Premenstrual syndrome (PMS) is a condition which includes a group of physical and/or psychological symptoms that women of reproductive age experience during the luteal phase of the menstrual cycle, and which resolve at, or shortly after menses begins.[1],[2],[3],[4] It is one of the most common women’s health issues.
About 80% of women have at one point suffered from unpleasant physical or emotional/psychological symptoms before their period, but only the severe side of this spectrum, when symptoms negatively affect social life or workplace function, is considered PMS.[5]
PMS Symptoms
Common symptoms of PMS include:
- bloating
- breast tenderness
- headache
- anxiety
- irritability
- depression
- decreased concentration
- fatigue[6]
Neurotransmitter and Hormones Effect on PMS
PMS symptoms are influenced by both neurotransmitters and hormones, including serotonin, GABA, estrogen, and progesterone.
Estrogen and progesterone levels increase and decrease throughout the menstrual cycle to prepare the body for pregnancy, or not, depending on if an egg is fertilized.
Studies have found that women with PMS do not have significantly different amounts of estrogen and progesterone, but rather an abnormal physiological response to the normal hormone cycle.[8]
Serotonin and PMS
Serotonin usually fluctuates in women throughout the menstrual cycle, most likely due to estrogen’s modulatory effects.[9] Estrogens can affect dopamine and serotonin neurotransmission, which influences mood.[10] Studies have shown that plasma serotonin levels were lower during the luteal phase in women with PMS compared to non-symptomatic controls.[11]
Low serotonin appears to have a notable impact on PMS symptoms. Increasing serotonin in the synapse of neurons, and thus, increasing the effects of serotonin in the body generates good mood and relaxation. A possible serum serotonin deficiency can be made up for by increasing serotonin synthesis through eating meals rich in tryptophan.[13] However, 5-HTP supplementation may be a more efficient method of supporting serotonin levels.*[14] 5-HTP is the direct precursor to serotonin.* Using 5-HTP can allow for increased conversion to serotonin, because it avoids the tendency of tryptophan to be diverted to other pathways in the presence of stress or inflammation.*[15]
Progesterone and GABA in PMS
The sex hormone progesterone, and its metabolites, have calming effects in the body by stimulating GABAA receptors.[16] One study found that women suffering from anxiousness and phobic symptoms experience fewer issues serum progesterone increased during the luteal phase. It is thought that the progesterone rise could be a counter-mechanism to prevent acute bouts of anxiousness.[17] Due to its GABAergic increasing ability, progesterone may be effective for improving mood and relieving anxiousness related to PMS.[18]
Alternative Methods for PMS
There are many more other alternative methods for addressing PMS too!
Dietary changes can be helpful in reducing symptoms. It is commonly suggested for women to reduce their intake of caffeine to reduce premenstrual breast tenderness and discomfort.[19] Women with PMS consume 257% more refined sugar, 79% more dairy products, and 62% more refined carbohydrates than women without symptoms.[20] Dairy products in particular can cause magnesium to be absorbed less efficiently.[21] This is important, because both magnesium and calcium influence symptomology.
There is evidence suggesting that PMS may be associated with dysregulation of calcium homeostasis. Supplementing with calcium can significantly reduce some physical and psychological symptoms of PMS.[22] Women with PMS also have lower serum blood magnesium than asymptomatic women.[23] Magnesium is involved in the activity of several neurotransmitters, including serotonin, so deficiencies are likely to contribute to symptoms.[24] Daily supplementation with magnesium has been shown to reduce several physical symptoms of PMS, including headache, bloating, and breast tenderness.[25]
An effective herbal remedy women with PMS might consider is chasteberry, also known as Vitex. This herb has actually been used by women for menstrual cycle issues since at least the 4th century BC.[26]
Several double-blind, placebo controlled studies have shown Vitex to be significantly more effective at addressing PMS than placebo.[27] One study found that of women with PMS who used a Vitex tincture, 33% reported total relief of symptoms![28] It is thought that this helpful herb works by increasing the concentration of luteinizing hormone levels that normalize the last half of the menstrual cycle.[29]
You may already know how important essential fatty acid profiles are for general brain health, but it turns out they may play a role in PMS as well! In fact, researchers have noted that women with PMS tend to have a reduced ability to convert linoleic acid to gamma-linoleneic acid (GLA) within the omega-6 pathway.[30] One study treated women with PMS with 1-2 grams of evening primrose oil per day, around the onset of their symptoms. It was found that 61% of those women had complete relief, and 23% had partial relief of their symptoms after 3 months of treatment.
