Vitamins that may be helpful
Many,9 10 11 12 13 though not
all,14 clinical trials show that taking 50–400 mg of vitamin B6 per day for several months help relieve
symptoms of PMS. A composite analysis of the best designed controlled trials shows that
vitamin B6 is more than twice as likely to reduce symptoms of PMS as is placebo.15
Many doctors suggest 100–400 mg per day for at least three months. However, intakes
greater than 200 mg per day can cause side effects and should never be taken without the
supervision of a healthcare professional.
Women who consume more calcium from their
diets are less likely to suffer severe PMS.16 A large double-blind trial found that
women who took 1,200 mg per day of calcium for three menstrual cycles had a 48% reduction in
PMS symptoms, compared to a 30% reduction in the placebo group.17 Other
double-blind trials have shown that supplementing 1,000 mg of calcium per day relieves
premenstrual symptoms.18 19
Women with PMS have been shown to have impaired conversion of linoleic acid (an essential
fatty acid) to gamma linolenic acid (GLA).20 Because a deficiency of GLA might, in
theory, be a factor in PMS and because evening
primrose oil (EPO) contains significant amounts of GLA, researchers have studied EPO as a
potential way to reduce symptoms of PMS. In several double-blind trials, EPO was found to be
beneficial,21 22 23 24 whereas in other trials it
was no more effective than placebo.25 26
Despite these conflicting results, some doctors consider EPO to be worth a try; the amount
usually recommended is 3–4 grams per day. EPO may work best when used over several
menstrual cycles and may be more helpful in women with PMS who also experience breast
tenderness or fibrocystic breast
Women with PMS have been reported to be at increased risk of magnesium
deficiency.28 29 Supplementing with magnesium may help reduce symptoms.30
31 In one double-blind trial using only 200 mg per day for two months, a significant
reduction was reported for several symptoms related to PMS (fluid retention, weight gain, swelling of extremities,
breast tenderness, and abdominal bloating).32 Magnesium has also been reported to
be effective in reducing the symptoms of menstrual migraine headaches.33 While the
ideal amount of magnesium has yet to be determined, some doctors recommend 400 mg per
day.34 Effects of magnesium may begin to appear after two to three months.
A preliminary, uncontrolled trial found that women with severe PMS who took potassium supplements had complete resolution of PMS
symptoms within four menstrual cycles.35 Most participants took 400 mg of potassium
per day as potassium gluconate plus 200 mg of potassium per day as potassium chloride for the
first two cycles, then switched to solely the gluconate form (600 mg potassium per day) for
the remainder of the year-long trial. Without exception, all of the women found their symptoms
(i.e., bloating, fatigue, irritability, etc.) decreasing gradually over three cycles and
disappearing completely by the fourth cycle. Controlled trials are needed to confirm these
The amino acid, L-tryptophan has been shown
to help relieve PMS symptoms. In a double-blind trial, women with premenstrual discomfort
received 6 grams per day of L-tryptophan or placebo for 17 days.36 Those who took
L-tryptophan had significant improvement of symptoms, including mood swings, tension,
irritability, breast sensitivity, water retention, and headache. There was a slight reduction
in premenstrual depression, but it was not statistically significant. L-tryptophan is
available only by prescription. It has not been determined whether 5-hydroxytryptophan (5-HTP, a metabolic byproduct of
L-tryptophan that is available without prescription) has similar effects.
In a double-blind trial, supplementing with
soy protein (providing 68 mg of isoflavones per day) for two menstrual cycles was
significantly more effective than a placebo at relieving premenstrual swelling and
cramping.37 The placebo used in this study was cow's milk protein. Some doctors believe that cow's
milk, because of its estrogen content, can
worsen premenstrual symptoms. If that is the case, then the beneficial effect of soy protein
may have been overestimated in this study.
