PMS - Common, Not Inevitable

Practical Tips for Reducing the Symptoms of Premenstrual Syndrome

Summary of useful things for PMS

1. Progesterone

   1. Can help to increase progesterone levels during the luteal phase, and protect against excess estrogen. Should be bio-identical progesterone dissolved in vitamin E.

2. Oxaloacetate (Product is “benaGene” - can buy on Amazon)

   1. This is created from an enzyme that requires biotin and manganese.

   2. It improves the emotional symptoms of PMS, like anxiety and poor mood.

3. Vitamin B6 + Magnesium

   1. Lowers prolactin and glutamate, and increases dopamine and GABA, which helps with many PMS symptoms.

   2. Magnesium can also help directly with menstrual cramps

4. Vitamin D + Calcium

   1. Many positive effects on mood, digestion and immunity, can also lower prolactin and PTH all of which should help lower PMS symptoms.

5. Raw Carrot Salad

   1. Helps improve estrogen detoxification and gut motility, thus improving PMS symptoms.

   2. Grated raw carrots, olive/coconut oil, salt and vinegar

6. Vitamin E

   1. Lowers excess estrogen, prolactin, prostaglandins and leukotrienes, leading to a reduction of PMS symptoms.

7. Ceylon Cinnamon, Gingko Biloba, Pine Bark, Ginger

   1. They inhibit enzymes that create inflammation leading to less severe menstrual cramps.

“Nutrition which supports the adrenals, ovaries, thyroid and liver can raise the body temperature toward normal, while reducing premenstrual symptoms and dysmenorrhea. Usually, vitamins A, E, pantothenic acid, and C will raise the temperature; sometimes other B complex vitamins are needed, as well as minerals such as iodine, manganese, zinc, and magnesium.”

-Nutrition For Women, Ray Peat

It seems that prolactin and glutamate exacerbate PMS, whereas dopamine and GABA can ameliorate it. Interestingly enough, vitamin B6 is one of the most well-known nutrients utilized for the amelioration of PMS. Well, vitamin B6 lowers prolactin and increases dopamine. It also lowers glutamate and increases GABA. So, vitamin B6 is a perfect example to show which hormones and neurotransmitters can worsen PMS and which ones can help lessen the symptoms. Vitamin B6 and magnesium are both very useful for the emotional/psychological symptoms of PMS, but they both can help with the physical symptoms of PMS too. For example, vitamin B6 has a slight analgesic effect.

Typically vitamin B6 has more of a beneficial effect when you also take it with magnesium. So to reduce PMS symptoms, I think vitamin B6 (P5P form not pyridoxine HCL) with magnesium would be best. I think a big mistake in studies is when they use pyridoxine HCL as the form of vitamin B6 as opposed to P5P “pyridoxal 5’ phosphate”. P5P is the active form of B6, and pyridoxal HCL must be converted into P5P in order to be useful.

“After the intervention, the mean score of PMS significantly decreased in all three groups (p < 0.05). The decrease was the greatest in the Mg plus vitamin B6 group”

-Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome"

“Magnesium also helps to maintain ATP levels, and for example can be used to stop menstrual cramps”

-Nutrition for Women, Ray Peat

Vitamin E is another nutritional supplement that can lower prolactin, which is one reason why it can help with PMS. Taking a vitamin E supplement that is composed of natural mixed tocopherols would be best. Vitamin E also lowers inflammation by lowering eicosanoids like prostaglandins and helps protect against excess estrogen, all of which help against PMS. Since vitamin E lowers both prolactin and inflammation it should be useful for both the emotional and physical symptoms of PMS.

Vitamin D has been shown to be able to lower excessive PTH (parathyroid hormone) and prolactin, this should explain part of how vitamin D helps lessen PMS symptoms. A good goal is a vitamin D level of 125 nmol/L (or 50 ng/ml). However, even if you don’t run a blood test most people do very well with vitamin D supplementation. Especially when it is vitamin D in a soft gel that has olive oil as the base. Most people take 1,000-5,000 IU a day, more may be needed depending on blood test levels. Vitamin D also helps with the absorption of calcium. Both vitamin D and calcium have been found to also lower menstrual/period cramps which is part of “primary dysmenorrhea”.

