — for emotional symptoms such
as grief, panic, and mood swings; this remedy is most appropriate for
individuals who feel particularly vulnerable
- Lachesis — for individuals who tend to
be annoyed, caustic, talkative, and envious and whose pain and bloating is worse
on the left side; symptoms tend to worsen upon awakening in the morning and with
exposure to heat or light pressure; symptoms improve dramatically when
- Lycopodium — for bloating with
backaches and gas that are the worst during early evening and in warm weather
- Magnesia phos — for sharp cramps that
are relieved by bending forward, abdominal massage, and warmth (such as a
heating pad), but are worsened by cold air
- Nux vomica — for individuals who are
extremely irritable, confrontational, and feel nauseous
- Pulsatilla — for irregular periods
with cramps, bloating, and/or mood swings as the predominant symptoms; an
appropriate candidate for Pulsatilla is gentle and yielding but clingy
and cries easily; may have nausea and water retention that is aggravated by heat
- Sepia — for bloating, mood swings,
constipation, drowsiness, and irritability
Although scientific evidence regarding the use of acupuncture for PMS is
lacking, this condition is frequently treated by acupuncturists. Acupuncturists
treat people with PMS based on an individualized assessment of the excesses and
deficiencies of qi located in various meridians. In the case of PMS, a qi
deficiency is usually detected in the liver and/or spleen meridians. Many
treatments include moxibustion (a technique in which the herb mugwort is burned
over specific acupuncture points), and qualified practitioners may also
recommend herbal treatment or dietary modifications.
Some studies suggest that chiropractic spinal manipulation may be effective
for women with PMS. Women with PMS have been found to have a higher rate of
spine-related problems (such as tenderness and muscle weakness) than those who
do not have PMS. In one study, researchers found that women with PMS experience
a significant decrease in symptoms after receiving spinal manipulation and soft
tissue therapy compared to those who do not receive the chiropractic treatment.
The researchers note that these effects may be short-lived and that monthly
chiropractic treatment would probably be needed to maintain these positive
Severe PMS can disrupt a woman's life. Psychological and emotional support as
well as treatment of the physical symptoms may help.
Ongoing follow-up and regular evaluations are necessary.
American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association;
Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed.
Garden City, NY: Avery Publishing; 1997:443-445.
Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace
Beck WW. Obstetrics and Gynecology. 2nd ed. New York, NY: John Wiley;
Blumenthal M, ed. The Complete German Commission E Monographs. Boston,
Mass: Integrative Medicine Communications; 1998:119-20, 108, 90, 226-7.
Bowman MA. Ambulatory Care for the Adult. Madison, Conn: Fence Creek
Publishing; 1998:121, 139, 140, 438.
Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines.
3rd ed. New York, NY: Penguin Putnam; 1997: 188-189.
Cunningham FG, et al. Williams Obstetrics. 19th ed, Norwalk, Conn:
Appleton & Lange; 1993:97-99.
Danforth's Obstetrics and Gynecology. 7th ed. Philadelphia, Pa: J. B.
Lippincott; 1994:599-600, 677-678.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:290.
Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal
Medicines. Montvale, NJ: Medical Economics Company; 1998:1222-3, 1175,
Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New
York, NY: Warner Books; 1996: 185-186.
Keye WR Jr. The Premenstrual Syndrome. Philadelphia, PA: W. B.
Saunders; 1988: 48, 55, 62, 74, 78, 114-118, 120, 147-149, 151-152, 180-183.
Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North
Atlantic Books; 1992:112-118.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:58-62, 68-9, 82-6, 210-1,
274-6, 310-5, 343-7.
Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin,
Calif: Prima Publishing; 1998:470-479.
Rivlin ME, Martin RW. Manual of Clinical Problems in Obstetrics and
Gynecology. 4th ed. Boston, Mass: Little, Brown; 1994:401-404.
Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin
Putnam; 1995: 190-191.
Walsh MJ, Polus B. The frequency of positive common spinal clinical
examination findings in a sample of premenstrual syndrome sufferers. J
Manipulative Physiol Ther. 1999a;22(4):216-220.
Walsh MJ, Polus B. A randomized placebo controlled clinical trial on the
efficacy of chiropractic therapy on premenstrual syndrome. J Manipulative
Physiol Ther. 1999b;22(9):582-585.
Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats
Publishing Inc; 1987:364-369.
|Review Date: March 2000|
|Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace,
Cambridge, MA; Gary Guebert, DC, DACBR, (Chiropractic section October 2001)
Login Chiropractic College, Maryland Heights, MO; Richard A. Lippin, MD,
President, The Lippin Group, Southampton, PA; Joseph Trainor, DC, (Chiropractic
section October 2001) Integrative Therapeutics, Inc., Natick, MA; Marcellus
Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's Catholic
Medical Center, New York, NY; Ira Zunin, MD, MPH, MBA, (Acupuncture section
October 2001) President and Chairman, Hawaii State Consortium for Integrative
Medicine, Honolulu, HI.|
Copyright © 2004 A.D.A.M., Inc
The publisher does not accept any responsibility for the accuracy of
the information or the consequences arising from the application, use, or misuse
of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed