A Diet for PMS

While researching this article, I read that premenstrual syndrome, or PMS, affects up to 40% of menstruating women. That number surprised me, as I've yet to meet a woman who claims she's never experienced PMS. Except for my mother, that is; but then she didn't have any symptoms of menopause, either. I should be so lucky - if PMS is any indicator, it's not looking good.

PMS actually doesn't come up that often in my patient interactions; patients usually only mention it if it's particularly severe or affecting their relationships or work performance. It's not something I usually bring up in a periodic health examination or during a Pap test, though I probably should. Especially given what I know now about the basic nutritional interventions that can help manage symptoms - this information could probably make a real difference to the lives of a significant number of women.

The classic symptoms of PMS include pre-menstrual depression and moodiness, irritability, breast tenderness, headaches, abdominal cramping, insomnia, bloating and food cravings. It's enough to make you want to drown yourself in a vat of ice cream, or bury yourself in chocolate cake. Neither of these remedies, unfortunately, is particularly helpful in the long run.

In 2000 the American College of Obstetricians and Gynecologists published recommendations for the management of PMS. Their Level B recommendations (based on "limited or inconsistent evidence"): 1) Carbohydrate-rich foods and beverages may improve mood symptoms and food cravings and are a reasonable first line approach; 2) Calcium supplements have been shown to be effective in treatment; and 3) Magnesium, Vitamin B6 and Vitamin E have minimal effectiveness in treatment of PMS. Their Level C recommendations (based on consensus and expert opinion) recommend complex carbohydrates and calcium, magnesium and vitamin E supplements as first-line treatment, before considering "Step 2", anti-depressant medications.