Premenstrual tension syndrome, more commonly known as premenstrual syndrome (PMS), is a very common condition affecting women of reproductive age. It is estimated that nearly half of women worldwide experience PMS. Symptoms typically occur during the final phase of the menstrual cycle and usually resolve once menstruation begins. PMS can involve a wide range of physical and psychological symptoms that recur monthly and vary in severity from person to person.
Many women experience emotional and cognitive changes during the premenstrual phase. These may include anxiety or tension, depressed mood, crying spells, mood swings, irritability or anger, changes in appetite or food cravings, insomnia, social withdrawal, difficulty concentrating, and changes in libido. These symptoms can significantly affect daily functioning, work performance, and interpersonal relationships.
PMS is also associated with a number of physical symptoms. Common complaints include headaches, fatigue, water retention, joint or muscle pain, abdominal bloating, constipation or diarrhea, breast tenderness, and acne. These physical symptoms often occur alongside emotional changes and tend to follow a predictable monthly pattern.
The exact cause of PMS is not fully understood. However, it is known that significant fluctuations in hormone levels and brain neurotransmitters occur during the menstrual cycle, particularly in the luteal phase, which is the final portion of the cycle. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and an impaired cortisol response during this phase may also contribute to symptoms. Because of this, supporting balanced hormonal and neurotransmitter function is central to improving PMS.
Hormonal and neurotransmitter balance is influenced by many factors, including exercise habits, smoking, alcohol intake, sleep duration, dietary patterns, nutrient status, stress levels, and personal attitudes toward menstruation. It has also been observed that the COVID-19 pandemic negatively affected endocrine balance for many women, contributing to worsening PMS symptoms.
Conventional medical treatment for PMS often focuses on oral contraceptives and antidepressant medications. While these therapies aim to manipulate hormone fluctuations and neurotransmitter levels, they may carry potential adverse effects and are not always ideal as first-line options.
Nutritional and holistic approaches work with the body’s natural regulatory systems and aim to restore normal physiological function rather than override it. When these foundational strategies are properly applied, many women experience significant improvement, and pharmacological treatment is often unnecessary.
Dietary patterns play a major role in PMS symptom severity. Diets that are lower in carbohydrates, fats, salt, and alcohol, and higher in unprocessed whole foods, have been shown to reduce both the risk and intensity of PMS. Women who follow a Western-style diet rich in fast foods, soft drinks, and processed meats are more likely to experience PMS than those who consume healthier diets.
Excessive intake of ultra-processed foods and heightened food cravings are also associated with increased PMS symptoms. Alcohol and caffeine intake should be limited, while fruits, vegetables, whole grains, calcium-rich foods, and high-quality protein should be emphasized. Regular physical activity is also recommended, as exercise has been shown to help alleviate both physical and emotional PMS symptoms.
In naturopathic and traditional Chinese medicine, dietary and herbal therapies are often used to support liver function. The liver plays a central role in hormone metabolism, and improved liver function is thought to promote healthier hormone balance. Diet, herbal therapies, and nutritional supplements that support liver health may therefore be beneficial for women with PMS.
Several nutritional supplements have been shown to help alleviate PMS symptoms by supporting hormone metabolism and neurotransmitter balance. Vitamin B6 at a dose of 50 mg, calcium at 1000 mg, and zinc at 30 mg have consistently demonstrated benefits for emotional symptoms of PMS. Vitamin D supplementation, typically between 2000 and 5000 IU daily, has been shown to reduce pain intensity associated with menstrual cramps and improve both physical and mood-related symptoms, particularly in women with low vitamin D levels.
Magnesium is another important mineral for PMS management. Women with PMS often have lower blood magnesium levels. Supplemental magnesium at a daily dose of approximately 300 mg has been shown to improve symptoms such as depression, irritability, general pain, abdominal discomfort, headaches, and menstrual cramps.
Certain plant extracts have also demonstrated benefit in PMS management. Saffron extract has been shown to positively affect PMS symptoms and menstrual cramp pain when taken at a dose of 28 to 30 mg daily. Chasteberry (Vitex agnus-castus) has a long history of use in herbal medicine for PMS and has been shown in multiple studies to reduce symptom severity. A typical daily dose ranges from 180 to 250 mg of a standardized extract.
In more severe cases of PMS, bioidentical hormone therapy may be considered. Progesterone used one to two weeks before the onset of menstruation can help reduce symptoms. This may be administered orally or transdermally. In some cases, clinicians trained in hormone therapy may use cyclic estrogen and progesterone to prevent PMS and dysmenorrhea. Hormonal therapies should always be used under the supervision of a knowledgeable healthcare professional.