Although women with PMS do not appear to be deficient in vitamin E,38 a double-blind trial reported
that 300 IU of vitamin E per day may decrease symptoms of PMS.39
Some of the nutrients mentioned above appear together in multivitamin-mineral supplements. One double-blind
trial used a multivitamin-mineral supplement containing vitamin B6 (600 mg per day), magnesium (500 mg per day), vitamin E (200 IU per day), vitamin A (25,000 IU per day), B-complex vitamins, and various other vitamins and
minerals.40 This supplement was found to relieve each of four different categories
of PMS symptoms. Related results have been reported in other clinical trials.41
Most well-controlled trials have not found vaginally applied natural progesterone to be effective against the symptoms of
premenstrual syndrome.43 Only anecdotal reports have claimed that orally or
rectally administered progesterone may be effective.44 Progesterone is a hormone,
and as such, there are concerns about its inappropriate use. A physician should be consulted
before using this or other hormones. Few side effects have been associated with use of topical
progesterone creams, but skin reactions may occur. The effect of natural progesterone on breast cancer risk remains unclear; some research
suggests the possibility of increased risk, whereas other research points to a possible
reduction in risk.
Very high amounts of vitamin A—100,000 IU per day or more—have reduced symptoms
of PMS,45 46 but such an amount can cause serious side effects with
long-term use. Women who are or who could become
pregnant should not supplement with more than 10,000 IU (3,000 mcg) per day of vitamin A.
Other people should not take more than 25,000 IU per day without the supervision of their
doctor. As yet, no trials have explored the effects of these safer amounts of vitamin A in
women suffering from PMS.
Many years ago, research linked B vitamin deficiencies to PMS in preliminary
research.47 48 Based on that early work, some doctors recommend
B-complex vitamins for women with PMS.49
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
1. Rossignol AM, Bonnlander H. Prevalence and severity of the
premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content.
J Reprod Med 1991;36:131–6.
2. Halliday A, Bush B, Cleary P, et al. Alcohol abuse in women seeking
gynecologic care. Obstet Gynecol 1986;68;322–6.
3. Rossignol AM, Zhang J, Chen Y, Xiang Z. Tea and premenstrual syndrome
in the People’s Republic of China. Am J Public Health 1989;79:67–6.
4. Rossignol AM. Caffeine-containing beverages and premenstrual syndrome
in young women. Am J Public Health 1985;75(11):1335–7.
5. Rossignol AM, Bonnlander H. Caffeine-containing beverages, total fluid
consumption, and premenstrual syndrome. Am J Public Health 1990;80:1106–10.
6. Fenster L, Quale C, Waller K, et al. Caffeine consumption and
menstrual function. Am J Epidemiol 1999;149:550–7.
7. Werbach MR. Nutritional Influences on Illness, 2d ed.
Tarzana, CA: Third Line Press, 1993, 540–1 [review].
8. Prior JC, Vigna Y, Sciarretta D, et al. Conditioning exercise
decreases premenstrual symptoms: a prospective, controlled 6-month trial. Fertil
9. Barr W. Pyridoxine supplements in the premenstrual syndrome.
10. Gunn ADG. Vitamin B6 and the premenstrual syndrome. Int J Vitam
Nutr Res 1985;Suppl 27:213–24 [review].
11. Kleijnen J, Riet GT, Knipschild P. Vitamin B6 in the treatment of the
premenstrual syndrome—a review. Br J Obstet Gynaecol 1990;97:847–52
12. Williams MJ, Harris RI, Deand BC. Controlled trial of pyridoxine in
the treatment of premenstrual syndrome. J Int Med Res 1985;13:174–9.
13. Brush MG, Perry M. Pyridoxine and the premenstrual syndrome.
Lancet 1985;i:1399 [letter].
14. Hagen I, Nesheim B-I, Tuntland T. No effect of vitamin B6 against
premenstrual tension. Acta Obstet Gynecol Scand 1985;64:667–70.
