The best natural supplements for premenstrual syndrome (PMS) are calcium, magnesium, vitamin B6, evening primrose oil, isoflavones, Agnus castus, Ginkgo biloba and St John’s Wort. These supplements all have research evidence to support their use in PMS and can usually help when other approaches have failed.
Supplements for PMS
Not all supplements will consistently relieve symptoms of PMS for all women, as it depends on whether your symptoms are predominantly related to fluid retention, depression, anxiety or headache and fatigue.
Most supplements provide benefit for 2 out of 3 women with PMS and because of the underlying hormone imbalances involved, you need to take them for 3 months to assess the full benefits. In most cases, just using these supplements for one month is not sufficient to correct any underlying hormone imbalances and improve your symptoms.
Persevere for 3 months and keep a PMS symptom diary to record what happens, as it is not always easy to remember how symptoms change from month to month.
You can download a PMS Diary Symptom Tracker like this one using the link at the end of this page.
Calcium supplements for PMS
Alterations in calcium regulation can cause mood disturbances and symptoms associated with low calcium levels are similar to those of PMS. Researchers found blood calcium levels were significantly lower in women with PMS than those without, so there was a raised magnesium to calcium ratio. There may also be links between PMS, calcium balance and parathyroid hormone concentrations.
In a trial involving 33 women with premenstrual syndrome, taking 1 gram calcium supplements for three months significantly improved low mood, water retention and pain – symptom severity was at least halved compared to when they took placebo for 3 months, with 73% reporting fewer symptoms with placebo.
Another trial involving 466 women with moderate to severe PMS found that taking calcium (1200mg per day) for three cycles produced a significant 48% reduction in total symptom scores, including negative affect, fluid retention, food cravings and pain compared with only a 33% reduction for placebo.
Calcium is usually taken together with vitamin D to boost calcium absorption. The combination of calcium and vitamin D appear to reduce PMS symptoms of headache, negative emotions, fluid retention and pain.
Magnesium supplements for PMS
Magnesium is needed for over 300 enzymes to work properly and is thought to help PMS through involvement in dopamine and insulin secretion, essential fatty acid metabolism, nerve transmission and sex hormone receptor interactions. Magnesium is also needed to help stabilise blood sugar levels, interacts with vitamin B6 to reduce the effects of excess oestrogen, and with zinc to regulate the way sex hormones activate certain genes.
Taking magnesium supplements can significantly improve premenstrual symptoms associated with fluid retention such as weight gain, bloating, swelling and breast pain. Trials have also found that magnesium can improve premenstrual mood changes and menstrual migraine.
Magnesium supplements also reduce irritability, depression, anxiety/tension, bloating and tiredness. Magnesium acts as a muscle relaxant and can reduce painful periods that may be associated with PMS. It will only help if you are magnesium deficient, but that is relatively common. Magnesium levels are often significantly lower in women with PMS than in women who do not experience PMS.
When over 800 women took a magnesium supplement (Magnesium-OK) that also included other vitamins and minerals (eg B6, zinc) 73% reported less irritability, 66% improved depression, 66% improved anxiety/tension, 48% improved tiredness & headaches and 50% had less bloating.
In a controlled, crossover study involving 38 women, taking 200mg magnesium for 2 months significantly improved premenstrual symptoms associated with fluid retention (weight gain, oedema, mastalgia, bloating). There were no significant effects on depression or anxiety however.
Vitamin B6 supplements for PMS
Vitamin B6 can reduce the effects of excess oestrogen and seems to be most beneficial for the fatigue and emotional symptoms of PMS such as depression and irritability through its role as a cofactor in neurotransmitter synthesis.
A trial involving 68 women found that vitamin B6 at a dose of 50mg per day for three months improved premenstrual emotional symptoms of depression, irritability and tiredness compared with placebo. Overall, emotional symptoms decreased by 69% and physical symptoms by 52%.
One study compared the effects of high dose vitamin B6 (300 mg per day) against three prescribed drugs – an SSRI antidepressant (fluoxetine), a benzodiazepine (alprazolam) and a betablocker (propranolol) in 120 women with severe premenstrual syndrome. Fluoxetine reduced symptoms by 65.4%, propranolol by 58.7%, alprazolam by 55.6% and vitamin B6 by 45.3% which performed better than placebo.
If you don’t want to take prescribed drugs, then vitamin B6 is an alternative option if calcium and magnesium have not helped. Pharmacological doses of vitamin B6 have been linked with nerve problems (sensory neuropathy) however and should not be taken long-term.
Evening primrose oil supplements for PMS
Evening primrose oil is a rich source of gamma-linolenic (also known as gamolenic acid, or GLA) which is one of the few omega-6 oils with an anti-inflammatory action similar to that of omega-3s when intakes are sufficiently high.
