Reviewed September 2020

Busting PMS myths – do home remedies actually help?

natural remedies pms

Premenstrual syndrome, or PMS, is the physical, psychological, and behavioural symptoms which recur during the luteal phase (after ovulation until your period starts) of the menstrual cycle and regress or disappear during the rest of your cycle.1

Some women experience severe PMS, otherwise known as premenstrual dysphoric disorder (PMDD). If your symptoms are interfering with your day-to-day life, it is important to seek medical help.

Many theories exist as to why women experience PMS. One of these suggests that some women experience an increase in sensitivity to the change in hormone levels, since the levels appear the same in women who have no symptoms.2

Another theory is related to the neurotransmitters serotonin and gamma-aminobutyric acid (GABA). The receptors of these neurotransmitters are responsive to oestrogen and progesterone. In particular, the breakdown product of progesterone, called allopregnanolone, which influences GABA receptors, has been noted to be reduced in women with PMS symptoms.3,4 These changes result in wide physical and/or psychological disturbances, the most common being abdominal bloating, irritability, mastalgia (breast pain), mood swings, and joint pains.

It is estimated that 40% of women experience symptoms of PMS and 5-8% of those women experience severe PMS.5 In fact, epidemiological studies show that 75% of fertile women experience mild to moderate PMS symptoms.6

Given the effect of PMS on society as a whole, and the suggestion that a lot of women are simply tolerating or self-managing their symptoms, we have looked at what you can do yourself to alleviate any symptoms you may have. Please note, however, that no strong scientific evidence exists to support these remedies, but some women have said they find them beneficial.

Vitamins and minerals

Vitamin B6, also known as pyridoxine, is thought to be required for the optimum development of the corpus luteum (a structure which develops in an ovary after an egg has been released, and which breaks down after a few days if pregnancy does not occur), which produces progesterone.

Studies have shown mixed results when it comes to its effect on treating PMS symptoms, although some women have found it beneficial. The recommended dose from the Department of Health is 10mg.7 Most studies used higher doses than this however, but side effects such as nerve damage to the hands and feet can occur with high doses.8 Instead of a supplement, incorporating foods rich in B6, such as legumes, nuts, or fish may be useful.

It is estimated that 40% of women experience symptoms of PMS and 5-8% of those women experience severe PMS

Some women have lauded evening primrose oil as useful in calming premenstrual symptoms, as it contains unsaturated fatty acids. In one trial of evening primrose oil it was shown to improve menstrual symptoms when given at both 1g/day dosage and 2g/day dosage when compared with a placebo.9 Like vitamin E, it may help with breast symptoms. Fatty acids are thought to help decrease inflammation, and substances that increase inflammation have been noted in women with breast tenderness. Vitamin E is known as an antioxidant and is thought to prevent unsaturated fatty acids from oxidising.10

Other vitamins and minerals such as vitamin D, calcium, magnesium, and isoflavones have been shown in various studies to have some benefits when it comes to relieving symptoms of PMS.11 Calcium and vitamin D were shown to be beneficial in improving overall symptoms in two studies.12,13

Magnesium, used before menstruation, may also be helpful in reducing symptoms of PMS relating to anxiety.14 It was also noted to have a positive role in treatment of symptoms when combined with vitamin B6.15

Lifestyle changes

Basic lifestyle changes may help reduce or relieve your PMS symptoms. With respect to dietary changes, incorporating foods known to have vitamins and minerals shown to improve PMS symptoms may be useful for some women. While no specific dietary modifications have been studied in depth, certain changes have been associated with improved symptoms.

This includes eating little and often to maintain blood sugar levels, incorporating complex carbohydrates and good sources of protein, and cutting back on salt and refined sugars. Maintaining a steady, normal blood sugar level helps maintain hormone levels as it provides regular nutrients and energy needed for hormones to be made and function optimally. Cutting back on alcohol, salt, and caffeine, and drinking plenty of water can help decrease fluid retention, thus easing symptoms of bloating and breast tenderness.

Maintaining a steady, normal blood sugar level helps maintain hormone levels as it provides regular nutrients and energy needed for hormones to be made and function optimally

Exercise, including aerobic exercise and yoga, have been shown to have mixed benefits in reducing symptoms of PMS. Exercise is known to help with stress reduction by modulating associated hormones, so in theory it should be beneficial for some PMS symptoms too. Seeing a psychologist for a therapy called cognitive behaviour therapy (CBT) has been shown to maintain the effects of treatments if PMS is severe.16

Herbal remedies

In a systematic review into herbal remedies for PMS, four trials, including almost 600 women, supported the use of Vitex agnus castus L., also known as chasteberry, which is thought to help the body produce more progesterone.17 In women with PMS, one theory is that progesterone levels may be low at the time when they are supposed to be high.

However, this study concluded that there was inadequate safety data to support use of chasteberry.18 Another systematic review of 29 randomised controlled trials (RCTs) found the evidence for chasteberry contradictory, and therefore that reliable recommendations could not be given.19 On top of this, there is no standard dose established for chasteberry.

