Main Article Content
Premenstrual syndrome, herbs, vitamins, minerals, systematic review
As many women experiencing symptoms of premenstrual syndrome (PMS) seek relief from natural products (NP), health care providers should have quality information available to aid women in making evidence-based decisions regarding use of these products. Objective To identify herbs, vitamins and minerals advocated for the treatment of PMS and/or PMDD and to systematically review evidence from randomized controlled trials (RCTs) to determine their efficacy in reducing severity of PMS/PMDD symptoms.
Searches were conducted from inception to April 2008 in Clinical Evidence, The Cochrane Library, Embase, IBID, IPA, Mayoclinic, Medscape, MEDLINE Plus, Natural Medicines Comprehensive Database and the Internet to identify RCTs of herbs, vitamins or minerals advocated for PMS. Bibliographies of articles were also examined. Included studies were published in English or French. Studies were excluded if patient satisfaction was the sole outcome measure or if the comparator was not placebo or recognized therapy.
Sixty-two herbs, vitamins and minerals were identified for which claims of benefit for PMS were made, with RCT evidence found for only 10. Heterogeneity of length of trials, specific products and doses, and outcome measures precluded meta-analysis for any NP. Data supports the use of calcium for PMS, and suggests that chasteberry and vitamin B6 may be effective. Preliminary data shows some benefit with ginkgo, magnesium pyrrolidone, saffron, St. John’s Wort, soy and vitamin E. No evidence of benefit with evening primrose oil or magnesium oxide was found.
Only calcium had good quality evidence to support its use in PMS. Further research is needed, using RCTs of adequate length, sufficient sample size, well-characterized products and measuring the effect on severity of individual PMS symptoms.
2. Bruyere HJ. An update on premenstrual syndrome. Pharm Times 1999;65(7):105-117.
3. Johnson SR. Premenstrual syndrome, premenstrual dysphoric disorder and beyond: A clinical primer for practitioners. Obstet Gynecol 2004;104:845- 859.
4. Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual syndrome. Am Fam Phys 2003;67(8):1743-1752.
5. Domoney CL, Vashisht A, Studd WW. Premenstrual syndrome and the use of alternative therapies. Ann NY Acad Sci 2003;997:330-340.
6. Dennehy CE. The use of herbs and dietary supplements in gynecology: An evidence-based review. J Midwifery Women's Health 2006;51:402- 409.
7. Girman A, Lee R, Kligler B. An integrative medicine approach to premenstrual syndrome. Am J Obstet Gynecol 2003;188(4):S56-S65.
8. Tesch BJ. Herbs commonly used by women: An evidence-based review. Am J Obstet Gynecol 2003;188(5 Part 2):S44-S54.
9. Chavez M, Spitzer MF. Herbals and other dietary supplements to reduce premenstrual syndrome (PMS). Psychiatr Ann 2002;32:61-71.
10. Bendich A. The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms. J Am Coll Nutr 2000;19(1):3-12.
11. Hardy ML. Herbs of special interest to women. J Am Pharm Assoc 2000;40:234-242.
12. Fugh-Berman A, Kronenberg F. Complementary and alternative medicine (CAM) in reproductive age women: A review of randomized controlled trials. Reprod Toxicol 2003;17:137-152.
13. Stevinson C, Ernst E. Complementary/alternative therapies for premenstrual syndrome: A systematic review of randomized controlled trials. Am J Obstet Gynecol 2001;185(1):227-235.
14. Turner S, Mills S. A double-blind clinical trial on a herbal remedy for premenstrual syndrome: A case study. Complement Ther Med 1993;1:73-77.
15. Lauritzen CH, Reuter HD, Repges R, Bohnert K, Schmidt U. Treatment of premenstrual tension syndrome with Vitex agnus castus. Controlled, double-blind study versus pyridoxine. Phytomed 1997;4(3):183-189.
16. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: Prospective, randomised, placebo controlled study. BMJ 2001;322:134-137.
17. Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharm 2003;18(3): 191-195.
18. Puolakka J, Makarainen L, Vinikka L, Ylikorkala O. Biochemical and clinical effect of treating the premenstrual syndrome with prostaglandin synthesis precursors. J Repro Med 1985;30(3):149- 153.
19. Khoo SK, Munro C, Battistutta D. Evening primrose oil and treatment of premenstrual syndrome. Med J Aust 1990;153(4):189-192.
20. Collins A, Cerin A, Coleman G, Landgren BM. Essential fatty acids in the treatment of premenstrual syndrome. Obstet Gynecol 1993;81(1):93-98.
21. Tamborini A, Taurelle R. Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome. Rev Fr Gynecol Obstet 1993;88(7-9):447-457.