GLA is converted into substances (series 1 prostaglandins) which relax blood vessels, lower blood pressure, decrease inflammation, improve nerve function and circulation, and have beneficial effects on hormone and calcium balance. While you can make small amounts of GLA, this process is easily blocked by factors such as increasing age, smoking, pollution, lack of certain vitamins and minerals or excessive intakes of saturated fat, sugar or alcohol.
Evening primrose oil is widely taken to treat premenstrual syndrome and cyclical breast pain. One study found supplements relieved bloating and breast pain in 95% of women, irritability in 80%, low mood in 74%, swollen peripheries in 79% and anxiety in 53%. It is also taken for both cyclical and non-cyclical breast pain (mastalgia). The Cardiff Mastalgia Clinic reported that 92% of 324 patients with cyclical mastalgia and 64% of 90 women with non-cyclical mastalgia obtained a clinically useful response to therapy. Danazol was the most effective drug, with bromocriptine and evening primrose oil having equivalent efficacy. Adverse events were much less common with EPO than danazol or bromocriptine, however.
Evening primrose oil is especially helpful in reducing low mood, sugar cravings and breast pain linked with PMS. A study involving 120 women with premenstrual syndrome found better results at a dose of 2g evening primrose oil daily compared with 1g daily.
Some studies have not shown a benefit, however, and your response may depend on whether or not your diet is lacking in antiinflammatory omega 3 essential fatty acids.
Isoflavone supplements for PMS
Isoflavones are plant hormones that have a similar structure to human oestradiol and can interact with oestrogen receptors. This helps to balance the effects of progesterone during the second half of the menstrual cycle. The main sources of isoflavones are soy beans, kudzu (Japanese knotweed) and red clover.
The effects of soy isoflavones on premenstrual symptom severity was studied in 23 women who took the supplements or placebo. After two cycles of taking soy isoflavones, total symptoms and physical symptoms were significantly reduced especially headache and breast tenderness, cramps and swelling.
Another study involving 49 women with PMS found a daily combination of 60mg soy isoflavones, 100mg dong quai and 50mg black cohosh taken significantly reduced the frequency of menstrual migraine attacks after 9 weeks treatment, and persisting for 24 weeks of treatment, compared with placebo.
Agnus castus herbal supplements for PMS
Agnus castus extracts contain substances such as apigenin which can stimulate oestrogen receptors. Agnus castus is also believed to have a progesterone-moderating action and is one of the most popular herbal remedies for PMS.
A study involving 170 women with PMS, showed that Agnus castus fruit extracts improved symptoms of irritability, mood changes, headache and breast fullness. Overall, responder rates for 52% for Agnus castus compared with 24% for placebo.
Other studies have found agnus castus to be effective in relieving physical symptoms such as headaches, sore breasts, bloating and fatigue as well as increased appetite, sweet cravings, nervousness/ restlessness, anxiety, depression, mood swings and lack of concentration.
A study involving 67 women with premenstrual syndrome assessed the effects of Agnus castus in reducing four symptoms of low mood, water retention, food cravings and pain .By the 3rd cycle of treatment, all the four symptom factor scores were significantly reduced by 60% after the 3rd month of treatment.
Another clinical trial involving 217 women found that total premenstrual symptoms score decreased from 29.23 at the start of the trial to 6.41 after 3 months in those taking Agnus castus, which was twice as effective as placebo.
Ginkgo biloba herbal supplements for PMS
The Ginkgo biloba tree has fan-shaped leaves that contain a wide variety of antioxidants which reduce inflammation and improve circulation to help flush away excess fluid.
Ginkgo biloba supplements are best known for improving memory, but they are also used to improve PMS symptoms – not just to help clear thoughts but to reduce fluid retention, too.
Ginkgo biloba extracts were used to treat the congestive symptoms of premenstrual syndrome such as bloating and breast pain in 165 women. After two months, significant improvements were noted, especially in reducing breast symptoms compared with placebo. Emotional symptoms were also improved.
Another study involving 85 university students with PMS found that Ginkgo biloba extracts significantly reduced the overall severity of physical and emotional premenstrual symptoms by 23.68% compared with placebo (8.74%).
St John’s Wort supplements for PMS
St John’s wort contains a number of substances that have a natural, antidepressant action. These include hypericin and pseudohypericin but especially hyperforin and adhyperforin.
PMS is often associated with low mood, and a pilot study of 19 women with found a significant improvement with overall premenstrual syndrome scores reducing by 51%.
Another study involving 25 women with severe PMS found that St John’s Wort reduced the incidence of premenstrual crying by 92%, low mood by 85% and nervous tension by 71%.
A further study involving 36 women with PMS found their physical and behavioural symptoms improved significantly more when taking St John’s wort extracts, than when the same women took placebo.