15. Wyatt KM, Dimmock PW, Jones PW, Shaughn O’Brien PM. Efficacy of
vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ
16. Rossignol AM, Bonnlander H. Premenstrual symptoms and beverage
consumption. Am J Obstet Gynecol 1993;168:1640 [letter].
17. Thys-Jacobs S, Starkey P, Bernstein D, et al. Calcium carbonate and
the premenstrual syndrome: Effects on premenstrual and menstrual symptoms. Am J Obstet
18. Thys-Jacobs S, Ceccarelli S, Bierman A, et al. Calcium
supplementation in premenstrual syndrome. J Gen Intern Med 1989;4:183–9.
19. Penland JG, Johnson PE. Dietary calcium and manganese effects on
menstrual cycle symptoms. Am J Obstet Gynecol 1993;168:1417–23.
20. Horrobin DF, Manku MS, Brush M, et al. Abnormalities in plasma
essential fatty acid levels in women with premenstrual syndrome and with nonmalignant breast
disease. J Nutr Med 1991;2:259–64.
21. Puolakka J, Makarainen L, Viinikka L, Ylikorkola O. Biochemical and
clinical effects of treating the premenstrual syndrome with prostaglandin synthesis
precursors. J Reprod Med 1985;30:149–53.
22. Ockerman PA, Bachrack I, Glans S, Rassner S. Evening primrose oil as
a treatment of the premenstrual syndrome. Rec Adv Clin Nutr 1986;2:404–5.
23. Massil H, O’Brien PMS, Brush MG. A double blind trial of Efamol
evening primrose oil in premenstrual syndrome. 2nd International Symposium on PMS,
Kiawah Island, Sep 1987.
24. Casper R. A double blind trial of evening primrose oil in
premenstrual syndrome. 2nd International Symposium on PMS, Kiawah Island, Sep
25. Khoo SK, Munro C, Battisutta D. Evening primrose oil and treatment of
premenstrual syndrome. Med J Aust 1990;153:189–92.
26. Collins A, Cerin A, Coleman G, Landgren B-M. Essential fatty acids in
the treatment of premenstrual syndrome. Obstet Gynecol
27. McFayden IJ, Forrest AP, Chetty U, Raab G. Cyclical breast pain -
some observations and the difficulties in treatment. Br J Clin Pract 1992;
28. Abraham GE, Lubran MM. Serum and red cell magnesium levels in
patients with premenstrual tension. Am J Clin Nutr 1981;34:2364–6.
29. Sherwood RA, Rocks BF, Stewart A, Saxton RS. Magnesium and the
premenstrual syndrome. Ann Clin Biochem 1986;23:667–70.
30. Nicholas A. Traitement du syndrome pre-menstruel et de la
dysmenorrhee par l’ion magnesium. in First International Symposium on Magnesium
Deficit in Human Pathology, ed. J Durlach. Paris: Springer-Verlag, 1973, 261–3.
31. Facchinetti F, Borella P, Sances G, et al. Oral magnesium
successfully relieves premenstrual mood changes. Obstet Gynecol
32. Walker AF, De Souza MC, Vickers MF, et al. Magnesium supplementation
alleviates premenstrual symptoms of fluid retention. J Womens Health
33. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of
menstrual migraine: effects on intracellular magnesium. Headache
34. Werbach MR. Premenstrual syndrome: magnesium. Int J Alternative
Complementary Med 1994;Feb:29 [review].
35. Takacs BE. Potassium: A new treatment for premenstrual syndrome.
J Orthomolec Med 1998;13:215–22.
36. Steinberg S, Annable L, Young SN, Liyanage N. A placebo-controlled
clinical trial of L-tryptophan in premenstrual dysphoria. Biol Psychiatry
37. Bryant M, Cassidy A, Hill C, et al. Effect of consumption of soy
isoflavones on behavioural, somatic and affective symptoms in women with premenstrual
syndrome. Br J Nutr 2005;93:731–9.