22. Agha-Hosseini M, Kashani L, Aleyaseen A, et al. Crocus sativus L. (saffron) in the treatment of premenstrual syndrome: A double-blind, randomised and placebo-controlled trial. Br J Obstet Gynaecol 2008;115:515-519.
23. Hicks SM, Walker AF, Gallagher J, Middleton RW, Wright J. The significance of "nonsignificance" in randomized controlled studies: A discussion inspired by a double-blind study on St. John's Wort (Hypericum perforatum L.) for premenstrual symptoms. J Alt Compl Med 2004;10(6):925-932.
24. Bryant M, Cassidy A, Hill C, Powell J, Talbot D, Dye L. Effect of consumption of soy isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome. Br J Nutr 2005;93:731-739.
25. Stokes J, Mendels J. Pyridoxine and premenstrual tension. Lancet 1972;299(7761):1177-1178.
26. Abraham GE, Hargrove JT. Effect of vitamin B6 on premenstrual symptomatology in women with premenstrual tension syndromes: A double blind crossover study. Infertil 1980;3(2):155-165.
27. Mattes JA, Martin D. Pyridoxine in premenstrual depression. Hum Nutr Appl Nutr 1982;36(2):131- 133.
28. Barr W. Pyridoxine supplements in the premenstrual syndrome. Practit 1984;228(1390):425-427.
29. Williams MJ, Harris RI, Dean BC. Controlled trial of pyridoxine in the premenstrual syndrome. J Int Med Res 1985;13(3):174-179.
30. Hagen I, Nesheim BI, Tuntlant T. No effect of vitamin B6 against premenstrual tension. A controlled trial. Acta Obstet Gynecol Scand 1985;64(8):667-670.
31. Smallwood J, Ah-Kye D, Taylor I. Vitamin B6 in the treatment of pre-menstrual mastalgia. Br J Clin Pract 1986;40(12):532-533.
32. Kendall KE, Schnurr PP. The effects of vitamin B6 supplementation on premenstrual symptoms. Obstet Gynecol 1987;70(2):145-149.
33. Doll H, Brown S, Thurston A, Vessey M. Pyridoxine (vitamin B6) and the premenstrual syndrome: A randomized crossover trial. J R Coll Gen Pract 1989;39(326): 364-368.
34. Diegoli MSC, da Fonseca AM, Diegoli CA, Pinotti JA. A double-blind trial of four medications to treat severe premenstrual syndrome. Int J Gynaecol Obstet 1998;62:63-67.
35. De Souza MC, Waler AF, Robinson PA, Bolland K. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for relief of anxiety-related premenstrual syndrome: A randomized, double-blind, crossover study. J Women's Health Gend Based Med 2000;9(2):131-139.
36. Kashanian M, Mazinani R, Jalalmanesh S. Pyridoxine (vitamin B6) therapy for premenstrual syndrome. Int J Gynaecol Obstet 2007;96(1):43-44.
37. 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: 115-122.
38. London RS, Murphy L, Kitlowski KE, Reynolds MA. Efficacy of alpha-tocopherol in the treatment of the premenstrual syndrome. J Repro Med 1987;32(6):400-404.
39. Thys-Jacobs S, Ceccarelli S, Bierman A, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: A randomized crossover trial. J Gen Intern Med 1989;4(3):183-189.
40. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: Effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol 1998;179(2):444-452.
41. Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AR. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol 1991; 78(2):177-181.
42. Walker AF, De Souza MC, Marakis G, Robinson PA, Morris AP, Bollans KM. Unexpected benefit of sorbitol placebo in mg intervention study of premenstrual symptoms: Implications for choice of placebo in RCTs. Med Hypothesis 2002;58(3):213- 220.
43. Kwan I, Onwude JL. Premenstrual syndrome. Clin Evid 2006;15:1-18.
44. Butterweck V, Schmidt M. St. John's Wort: Role of active compounds for its mechanism of action and efficacy. Wien Med Wochenschr 2007;157(13- 14):356-361.
45. Wyatt KM, Dimmock PW, Jones PW, O'Brien PMS. Efficacy of vitamin B6 in the treatment of premenstrual syndrome: A systematic review. BMJ 1999;318:1375-1381.
46. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. Washington DC: National Academy Press, 1997.
47. ACOG. Premenstrual syndrome. ACOG Pract Bull 2000;15:1-9.
48. Borenstein JE, Dean BB, Beifke E, Korner P, Yonkers KA. Differences in symptom scores and health outcomes in premenstrual syndrome. J Womens Health 2007; 16(8):1139-1144.
49. Yonkers KS, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Raplin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005;106:492-501.
50. Su TP, Schmidt PJ, Danaceau MA, et al. Fluoxetine in the treatment of premenstrual dysphoria. Neuropsychopharmacol 1997;16:346-56.