The symptoms of PMS
Premenstrual syndrome, or PMS, is a common and distressing condition that affects as many as 95% of women at some time during their fertile years. The majority of women have mild symptoms that they cope with on their own, using natural PMS treatments such as herbal supplements. One in five experience moderate symptoms that interfere with their life and work enough to seek medical help. One in twenty women experience severe symptoms.
More than 150 physical, emotional and behavioural symptoms have been described as forming part of the PMS complex, from bloating, breast pain and food cravings, to mood swings, low sex drive, irritability and aggression.
Symptoms of PMS tend to fall into one of four main groups, although symptoms often overlap. These are referred to as:
- PMS-A when the main symptoms are Anxiety, irritability and insomnia
- PMS-C when sugar Cravings, increased appetite, headache and fatigue predominate
- PMS-D where Depression, forgetfulness and confusion are most troublesome
- PMS-H (for Hyper-hydration) which is associated with fluid retention, weight gain, bloating and breast tenderness.
PMS-A and PMS-H are the most common types.
Mild PMS is diagnosed if symptoms are bothersome but do not interfere with your personal, social and professional life.
Moderate PMS is diagnosed if symptoms interfere with your life but you can still function relatively normally.
Severe PMS is diagnosed if your symptoms cause you to withdraw from social and professional activities and you are unable to function normally. When symptoms are severe and mainly emotional and behavioural, this is sometimes referred to as premenstrual dysphoric disorder.
The causes of PMS
The exact cause of PMS is unknown, but it appears to result from a relative imbalance between the two female hormones, oestrogen and progesterone.
These hormones are released in a cyclical pattern so that, during the first half of the menstrual cycle, oestrogen levels are higher than those of progesterone.
Once ovulation occurs, which is usually (but not necessarily) in the middle of the cycle, then progesterone levels rise rapidly to become higher than those of oestrogen.
This change in the relative balance of the female hormones is believed to have effects on brain chemicals, such as serotonin and gamma-aminobutyric acid (GABA), to affect mood and behaviour.
PMS is diagnosed when symptoms start within the two weeks before the first day of your period and cease promptly (within a day or two) of your period starting. This time frame is when progesterone hormone is more dominant than oestrogen hormone.
PMS can develop at any age during a woman’s fertile years. The average age of onset of PMS symptoms is 26 years, with symptoms often becoming worse over time.
It can help to keep a symptom diary for two or three cycles to confirm that symptoms recur regularly during the second half of your menstrual cycle. This will also help your doctor if you need to seek medical treatment, as they will ask you to do this anyway.
PMS and menopause
Many of the symptoms associated with PMS are also associated with perimenopause and it may be that women experiencing these symptoms in middle age are actually experiencing symptoms of the menopause.
Changes in usage of hormonal methods of contraception (eg stopping the Pill) can also unmask symptoms that were previously hidden by taking synthetic hormone treatments.
PMS and stress
Although stress can magnify symptoms of PMS and reduce your ability to cope with them, researchers have found no association between the severity of PMS symptoms and the amount of daily stress experience by individual women. Stress appears to account for only up to 10% of variation in PMS symptom severity. A reduced secretion of cortisol hormone associated with stress may play a role, however.
Other self-help measures for premenstrual syndrome
Some researchers suggest that progesterone hormone cannot bind properly to cell receptors when blood glucose levels are low. Nibbling regular carbohydrate snacks, every two to three hours, helps to maintain blood glucose levels and helps progesterone bind to cells so it can work properly. This may explain why sugar cravings often occur almost as a form of self-medication.
In one trial, in which women with PMS ate starchy foods (eg bread, rice cakes, digestive biscuits, wholegrain cereals) every 3 hours from first waking up until retiring to bed, over half gained relief from their symptoms, with a further 20% experiencing some improvement. Dietary changes alone, with no additional medication gave full relief of severe PMS symptoms in 19% of sufferers.
Other helpful approaches include:
- Cutting down on salt intake to reduce fluid retention
- Cutting back on alcohol and caffeine to reduce irritability and depression
- Following a wholefood – and preferably organic – diet with as little pre-packaged, convenience foods and additives as possible
- Eating more nuts, seeds and fish – especially oil fish (eg mackerel, salmon, herrings, sardines, pilchards) for essential fatty acids needed for optimum hormone balance
- Get sufficient sleep
- Reduce stress as much as possible
- If you smoke, do your utmost to stop, as smoking affects oestrogen and progesterone balance and can make PMS worse.
If symptoms of PMS are severe, always seek medical advice.
NB In the UK, NICE specifically tell doctors that dietary supplements such as vitamin B6, calcium, vitamin D, magnesium, evening primrose oil and Agnus castus ‘are not recommended for initiation in primary care’ to treat premenstrual syndrome. This is because if your doctor recommended them they would be ethically obliged to prescribe them. This does not mean they don’t work, and there is no reason why you should not try them yourself.
Download a PMS Diary Symptom Tracker via this link: PMS Diary Symptom Tracker