Calcium is also shown to be beneficial for PMS, so it would be a good idea to consume calcium in foods such as yogurt, cheese and milk. A2 cows dairy or goat dairy products are a better choice than normal cow products (A1 cow products) because the A1 cow products could cause digestive issues and can actually increase prolactin, which would not be good for PMS. Many people can do just fine on normal A1 dairy, but if milk and cheese bother you then I would strongly suggest trying A2 cow or goat (both of which either do not contain much or any of the inflammatory A1 protein). Cooked vegetables like broccoli and kale can be an ok source of calcium, so can eating fish with edible bones (like in canned sardines). Some people may want to supplement with calcium, such as with “pearl calcium” or “coral calcium”. Eating enough vitamin K2 (or supplementing) is also important, especially when it comes to calcium utilization.

“Low levels of Vit D and calcium are inversely related to the severity of primary dysmenorrhea, and taking Vit D and calcium can reduce the severity of primary dysmenorrhea and its associated systemic symptoms. Therefore, the use of calcium and Vit D supplements can be recommended to relieve dysmenorrhea”

-Role of vitamin D and calcium in the relief of primary dysmenorrhea: a systematic review

Zinc is another important nutrient for keeping prolactin down, and thus it is crucial to consume enough zinc if you want to prevent PMS. Zinc supplementation can be tricky, it has the potential to cause nausea and it can lead to imbalances with other nutrients such as copper. You also have to take it away from things that contain phytates and other anti-nutrients which means it can be a pretty annoying endeavour. Thus, I think getting zinc from food is far better and much easier than supplementation. Oysters are by far the best zinc source, and red meat is the second best. Many people do not like oysters and that is fine, if this is the case try consuming beef, bison or lamb often so you can get enough zinc. Fish and shellfish in general should have a good amount of zinc as well. If you are vegan or vegetarian, then maybe supplemental zinc would be advisable.

“Overall, zinc supplementation for 12 weeks among women with premenstrual syndrome had beneficial effects on physical and psychological symptoms of premenstrual syndrome”

-Effect of Zinc Supplementation on Physical and Psychological Symptoms, Biomarkers of Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Young Women with Premenstrual Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial

“In conclusion, zinc, as a simple and inexpensive treatment, was associated with improvement of PMS symptoms”
-The Effect of Zinc Supplementation on the Improvement of Premenstrual Symptoms in Female University Students: a Randomized Clinical Trial Study

The anti-prolactin (and pro-dopamine) drug bromocriptine is used to prevent menstrual migraines. We can glean from this that lowering prolactin is likely a major reason why different substances can help prevent certain PMS symptoms. You can find out more about Migraines and Frequent Headaches in my article on them.

There are many things you can do to increase GABA and lower glutamate, you can find out more in my various articles such as this one: The Dance of Glutamate and GABA. Things that improve the balance of glutamate and GABA should be very beneficial for reducing PMS symptoms.

Biotin, Manganese and Oxcaloacetate

One way that we utilize glucose is by making oxaloacetate via the enzyme pyruvate carboxylase. We take glucose and make pyruvate, and then this pyruvate becomes oxaloacetate. The main required nutrients for this enzyme are biotin and manganese.

Oxaloacetate is shown to be beneficial in PMS, and so is manganese. Given that you need adequate levels of biotin and manganese to create oxaloacetate, it is also reasonable to assume that increasing the consumption of biotin would help with PMS symptoms. Many women take oxaloacetate as a supplement for PMS, and this can be a good idea. However, I think eating a diet rich in manganese (mussels, pineapple, maple syrup, legumes) and biotin (organ meats, egg yolks (never just eat the white, always eat the full egg or just the yolk!) and peanuts) would be a good idea to make sure the enzyme has what it needs to make the oxaloacetate. Some people may want to supplement biotin and manganese, and this could be a worthwhile experiment to see if the PMS symptoms get better.

“The GABA/glutamate ratio may also play a major role in the emotional symptoms of PMS. Oxaloacetate supplementation can reduce glutamate levels in the brain via a process known as “glutamate scavenging”. In addition, oxaloacetate supplementation has been shown to increase GABA levels in animal models. By both lowering glutamate and increasing GABA levels, the GABA/glutamate ratio is altered, which may also help to alleviate emotional symptoms experienced by women during PMS.”

