Of women who buy supplements, 4% do so to alleviate symptoms of PMS, according to one report. Some of the things they turn to include chaste tree extract (chasteberry), evening primrose oil, black cohosh, and St. John's wort to chase away the premenstrual blues.
Do they work? Maybe.
There isn't conclusive scientific research about their effectiveness in curbing PMS symptoms. In the U.S., herbal supplements aren't required to prove their efficacy and aren't regulated by the FDA in the same way as prescription drugs. And there doesn't seem to be a consensus about the amounts to take to get the maximum benefit from any of these herbs.
What Is Premenstrual Syndrome and What Causes It?
PMS refers to physical and psychological symptoms that typically occur between 7 and 14 days before a woman's period starts and can last through their period. Those symptoms include headache, mood swings, irritability, bloating, cramps, sadness, indigestion, carb cravings, breast tenderness and pain, and sleep problems.
Every woman is different. Most, but not all, have experienced PMS symptoms to some degree, at some point. But not all get the same symptoms, and those symptoms range in severity between women, and even from month to month.
About 75% of menstruating women have some symptoms of PMS occasionally, while 5% report symptoms that are severe enough to mess up most of their month.
The exact cause of PMS is not known, but it is thought to be related to changes in hormone levels related to the menstrual cycle. Women with premenstrual dysphoric disorder (PMDD) experience symptoms such as depressed mood, tension, and other symptoms that are typically more severe than those seen with PMS. PMDD is usually treated with antidepressants and in some cases birth control pills.
Herbal Supplements for PMS
Of the herbal supplements mentioned in connection with PMS symptoms, chasteberry (Vitex agnus-castus) has gained the most traction with scientists for easing PMS-related breast pain. Chasteberry is a shrub that grows in southern Europe and Central Asia.
A few studies have shown that women treated with chasteberry extract reported less breast pain, bolstering the theory that chasteberry suppresses the release of prolactin, a hormone involved in breast milk production that's been linked to breast pain. It may also help with swelling, cramps, and food cravings. Another small study showed that chasteberry, combined with St. Johns' wort, lowered levels of depression, anxiety, and cravings.
Evening primrose oil (Oenothera biennis), which contains gamma-linolenic acid (GLA), is often mentioned as an antidote to breast pain, but there's insufficient evidence that it works.
Other herbs purported to help PMS symptoms are:
- Ginkgo biloba for breast tenderness and psychological symptoms, such as mood changes
- St. John's wort for depression
- Dandelion leaf for bloating
Joseph Sanfilippo, MD, a professor of obstetrics, gynecology, and reproductive sciences at the University of Pittsburgh School of Medicine, says patients mention chasteberry, and he doesn't have a problem with them using it. But he's not convinced it works.
Sanfilippo says he's also waiting for more evidence that ginkgo biloba and evening primrose oil can ease PMS symptoms.
"The problem is a lack of well-designed studies," he says. "There have been some studies showing that women who take chaste tree berry had some symptomatic improvement, but my problem is, we just don't have robust research we would like."
Are Herbal Supplements Safe?
Even though they're "natural," even herbal supplements have side effects and drug interactions. There are some cautions to consider:
- Chasteberry may interfere with birth control pills, antipsychotic drugs, and estrogen supplements.
- Evening primrose oil may raise the risk of bleeding, especially in people who take blood thinners such as warfarin (Coumadin).
- Dandelion leaf may lead to an allergic reaction in people with a ragweed allergy. It can interfere with the drug lithium and some antibiotics.
- St. John's wort interacts with many other medications, including birth control pills, and can cause rashes with direct exposure to the sun. It is important to check with your doctor before taking St. John's wort and other prescription medications together.
If you're taking, or thinking about taking, these or any other herbal supplements, talk to your doctor about it. They need to have a complete picture of everything you're taking, even if it's "natural" or doesn't require a prescription.
Conventional Treatments for PMS
SSRIs (selective serotonin reuptake inhibitors) include antidepressants like fluoxetine (Prozac, Sarafem), sertraline (Zoloft), and paroxetine (Paxil, Pexeva). They work by adjusting the brain's use of serotonin, a chemical that regulates mood and behavior.
Sanfilippo considers SSRIs to be the most effective therapy for the emotional/psychological symptoms of PMS -- in cases that are more acute.
Before Sanfilippo prescribes anything, however, he first recommends to patients that they avoid eating refined sugar and exercise more. "Treatment is lifestyle," he says.
Hormones, Vitamins, and Minerals for PMS
Correcting hormonal imbalances is the goal of treatment for PMS, says Uzzi Reiss, MD, a Beverly Hills, Calif., gynecologist who runs a center for PMS.
Reiss abides by diet and exercise as antidotes to PMS -- along with bioidentical hormone therapy and magnesium.
Views differ on how bioidentical hormones, which are said to have the same structure as a woman's own hormones and are made from natural sources, compare to synthetic versions of those hormones. The FDA has warned that bioidentical hormones aren't proven to be safer or more effective than chemical versions.
There is some data that oral magnesium supplements may help with PMS symptoms, including mood changes and fluid retention. Vitamin B6 may also be helpful in treating PMS-related breast pain.
Before Reiss recommends hormones, especially to younger women (whose estrogen and progesterone stores are ample), he starts with a patient's diet. It is often the easiest change to make, and it is his first line of defense against PMS, he says. He's concerned about hormones in milk and meat, as well as eating too much sugar.
"If a person is ready to be calm, eats right, exercises, the solution will be much faster than for somebody who is nervous all the time, is overweight, and eats badly,'' Reiss says.