Premenstrual Disorders
It is common for females to experience premenstrual symptoms. About 80% of females report at least one psychiatric or physical symptom during the luteal phase of their menstrual cycle.
Premenstrual Syndrome (PMS)
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Premenstrual syndrome (PMS) is one of the most common disorders among females of reproductive age, with a global prevalence ranging from 12-48%, varying considerably between countries. PMS is a cyclical and recurrent disorder characterized by various emotional, physical, and behavioral symptoms that can significantly impact one’s quality of life.
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Common symptoms of PMS include cramping, breast tenderness, bloating, fatigue, anxiety, depression, irritability, sleep disturbances, headache, backache, and changes in appetite. The severity and persistence of symptoms tend to fluctuate throughout menstrual cycles.
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The cause of PMS is poorly understood. Some suggest cyclical fluctuations in estrogen and progesterone throughout the menstrual cycle may trigger symptoms. Mood-related symptoms may also be related to estrogen and progesterone's effect on neurotransmitters serotonin, dopamine, and γ-aminobutyric acid (GABA).
Premenstrual Dysphoric Disorder (PMDD)
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Premenstrual dysphoric disorder (PMDD) has more severe affective or psychiatric symptoms which are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5). PMDD affects 3-8% of menstruating females. It is possible that fewer females have PMDD because of the strict diagnostic criteria.
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Affective symptoms may include angry outbursts, anxiety, confusion, depression, irritability, and social withdrawal. Somatic symptoms may include abdominal bloating, breast tenderness or swelling, headache, joint or muscle pain, swelling of extremities, and weight gain.
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The American College of Obstetricians and Gynecologists (ACOG) and The American Psychiatric Association (APA) have specific diagnostic criteria for PMS and PMDD. Please seek medical treatment from a physician or qualified health professional if you are experiencing symptoms associated with PMDD.
Dietary habits can positively influence premenstrual disorders, including eating breakfast and nutrient-dense foods while avoiding energy-dense snack foods high in sodium, sugar, and fat.
Nutritional Management of PMS
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Mediterranean Diet and PMS
The Mediterranean Diet is one of the healthiest dietary patterns and includes nutrient-dense foods that may help manage PMS symptoms. Diets rich in whole grains, fruits, vegetables, low-fat dairy, soy beverages, and low-fat protein sources are recommended for PMS. Additionally, the Mediterranean Diet provides certain nutrients, including calcium, vitamin D, vitamin B6, and magnesium, which are beneficial for PMS.
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Western Diet and PMS
A Western dietary pattern consisting of fast food, soft drinks, sweets, processed meat, red meat, salty foods, and foods high in fat is associated with an increased risk of PMS. Additionally, there may be a connection between PMS and high dietary sodium and refined carbohydrates. Moreover, the Western dietary pattern may lead to obesity and contribute to PMS symptoms. The Western dietary pattern may also contribute to PMS by increasing inflammation and oxidative stress.
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Whole Grains and PMS
Whole grains are an important part of a Mediterranean-style dietary pattern. Whole grains are nutrient-dense and contain fiber, B vitamins, calcium, and magnesium, which may be valuable for relieving PMS symptoms. Diets rich in whole grains may improve the severity of a wide range of PMS symptoms, including general, mood, behavioral, and physical symptoms. Additionally, vitamin B6 and calcium may help PMS by regulating mood and psychological imbalances, particularly symptoms of depression. While incorporating such nutrients in the diet is essential, supplementation may be necessary to achieve optimal levels.
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Nutrients and PMS/PMDD
Research supports that certain nutrients may be beneficial for PMS. There is an association between PMS and increased markers of inflammation. For example, cramps, breast pain, bloating, increased appetite, anxiety, and mood swings are associated with elevated C-reactive protein. Vitamin D may reduce PMS symptoms because it modulates immune function and inflammation. Maintaining optimal vitamin D levels (600 IU/day) is essential. Additionally, supplementing vitamin B6 (100 mg/day) and calcium (1,000 to 1,200 mg/day) may relieve certain symptoms. Lastly, maintaining adequate magnesium (310-320 mg/day) may help relieve PMS symptoms.
Nutrients of Importance
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Calcium
Calcium supplementation (1,000 to 1,200 mg/per day) may reduce PMS symptoms, including depression, fatigue, and changes in appetite. Additionally, the intensity of PMS symptoms may increase with a low intake of calcium. Also, there is a relationship between low calcium intake and dysmenorrhea. See dysmenorrhea for more information.
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Vitamin D
Maintaining adequate vitamin D levels (600 IU/day) is associated with a reduced risk of PMS and may benefit PMS by reducing mood-related symptoms of depression and anxiety. Conversely, inadequate vitamin D status is associated with PMS symptoms of fatigue, anxiety, confusion, cramps, desire to be alone, and changes in sexual desire.
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Vitamin B6
Vitamin B6 (100 mg/day) may help manage psychological symptoms of PMS. For example, vitamin B6 and calcium supplementation may have a role in treating PMS by regulating mood and psychological imbalances, particularly symptoms of depression. Additionally, the intensity of PMS symptoms may increase with a low intake of vitamin B6.
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Magnesium
Low magnesium intake is associated with increased intensity of PMS symptoms. Maintaining adequate levels (310-320 mg/day) may ease PMS symptoms and effectively prevent and treat dysmenorrhea. It regulates the effects of calcium by promoting relaxation of the uterus and relieving painful contractions. See dysmenorrhea for more information.