“Oxaloacetate/vitamin C supplementation during PMS significantly improved depression, perceived stress, anxiety, aggression, and suicidal ideation. The mean improvement in depression was 54.1%, 35.8% for perceived stress, 51.43% for generalized anxiety, and 17.8% for aggression. Suicidal ideation was reduced by 47.9%. All results were highly significant.”

“A combination of oxaloacetate and vitamin C supplementation helped to alleviate depression, anxiety, perceived stress, aggression, and suicidal ideation symptoms associated with PMS.”

-Oxaloacetate reduces emotional symptoms in premenstrual syndrome (PMS): results of a placebo-controlled, cross-over clinical trial

Oxaloacetate as a supplement is “benaGene” and you can buy it on Amazon and some other places.

Lack of Progesterone + Excessive Estrogen = PMS

The luteal phase (the phase which is from ovulation - menstruation, or the “second half” of the cycle) is the phase where women should be producing the most amount of progesterone. Well, because of this many people incorrectly assume that PMS is caused by progesterone. This is not the case. If a woman feels bad before her period, in the luteal phase, it is likely that her body is struggling to produce enough progesterone and as a result PMS symptoms surface. Furthermore, if a woman is having a hard time detoxifying estrogen then this can also cause PMS to worsen. So, if someone has any PMS symptoms, it is likely that there is both too little progesterone and too much estrogen.

Progesterone is a steroid hormone and thus its base is cholesterol. We take cholesterol, vitamin A (retinol) and active thyroid hormone (T3), and some other nutrients like vitamin B5 and convert this into pregnenolone, which can then be converted to other hormones such as progesterone. During the luteal phase, a woman produces a lot of progesterone from the ovaries, specifically the corpus luteam. Two major causes of low progesterone production would be low thyroid function/metabolic rate and lack of vitamin A consumption. The thyroid topic is vast and out of the scope of this article. But when it comes to vitamin A, the recommendation would be to try to consume enough of it so you can produce enough progesterone. Organ meats like liver (4oz of liver a week is a good amount) are hands down the best source of vitamin A. You can also supplement “desiccated liver” if you can’t stand eating actual liver. Liver pate and liver sausage are also options. Egg yolks and dairy (ghee, butter, cream) are also good sources of vitamin A, however, they contain far less than liver.

“The fact that progesterone (and probably pregnenolone) stimulates its own synthesis means that taking it does not suppress the body's ability to synthesize it, as happens with cortisol Sometimes, one dose or a few doses can restore the body's ability to produce enough of its own.” - Ray Peat

Increasing progesterone production can really help with PMS. One way to increase progesterone is to directly supplement with it. Supplemental progesterone does not lower a woman's endogenous production of progesterone, in fact, according to Ray Peat Ph.D., supplemental progesterone dissolved in vitamin E can stimulate the ovaries to make more progesterone. So supplementing progesterone can help you make more progesterone. It is very important that supplemental progesterone be dissolved in vitamin E. It can be used topically (such as in the form of an oil or a cream) or orally (like as progesterone dissolved in vitamin E oil). The oral progesterone that you get prescribed is not dissolved in vitamin E, and this can lead to some problems. When progesterone is not dissolved in vitamin E, the liver deactivates much of the progesterone, and the progesterone that is not deactivated is largely converted to other hormones such as allopregnanolone. That’s why it’s best to get progesterone dissolved in vitamin E, such as Progest-E, and Luna Oil (products and discounts at the end of the article).

“Over the years I have seen transdermal progesterone used in hundreds of women suffering from the full range of perimenstrual symptoms, including migraine, acne, depression, mastalgia, edema, and lethargy. Nearly all the women, applying the lotion themselves, are able to find the appropriate dosage for controlling their symptoms”

-From PMS to Menopause, Ray Peat

Never supplement synthetic progestins which are not bio-identical progesterone. These “progestins” are closer to androgens (male hormones) than they are to progesterone. Progestins are used for birth control and are not the same as bio-identical progesterone. They have very different effects.

Taking progesterone during the luteal phase means taking it from ovulation until menstruation. However, it seems to be ideal to start taking it a day or so after ovulation, and then continue taking it daily until you start the cycle again (until you start to menstruate). Taking it daily all month can prevent ovulation. Some people need to take it daily because of their symptoms, and this is fine but the “collateral damage” of that is the potential loss of ovulation for that cycle. There are some additional issues to the daily use of progesterone, such as the liver increasing its excretion of it. Overall, the default with supplementation of progesterone should be 2 weeks out of the month, and only using it daily if it is strongly indicated.

