Health: Can you control PMS?
Dietitian Orla Walsh on the common problem of PMS - what we should eat and other measures we can take to help ease that time of the month
Premenstrual syndrome (PMS) is an umbrella term for a group of physical, behavioural or mood changes that occur one to two weeks before menstruation. Symptoms usually stop once a woman's period begins. This means that for some women two to three weeks of every month are being disrupted by menstruation. Life is stressful enough without having to deal with PMS, so how can you control of your symptoms?
To understand PMS, it's important to understand a typical cycle. To take you back to biology class for a moment, the typical menstrual cycle lasts about 28 days.
This isn't an exact science and does indeed vary slightly from woman to woman. There are two phases within the menstrual cycle, one phase leading up to ovulation and the other occurring afterwards.
The first phase occurs from the day menstruation begins right up until ovulation. The second phase, which occurs after ovulation and before menstruation, is associated with PMS. During this phase, oestrogen and progesterone levels rise in preparation for pregnancy. The levels of these hormones reduce if pregnancy doesn't occur.
Although there may be many reasons someone suffers more from PMS, it's a safe assumption that the female hormones are involved. Causes as such may not be the same for everybody but include monthly hormonal fluctuations, abnormal levels of hormones, hormonal dysregulation, or that a person is simply more sensitive to hormonal fluctuations.
Considering this, it's no wonder that approximately 85% of women display at least one PMS symptom (see table, right). Fortunately, many women experience mild symptoms. Nevertheless, there is a subset of women, a little less than 10%, who are thought to have a more severe form of PMS called premenstrual dysphoric disorder (PMDD).
As you may notice from the table, other medical and psychiatric conditions have similar symptoms to PMS. For this reason it is important to seek guidance from your local GP if you have concerns. Keeping a chart of your symptoms on a calendar for comparison with your cycle is helpful to your practitioner in making a diagnosis or helping decide on the best form of action for you.
The link between PMS and your lifestyle
A BMI <27.5kg/m2 has been shown to be significantly associated with risk of PMS. For each 1kg/m2 increase in BMI above healthy there is a reported 3% increase in risk of PMS. Extreme fluctuations in weight may matter too as those who experienced a yo-yo in weight have been reported to have a 36% higher risk of PMS.
A case-control study looked at women aged 27 to 44 who were free of PMS at the beginning of the study. At the 10-year follow-up, they compared alcohol intake of women who did not experience PMS. Results from this study didn't point to any significant relationship between regular alcohol intake and PMS incidence.
Before you go celebrating, let's look at this logically. Alcohol is not good for us. There is no safe amount. Although alcohol may not increase our risk or incidence of PMS, it can exacerbate most PMS symptoms.
For example, alcohol will negatively impact our sleep, our bowels, cravings, mood and energy levels. Alcohol also lowers the body's levels of B vitamins, important nutrients in PMS management.
The same study that was mentioned above investigated the link between smoking and PMS. In the study, current smokers were twice as likely as those that have never smoked to develop PMS. The study also showed that the longer a person has smoked for and the earlier they started to smoke, the greater their risk of developing PMS. Additionally, those that smoked between the ages of 15 to 19 were at a 40% higher risk of developing acne, anger and backaches.
The reason for this is that smoking affects our levels of hormones. Smoking has been associated with lower progesterone levels after ovulation and between menses.
It has also been associated with higher levels of testosterone, shorter menstrual periods and more irregular cycles.
What's more, smoking may lower the body's vitamin D level which has been associated with PMS incidence and severity.
Individual symptom management
Dietitians are able to guide a person on dietary changes to improve management of many of the individual symptoms of PMS. For example, dietary modifications can greatly improve the likes of gut issues, low energy, water retention and poor sleep. Nonetheless, there are many individual micronutrients that may play a central role in PMS risk, development and management.
Vitamin D, calcium and magnesium
In a case-control study, intake of calcium and vitamin D was measured on three separate occasions by a food frequency questionnaire.
Women with the highest vitamin D and calcium intake had a lower risk of PMS when compared to those with poor intake. Interestingly, the intake of skimmed or low-fat milk was also associated with a lower risk.
In a different study, nutritional status of vitamin D, calcium and magnesium was compared in young students affected by PMS. Unlike the other study that looked at total intake, this study looks at blood levels of these nutrients.
Most of those within the study were deficient in vitamin D, so information regarding this vitamin and risk was difficult to ascertain.
Nonetheless, this study showed a linked between calcium and magnesium status and PMS risk. Interestingly, more than one-third of the PMS cases were deficient in magnesium.
Therefore ensuring adequate intakes of vitamin D, calcium and magnesium seems to be important in the management of PMS.
B vitamins play a role in many different areas within the body. In particular thiamine (vitamin B1), riboflavin (vitamin B2) and vitamin B6 are required to synthesize neurotransmitters that are potentially involved in the pathophysiology of PMS.
In a study, intakes of vitamin B1 and B2 from food were each inversely associated with the incidence of PMS. Women with the highest intake of vitamin B2 had a 35% lower risk of developing PMS than did those with the lowest intake. Focus on ensuring foods rich in these foods are within your diet may help manage your PMS.
In a more robust study called a systematic review, the effectiveness of vitamin B6 in the management of PMS was investigated while combining results from nine studies. The authors acknowledged the low quality of most of the trials included. However, results suggest that vitamin B6 is likely to be of benefit in treating PMS.
Considering this, what foods should you introduce into your weekly shop? Generally speaking, dairy, nuts, seeds and oily fish appear to play central roles in PMS relief.
Although many nutrients are important for PMS management, many people like to go down the alternate route. Chasteberry, Ginko and Evening Primrose Oil (above) are common choices. But do they work?
Chasteberry (Vitex agnus-castus) is a fruit of the chaste tree. Although there isn't a lot of solid science linking chasteberry to improvements in any condition, there are preliminary data suggesting that it may help with PMS.
In one study, a supplement was given to 170 participants each day for three consecutive cycles. It was randomised and controlled, which means that some people received the supplement while others were taking a placebo. Neither the participants nor the researchers knew who was taking what. Those taking the supplement showed greater improvement in symptoms such as irritability, anger, headache and breast fullness. Overall, when used appropriately, chasteberry appears to be generally well tolerated and safe. However, those on the contraceptive pill are not advised to take it, as a precautionary measure.
Ginkgo is one of the oldest living tree species in the world and has a long history in traditional Chinese medicine. It has been reported that the extract from ginkgo leaves is used as a dietary supplement for many conditions including PMS.
In one study, gingko biloba was found to improve PMS symptoms, particularly breast tenderness and fluid retention. However, its safety has come under question with side effects such as headache, stomach upset, bleeding risk and allergic skin reactions being reported.
Evening Primrose Oil (EPO) is the fatty acids that have been extracted from the seeds of its flower. In a review of 10 studies, only two of the studies were well designed. Both of these studies showed that EPO had no benefit to PMS.