Treatment Guide

Premenstrual Syndrome (PMS) and Nutritional Deficiencies That Cause It

PMS Nutrition Gluten FreePremenstrual syndrome (PMS) is a female menstrual disorder that occurs regularly around ovulation and subsides within a few days of the onset of menstruation.  PMS affects up to 75% of women during their childbearing years.

Symptoms.  Most women with PMS will have abdominal cramps, be anxious, irritable, sad, emotionally unstable and feel bloated and uncomfortable in the days leading up to their period.  PMS symptoms commonly worsen in the years approaching menopause.

Diagnosis of PMS depends on 5 or more of the symptoms listed below with at least one symptom being one of the first 4:

  • feeling sad, hopeless, or self-deprecating;
  • feeling tense, anxious, or “on edge”;
  • marked emotional lability (unstable mood) interspersed with frequent tearfulness;
  • greatly depressed mood, persistent irritability, anger and increased interpersonal conflicts;
  • decreased interest in usual activities;
  • difficulty concentrating;
  • feeling fatigued, lethargic, or lacking energy;
  • marked changes in appetite which may be associated with binge eating or cravings;
  • sleepiness or insomnia;
  • a subjective feeling of being overwhelmed or out of control;
  • physical symptoms such as breast tenderness or swelling, headaches or sensation of “bloating” or weight gain, with tightness of clothes, shoes or rings.

There may be joint or muscle pain.  Symptoms may be associated with suicidal thoughts.  About half of women with severe PMS have a psychiatric disorder. As many as 10% of women who report PMS symptoms have had suicidal thoughts. Suicide in women with depression is much more likely to occur during the second half of the menstrual cycle.

Cause. Although the exact cause of PMS has not been identified, PMS is known to result from deficiencies of calcium, magnesium, omega fatty acids, vitamin B6, vitamin E, and vitamin D and to respond to adequate/high levels of these nutrients.

Tests. There are no physical examination findings or lab tests specific to the diagnosis of PMS. Other potential causes of symptoms are first ruled out.

Treating Premenstrual Syndrome.

1Replenish the missing nutrients 

  • Calcium.  This mineral helps relieve early fatigability, changes in appetite, depression,1 anxiety, irritability, negative emotion, cramps, soreness, fluid retention,2 breast pain, insomnia, and excessive bleeding.Good food sources include: milk and milk products (yogurt, cheese), tofu, canned salmon and sardines (with bones).  Lesser amounts are found in nuts (especially almonds and Brazil nuts), molasses, broccoli, cabbage, collards, Bok choy and dark, green leafy vegetables.
  • Magnesium. This mineral helps relieve constipation, irritability, fatigue, weakness, muscle spasms, headache including migraine,3 mood changes,insomnia, anxiety, depression,4 confusion and elevated blood pressure. Adequate vitamin B6 helps to make magnesium more available to cells.Good food sources of magnesium include: whole grains, beans, peas, seeds (especially buckwheat and pumpkin), nuts, peanuts, banana, green leafy vegetables, halibut, haddock, seafood and chicken.  The most effective magnesium supplement is chelated magnesium or magnesium citrate tablets. Magnesium oxide, though cheap, is poorly absorbed.
  • Vitamin B6 (pyridoxine).  This vitamin helps relieve mood swings, depression, irritability, fatigue,5 breast soreness, weakness, sleeplessness, apathy,6 sore tongue, and skin inflammation.Good food sources of vitamin B6 include: poultry, beef, liver, halibut, pork, rainbow trout, whole milk or 2%, then egg, banana, potato, sunflower seeds, beans, tomato juice, avocado, canned sockeye salmon, canned tuna, brown rice, prunes, peanut butter, Brussels sprouts, orange, spinach and walnuts.  Animal sources are more easily absorbed than plant sources.
  • Vitamin E.  This vitamin helps relieve emotional and physical symptoms including breast pain7 and cramps and reduce blood loss.8   Good food sources of vitamin E include: sunflower oil, almonds, corn oil, avocado, olive oil, beans, apricots, plant leaves, and brown rice. Animal sources are low in vitamin E.
  • Vitamin D.  This vitamin helps relieve headache and PMS symptoms.Good food sources of vitamin D include: fish liver oil, eggs, herring, salmon, mackerel, sardines, tuna, and fortified milk and butter.
  • Omega-3 Fatty Acids.  Fish oil can relieve apathy, difficulty thinking, sleep problems and  depression.  Good food sources of omega-3 includes: fish oil, sardines, herring, mackerel, salmon, anchovy, and lesser amounts in eggs. 
  • Omega-6 Fatty Acids.  Primrose oil (1 to 2 grams per day) can significantly relieve premenstrual symptoms including depression and breast pain, prolonged bleeding, and faulty thinking.11 Prolonged use (more than 3 months) works best.10  Good food sources of omega-6 includes: meat and milk products, safflower oil, corn oil, nuts, and seeds.