38. Chuong CJ, Dawson EB, Smith ER. Vitamin E levels in premenstrual
syndrome. Am J Obstet Gynecol 1990;163:1591–5.
39. London RS, Sundaram GS, Murphy L, Goldstein PJ. The effect of
alpha-tocopherol on premenstrual symptomatology: a double blind study. J Am Coll Nutr
40. London RS, Bradley L, Chiamori NY. Effect of a nutritional supplement
on premenstrual symptomatology in women with premenstrual syndrome: a double-blind
longitudinal study. J Am Coll Nutr 1991;10:494–9.
41. Stewart A. Clinical and biochemical effects of nutritional
supplementation on the premenstrual syndrome. J Reprod Med 1987;32:435–41.
42. Chakmakjian Z, Higgins C, Abraham G. The effect of a nutritional
supplement, Optivite for women, on premenstrual tension syndrome: effect of symptomatology,
using a double-blind crossover design. J Appl Nutr 1985;37:12.
43. Freeman E, Rickels K, Sondheimer SJ, Polansky M. Ineffectiveness of
progesterone suppository treatment for premenstrual syndrome. JAMA
44. Martorano JT, Ahlgrimm M, Colbert T. Differentiating between natural
progesterone and synthetic progestins: clinical implications for premenstrual syndrome and
perimenopause management. Comp Ther 1998;24:336–9.
45. Block E. The use of vitamin A in premenstrual tension. Acta
Obstet Gynecol Scand 1960;39:586–92.
46. Argonz J, Abinzano C. Premenstrual tension treated with vitamin A.
J Clin Endocrinol 1950;10:1579–89.
47. Biskind MS. Nutritional deficiency in the etiology of menorrhagia,
metrorrhagia, cystic mastitis and premenstrual tension: treatment with vitamin B-complex.
J Clin Endocrinol Metabol 1943;3:227–34.
48. Biskind MS, Biskind GR, Biskind LH. Nutritional deficiency in the
etiology of menorrhagia, metrorrhagia, cystic mastitis and premenstrual tension. Surg
Gynecol Obstet 1944;78:49–57.
49. Piesse JW. Nutritional factors in the premenstrual syndrome. Int
Clin Nutr Rev 1984;4(2):54–80 [review].
50. Milewicz A, Gejdel E, Sworen H, et al. Vitex agnus castus extract in
the treatment of luteal phase defects due to latent hyperprolactinemia: Results of a
randomized, placebo-controlled double-blind study. Arzneimittelforschung
1993;43:752–6 [in German].
51. Dittmar FW, Böhnert KJ, et al. Premenstrual syndrome: Treatment
with a phytopharmaceutical. Therapiwoche Gynäkol 1992;5:60–8.
52. Loch EG, Selle H, Boblitz N. Treatment of premenstrual syndrome with
a phytopharmaceutical formulation containing Vitex agnus castus. J Women Health
Gender-Based Med 2000;9:315–20.
53. Schellenberg R. Treatment for the premenstrual syndrome with agnus
castus fruit extract: prospective, randomized, placebo controlled study. BMJ
54. Lauritzen C, Reuter HD, Repges R, et al. Treatment of premenstrual
tension syndrome with Vitex agnus castus. Controlled, double-blind study versus pyridoxine.
55. Dittmar F. Das pramenstruelle Spannungssyndrome. Jiatros
56. Tamborini A, Taurelle R. Value of standardized Ginkgo biloba
extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome. Rev
Fr Gynecol Obstet 1993;88:447–57 [in French].
57. Qi-bing M, Jing-yi T, Bo C. Advance in the pharmacological studies of
radix Angelica sinensis (oliv) diels (Chinese danggui). Chin Med J
58. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete
German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American
Botanical Council and Boston: Integrative Medicine Communications, 1998, 90.
59. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum
and Beaconsfield, UK: Beaconsfield Publishers Ltd, 1988, 315.