Other than increasing progesterone to help with PMS, helping to lower excess estrogen can also be very therapeutic. Vitamin E is one way to help protect against excess estrogen, which is another reason why vitamin E can be so useful for those suffering from PMS. Stinging Nettle leaf tea can act as a natural aromatase inhibitor, which means it prevents other hormones from turning into estrogen. Boiled white button mushrooms (not raw!) are also aromatase inhibitors. Progesterone is a very potent aromatase inhibitor and is the body’s main endogenous protector against excess estrogen. Also, keep in mind, excess estrogen can increase prolactin and inhibit thyroid function, both of which can increase the severity of PMS symptoms.

“Aging, stress, menopause, Cushing's syndrome, and the premenstrual syndrome all overlap so much that each state can probably give us some insight into the others. An elevated estrogen/progesterone ratio is likely to be a common feature.”

“Katharina Dalton has found that premenstrual symptoms, which result from a relative estrogen surplus and a progesterone deficiency, often continue during the menopause”

-Nutrition For Women, Ray Peat

It is also important to note that allopregnanolone, a neurosteroid that is a metabolite of progesterone, is a potent anti-depressant and helps to improve mood dramatically. Increasing allopregnanolone production should be very useful for PMS. The best way to improve allopregnanolone is by increasing its precursors, pregnenolone and progesterone.

If you want to learn about information related to how progesterone can help with menstrual headaches and migraines check out my articles on PCOS and Migraines. Progesterone is also great for depression and anxiety in women, you can learn more about using progesterone for anxiety in this article.

Gut Motility Promotion for PMS

When gut motility is slow that means that things moving through the intestine are not moving quickly enough. This can show up as constipation, but it doesn't have to, it can show up as bloating, gas and stomach upset as well. Slow gut motility can massively worsen PMS symptoms for many reasons. One of them is that we detoxify estrogen in the bile and must excrete it in the bowels, if you are not moving it out of your system quickly enough then you can reabsorb the detoxified estrogen. This is a major reason why the raw carrot salad is so beneficial for PMS, the idea is the grated raw carrots will bind to the detoxified estrogen so you can have an easier time removing it from your intestines. The raw carrot salad is grated raw carrots, olive/coconut oil, salt and vinegar, eaten daily.

“Many people find that daily use of the raw carrot eliminates their PMS, headaches, or allergies.”

-From PMS to Menopause, Ray Peat

Increasing gut motility with certain herbal products like aloe vera juice (inner leaf fillet) and well-aged cascara sagrada bark can also be very helpful. These both contain a form of “emodin” which can help calm down intestinal inflammation and can help improve gut motility. Increasing bile production can also help, the amino acids taurine and glycine are useful for this, as is choline.

Good thyroid function is essential for good gut motility, so improving the metabolism can also be a great way to prevent PMS, but this is more of a long-term strategy. A classic sign of hypothyroidism is chronic constipation, which clearly will make PMS worse.

Herbal Products for PMS

Many herbal supplements seem to be useful for PMS, such as Cinnamon, Ginger, Gingko Biloba, Pycnogenol, Vitex and Evening Primrose Oil. One thing that most of them have in common is they can inhibit (to some degree) the enzyme phospholipase A2 (PLA2). This enzyme breaks down phospholipids and releases a massive amount of arachidonic acid which then enters the COX and LOX enzymes, creating the eicosanoids: prostaglandins and leukotrienes. Both of these eicosanoids seem to play a large role in PMS, especially by increasing menstrual cramps.

What we can glean from these herbs is that lowering prostaglandins and leukotrienes can be highly therapeutic for PMS. Other things that can lower COX and/or LOX are vitamin E and Boswellia Serrata. I talk about COX and LOX (and prostaglandins and leukotrienes) in detail in my article on asthma “Wheeze No More”. Aspirin and Ibuprofen (Advil) are OTC COX inhibitors and thus limit prostaglandin production. These should all help with menstrual cramps to some degree.

Ceylon Cinnamon seems to be very effective for menstrual pain/cramps.