2.  Develop a healthy lifestyle.  In addition to good nutrition, here are 4 basic steps to better health:

  • Drink plenty of fluids (not soft drinks or other beverages with caffeine) to help reduce bloating, fluid retention, and other symptoms. Caffeine is linked to painful breast lumps and premenstrual breast pain.
  • Lower salt intake and avoid simple sugars, caffeine, and alcohol.
  • Lower fat intake to 20% of calories to help reduce fluid retention. Use oil  or margarine containing omega fatty acids such as olive oil instead of butter.
  • Get regular aerobic exercise throughout the month to help reduce the severity of PMS symptoms and improve muscle tone.

3.  Avoid or limit use of medications.  Medications that are commonly used to suppress symptoms cannot cure PMS but will deplete nutrients, making PMS worse in the long run. For example, hormone treatments that suppress the production of hormones and the menstrual cycle deplete vitamins B2, B3, B6, B12, C, folic acid, magnesium, selenium, and zinc.

Other conventional drugs used for PMS include diuretics (drugs that rid the body of excess water), such as Lasix. These drugs deplete calcium, magnesium, vitamin B1, vitamin B6, vitamin C, potassium, sodium, and zinc.  Painkillers, such as aspirin, deplete calcium, folic acid, vitamin C, iron, pantothenic acid, and potassium.  Antidepressants such as Prozac deplete coenzyme Q10 and vitamin B12. All of these dugs can cause adverse effects.

Ultimately, to relieve PMS, it is necessary to correct the nutritional deficiencies that are causing corresponding symptoms.  So the first step is to identify the missing nutrients.  

The Gluten Free Works Treatment Guide is an excellent place to start. Subscribe and visit our section on Premenstrual Syndrome.

Sources: accessed 7 7 11

Taber Cyclopedic Medical Dictionary, 19th ed. F.A. Davis Company, Philadelphia, PA.

Libonati, C. Recognizing Celiac Disease. GF Works Publishing. 2007.

Research Studies:

  1. Ghanbari Z Haghollahi F, Shariat M, Foroshani AR, Ashrafi M. Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwan J Obstet Gynecol. 2009 Jun;48(2):124-9.
  2. Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Int Med. 1989 May-Jun;4(3): 183-9.
  3. Quaranta S, Buscaglia MA, Meroni MG, Colombo E, Cella S. Pilot study of the efficacy and safety of a modified-release magnesium 250 mg tablet (Sincromag) for the treatment of premenstrual syndrome. Clin Drug Investig. 2007;27(1):51-8.
  4. Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AR. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991 Aug;78(2):177-81.
  5. Doll H, Brown S, Thurston A, Vessey M. Pyridoxine (vitamin B6) and the premenstrual syndrome: a randomized crossover trial. J R Col Gen Pract.1989. 39(326):364-8.
  6. Williams MJ, Harris RI, Dean BC. Controlled trial of pyridoxine in the premenstrual syndrome. J Int Med Res 1985. 13(3):174-9.
  7. London RS, Sundaram GS Murphy L, Goldstein PJ. The effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. J Am Coll Nutr. 1983 2(2):115-22.
  8. A randomized controlled trial of vitamin E in the treatment of primary dysmenorrhea.  BJOG: an  international  journal of obstetrics and Gynecology. 2005; 112(4):466-9.
  9. Bertone-Johnson ER Chocano-Bedoya PO Zagarins SE Micka AE Ronnenberg AG.Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population. J Steroid Biochem Mol Biol. 2010;121(1-2):434-7
  10. Rocha Filho EA, Lima JC, Pinho Neto JS Montarroyos U. Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reprod Health. 2011;8(1)2.

Author Information: Cleo Libonati, RN, BSN
Cleo Libonati is a Co-Founder of Gluten Free Works, Inc.
She is the author of Recognizing Celiac Disease.
She can be reached by E-mail.

About Cleo Libonati, RN, BSN

Cleo Libonati, RN, BSN is CEO and co-Founder of Gluten Free Works, Inc. and She is the author and publisher of the highly recommended celiac disease reference guide, Recognizing Celiac Disease.

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