Other herbal remedies including St. John’s Wort, ginkgo biloba, and curcumin have shown some benefits in studies.20 However, St. John’s Wort can have some adverse effects, and it can interact with other treatments, such as antidepressants.21

Alternative therapies

Therapies known to help with relaxation and stress reduction, such as reflexology and acupuncture, have been shown to provide some relief from symptoms. Several studies have suggested a benefit from acupuncture, although there may be some bias in the results.22 Reflex points on the ears, hands, and feet seemed to improve symptoms.23 Acupuncture is thought to help as it affects the neurotransmitters that influence various psychosomatic functions (the interaction between psychological and bodily functions).24 It is important these are administered by professionally trained practitioners.

It is important to consult with your doctor before trying any alternative therapy to ensure it is safe for you, particularly to ensure it won’t interact with any other medicines you may already be taking.

Featured image shows a woman looking out of the window with her back to the camera. The image is cropped so you can only see her head and shoulders.

Last updated September 2020
Next update due 2022

Dr. Deyo Famuboni, MB ChB

Dr. Deyo Famuboni is a UK trained GP with over 10 years of medical experience. After graduating from the University of Edinburgh, she went on to do further training within a wide range of medical specialities including obstetrics and gynaecology. She has spent time working abroad as well as within the NHS and private sectors in the UK. She is a member and clinical advisor of the Royal College of General Practitioners and a diplomate of the Royal College of Obstetrics and Gynaecology, Royal College of Paediatricians and the Faculty of Sexual and Reproductive Health. She also has a strong interest in nutrition and health.

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References

  1. NICE, Premenstrual syndrome: What is it?, Clinical Knowledge Summary, National Institute for Health and Care Excellence, May 2019, [online] (accessed 15 September 2020)
  2. NICE, Premenstrual syndrome: What causes it?, Clinical Knowledge Summary, National Institute for Health and Care Excellence, May 2019, [online] (accessed 15 September 2020)
  3. Ibid
  4. Walsh, S., et al., Diagnosis, pathophysiology and management of premenstrual syndrome, The Obstetrician & Gynaecologist, 2015, Vol. 17, Issue 2, pp. 99–104
  5. RCOG, Management of Premenstrual Syndrome: Green-top Guideline No. 48, British Journal of Obstetrics and Gynaecology, Vol. 124, No. 3, 2017, pp. e73-e105
  6. Saeedian, K.A., et al., The association between the risk of premenstrual syndrome and vitamin D, calcium, and magnesium status among university students: a case control study, Health Promot Perspect, 2015, Vol. 5, No. 3, pp. 225-230.
  7. RCOG, Management of Premenstrual Syndrome: Green-top Guideline No. 48, British Journal of Obstetrics and Gynaecology, Vol. 124, No. 3, 2017, pp. e73-e105
  8. Ibid.
  9. Ibid.
  10. Jaafarnejad, F., et al., Compare the effect of flaxseed, evening primrose oil and Vitamin E on duration of periodic breast pain, J Educ Health Promot, 2017, Vol. 6, 2017, p. 85.
  11. RCOG, Management of Premenstrual Syndrome: Green-top Guideline No. 48, British Journal of Obstetrics and Gynaecology, Vol. 124, No. 3, 2017, pp. e73-e105
  12. Thys-Jacobs, S., et al, Calcium supplementation in premenstrual syndrome: a randomized crossover trial, J Gen Intern Med, 1989, vol 4, issue 3, pp 183-189
  13. Thys-Jacobs, S., et al., Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group, Am J Obstet Gynecol, August 1998, Vol. 179, No. 2, pp. 444-452.
  14. Boyle, N.B., et al., The effects of magnesium supplementation on subjective anxiety and stress – a systematic review, Nutrients, 2017, Vol. 9, No. 5, p. E429.
  15. Ibid
  16. RCOG, Management of Premenstrual Syndrome: Green-top Guideline No. 48, British Journal of Obstetrics and Gynaecology, Vol. 124, No. 3, 2017, pp. e73-e105
  17. Dante, G., and Facchinetti, F., Herbal treatments for alleviating premenstrual symptoms: a systematic review, J Psychosom Obstet Gynaecol, 2011, Vol. 32, No. 1, pp. 42–51.
  18. Ibid.
  19. Whelan, A.M., et al., Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review, Can J Clin Pharmacol., 2009, Vol. 16, No. 3, pp. e407-29.
  20. RCOG, Management of Premenstrual Syndrome: Green-top Guideline No. 48, British Journal of Obstetrics and Gynaecology, Vol. 124, No. 3, 2017, pp. e73-e105
  21. Ibid.
  22. Ibid.
  23. Oleson, T., & Flocco, W., Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology, Obstet Gynecol,  1993, Vol. 82, No. 6, pp. 906-11.
  24. Habek,D., et al., Using acupuncture to treat premenstrual syndrome, Arch Gynecol Obstet, 2002, Vol. 267, No. 1, pp. 23-6.