Many women experience a variety of unpleasant symptoms in the week or two before menstruating. These include irritability, anger, headaches, anxiety, depression, fatigue, fluid retention, and breast tenderness. When emotional symptoms related to depression predominate in PMS, the condition is sometimes called premenstrual dysphoric disorder (PMDD). These symptoms undoubtedly result from hormonal changes of the menstrual cycle, but apart from that general statement, medical researchers do not know the cause of PMS or how to treat it.

Conventional treatments for PMS and PMDD include antidepressants, beta-blockers, diuretics, oral contraceptives, and other hormonally active formulations. Of all these, antidepressants in the SSRI family (such as Prozac) are perhaps the most effective.

There is fairly good evidence that calcium supplements can significantly reduce all the major symptoms of PMS. There is also some evidence for the herbs chasteberry and ginkgo. Vitamin B6 is widely recommended as well, but its scientific record is mixed at best.

Calcium

A large double-blind, placebo-controlled study found positive results using calcium for the treatment of PMS symptoms.1 Participants took 300 mg of calcium (as calcium carbonate) four times daily. Compared to placebo, calcium significantly reduced mood swings, pain, bloating, depression, back pain, and food cravings.

Similar findings were also seen in earlier preliminary studies of calcium for PMS.2,3

For more information, including dosage and safety issues, see the full Calcium article.

Chasteberry

The herb chasteberry is widely used in Europe as a treatment for PMS symptoms. More than most herbs, chasteberry is frequently called by its Latin names: Vitex or Vitex agnus-castus.

A double-blind, placebo-controlled study of 178 women found that treatment with chasteberry over 3 menstrual cycles significantly reduced PMS symptoms.8 The dose used was one tablet 3 times daily of a chasteberry dry extract. Women in the treatment group experienced significant improvements in symptoms, including irritability, depression, headache, and breast tenderness.

A double-blind randomized trial of 162 women with PMS compared 8, 20, and 30 mg doses of chasteberry and placebo over the course of three menstrual cycles. Women who took 20mg or 30mg of chasteberry had significantly greater reduction in symptom scores compared to placebo with the greatest reduction in 20 mg dose. There was no significant difference when comparing 8mg to placebo.45

Unfortunately, there is little corroborating evidence as yet for this one well-designed study. A previous double-blind trial compared chasteberry to vitamin B6(pyridoxine) instead of placebo.9 The two treatments proved equally effective. However, because vitamin B 6 itself has not been shown effective for PMS ( see below), these results mean little.10

Even better evidence indicates that chasteberry can help the cyclic breast tenderness often, but not necessarily, connected with PMS.

For more information, including dosage and safety issues, see the full Chasteberry article.

Vitamin B 6

Vitamin B 6has been used for PMS for many decades, by both European and US physicians. However, the results of scientific studies are mixed at best. The most recent and best-designed double-blind study, enrolling 120 women, found no benefit.16 In this trial, three prescription drugs were compared against vitamin B 6 (pyridoxine, at 300 mg daily) and placebo. All study participants received 3 months of treatment and 3 months of placebo. Vitamin B 6 proved to be no better than placebo.

Approximately a dozen other double-blind studies have investigated the effectiveness of vitamin B 6for PMS, but none were well designed, and the results were mixed.17,18 Some books on natural medicine report that the negative results in some of these studies were due to insufficient B 6 dosage, but in reality there was no clear link between dosage and effectiveness.

It has been suggested that the combination of B 6 and magnesiummight be more effective than either treatment alone,19 but this remains to be proven.

For more information, including dosage and safety issues, see the full Vitamin B6 article.