Premenstrual syndrome can be as complex and confusing as it is common. Luckily for those women who suffer from it, simple and effective integrative options could truly improve their quality of life!
Are Neurotransmitters Contributing to PMS Symptoms?
Find out with the HPA-G profile which tests neurotransmitters as well as sex hormones. Become a Sanesco provider or find a provider near you to order the HPA-G profile.
References
[1]Aeli Ryua &Tae-Hee Kimb. (2015). Premenstrual syndrome: a mini review. Maturitas, 436-440.
[2] Mortola JF, Brunswick DJ, & Amsterdam JD. (2002). Premenstrual syndrome: Cyclic symptoms in women of reproductive age. Psychiatric Annals, 32(8), 452-462.
[3] Tieraona LD. (2001). Integrative treatments for premenstrual syndrome. Alternative Therapies in Health and Medicine, 7(5), 32-9.
[4] Verma RK, Chellappan DK, & Pandey AK. (2014). Review on treatment of premenstrual syndrome: From conventional to alternative approach. Journal of Basic and Clinical Physiology and Pharmacology, 25(4), 319-327.
[5] Clayton AH, Keller AE, Leslie C, et. al. (2006). Exploratory study of premenstrual symptoms
and serotonin variability. Archives of Women’s Health, 9: 51–57; Verma op. cit., Tieraona op. cit., Mortola op. cit., Aeli op. cit.
[6] Yonkers KA, O’Brien PM & Eriksson E. (2008). Premenstrual syndrome. The Lancet, 371(9619), 1200-10. Verma op. cit., Mortola op. cit., Aeli op. cit.
[8] Clayton op. cit., Mortola op. cit., Aeli op. cit., Verma op. cit.
[9] Watson CS, Alyea RA, Cunningham KA, et. al. (2010). Estrogens of multiple classes and their role
in mental health disease mechanisms. International Journal of Women’s Health, 2, 153-166; Clayton op. cit.
[10] Watson op. cit.
[11] Clayton op. cit.
[13]Verma op. cit.
[14] Nakamura K & Hasegawa H. (2009). Production and peripheral roles of 5-HTP, a precursor of serotonin. International Journal of Tryptophan Research, 2, 37.
[15] Ibid.
[16] Eser D, Baghai TC, Schule C, et. al. (2008). Neuroactive steroids as endogenous modulators of anxiety. Current Pharmaceutical Design, 14(33), 3525-33; Mortola op. cit
[17] Ibid.
[18] Ibid.
[19] Tieraona op. cit., Verma op. cit., Mortola op. cit
[20] Tieraona op. cit.
[21] Ibid.
[22] Tieraona op. cit., Verma op. cit., Mortola op. cit., Aeli op. cit.
[23] Tieraona op. cit
[24] Verma op. cit.
[25] Tieraona op. cit., Verma op. cit.
[26] Verma op. cit.
[27] Tieraona op. cit., Verma op. cit., Aeli op. cit.
[28] Tieraona op. cit.
[29] Verma op. cit.
[30] Tieraona op. cit.
Clinical Contributor
Marina Braine
Clinical Support Specialist at Sanesco International, Inc.
Marina Braine is a Clinical Support Specialist at Sanesco. She graduated from UNC-Asheville with her Bachelors of Science in Biology with a minor in French. She likes to keep active by hiking, running, and contra dancing around Asheville.