“Our results suggested that cinnamon significantly reduced pain, the amount of menstrual bleeding, nausea and vomiting in female college students. Therefore, cinnamon improves the severity of primary dysmenorrhea.”

-The Effect of Cinnamon on Menstrual Bleeding and Systemic Symptoms With Primary Dysmenorrhea

In addition to lowering inflammation via lowering the production of prostaglandins and leukotrienes Gingko Biloba and Vitex are likely also helping by the fact that they can increase dopamine and lower prolactin to some extent.

Herbs are a nice add-on to a PMS-lowering approach, especially if someone likes to keep it more “natural”. I think Ceylon Cinnamon, Pine Bark (Pycnogenol), Ginger and Gingko Biloba are likely the more useful out of the bunch.

Castor oil packs can be useful for premenstrual cramps, there is lots of information online on how to use a castor oil pack. I believe this also works, in part, by limiting prostaglandins.

Practical Steps

I suggest checking out Keith Littlewood’s information on PMS, he has some great informational videos on the topic. Also, reading Ray Peat’s books, such as “From PMS to Menopause” and “Progesterone in Orthomolecular Medicine”.

Below are suggestions for both physical and psychological PMS symptom relief. Some are more geared towards psychological/mood-related symptoms, like oxaloacetate and vitamin B6. Others are more geared toward the physical/pain symptoms, like cinnamon, ginger and calcium.

Magnesium is an example of something that can help with both the psychological and the physical symptoms of PMS.

Very Effective:

1. Progesterone in the luteal phase (must be dissolved in vitamin E)

   1. If you use Ona’s Natural products you can use discount code DEAN to save

   2. Cream (topical) or oil (topical OR oral) is fine

2. Oxaloacetate supplementation (benaGene)

3. Vitamin B6 (P5P) dose in the range of 10-60mg

4. Magnesium (threonate, glycinate or taurate)

   1. If you use LifeBlud’s product you can use discount code DEAN to save

5. Vitamin D (and eating a diet high in calcium, or supplementing calcium)

Effective:

1. Raw carrot salad (daily is best)

2. Ceylon Cinnamon (1-3g a day), Gingko Biloba (120mg a day), Ginger (500mg 3x a day) and Pycnogenol (50-100mg a day).

3. Vitamin E (Mixed Tocopherols)

   1. If you use LifeBlud’s product you can use discount code DEAN to save

4. Zinc (ideally from the diet, but supplementation may be warranted)

   1. If you do supplement zinc, maybe zinc carnosine would be best. This is because zinc carnosine is very good for gut health as it can help heal leaky gut. At the same time, it’s a source of zinc.

5. Biotin and Manganese

   1. Ideally from food, supplement if warranted

   2. Egg yolks, organ meat and peanuts for biotin, or a supplement.

   3. Mussels, shellfish, maple syrup, pineapple and pineapple juice, legumes for manganese, or a supplement

6. Castrol oil packs for cramps

7. Consuming enough vitamin A

8. Anything else that can balance glutamate and GABA, find out more in this article

Extra Ideas:

1. Pregnenolone

2. Myo-inositol

3. Taurine, Glycine

4. Theanine

5. Agmatine

6. Eat enough molybdenum (or supplement)

   1. Gluten-free oats and legumes like peas are both good sources of molybdenum. Liver is also a good source.

7. Vitamin B1, Pantethine (a form of vitamin B5) and other B vitamins

8. Vitamin K2

9. Vitamin C

10. Valerian root, Lemon Balm (tea or tincture)

11. For pain medication, Aspirin is best, Advil is neutral, and Tylenol is toxic.

If you enjoyed this article, please consider checking out the other articles I’ve written. Also, please feel free to subscribe (it is free to do so) and share the articles with others. Thank you!

*None of this is medical advice. I am not a medical professional, always talk to your doctor*

BTW: I am a frequent guest on the podcast “Stuff Your Doctor Should Know”.

Discount code DEAN works at:

1. Ona’s Naturals (progesterone oil, topical progesterone and pregnenolone creams)

2. LifeBlud (Magnesium products, Taurine, Theanine, B vitamins, Methylene Blue)

3. Health Natura (oral pregnenolone, Methylene Blue)

4. Saturee (skin care products, desiccated liver, aged Cascara Sagrada)