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    Premenstrual Syndrome (Holistic)

    Premenstrual Syndrome (Holistic)

    About This Condition

    Know your body and find your balance despite PMS. Because every woman is different, no single treatment effectively relieves all symptoms in all women. According to research or other evidence, the following self-care steps may be helpful.
    • Check out calcium and magnesium

      A daily supplement of 1,000 to 1,200 mg of calcium and 200 to 400 mg of magnesium to reduce the risk of mood swings, bloating, headaches, and other symptoms

    • Eat right

      Emphasize low-fat, high-fiber foods and plenty of fruits and vegetables to improve hormone metabolism

    • Stay active

      Aim for regular aerobic exercise to help reduce symptoms

    • Balance your body chemistry with vitex

      20 mg a day of a concentrated herbal extract for up to three months may help balance hormones

    About

    About This Condition

    Premenstrual syndrome (PMS) is a poorly understood complex of symptoms occurring a week to ten days before the start of each menstrual cycle.

    PMS is believed to be triggered by changes in progesterone and estrogen levels.

    Symptoms

    Many premenopausal women suffer from symptoms of PMS at different points in their menstrual cycle. Symptoms include cramping, bloating, mood changes, and breast tenderness tied to the menstrual cycle.

    Healthy Lifestyle Tips

    Women with PMS who jogged an average of about 12 miles a week for six months were reported to experience a reduction in breast tenderness , fluid retention , depression , and stress.1 Doctors frequently recommend regular exercise as a way to reduce symptoms of PMS.

    Eating Right

    The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

    Recommendation Why
    Eat right
    Eat more low-fat, high-fiber foods and plenty of fruits and vegetables to improve hormone metabolism.

    Several studies suggest that diets low in fat or high in fiber may help to reduce symptoms of PMS.2 Many doctors recommend diets very low in meat and dairy fat and high in fruit, vegetables, and whole grains.

    Limit sugar
    Some doctors recommend that women with PMS cut back on sugar for several months to see if it reduces their symptoms.
    Women who eat more sugary foods have been reported to have an increased risk of PMS.3 Some doctors recommend that women with PMS cut back on sugar consumption for several months to see if it reduces their symptoms. However, no trials have yet to study the isolated effects of sugar restriction in women with PMS.
    Avoid alcohol
    Alcohol can affect hormone metabolism, so drinking less alcohol may reduce PMS symptoms.

    Alcohol can affect hormone metabolism, and alcoholic women are more likely to suffer PMS than are nonalcoholic women.4 Some doctors recommend that women with PMS avoid alcohol for several months to evaluate whether such a change will reduce symptoms.

    Cut the caffeine
    Caffeine consumption has been associated with increased prevalence and severity of PMS.

    In a study of Chinese women, increasing tea consumption was associated with increasing prevalence of PMS.5 Among a group of college students in the United States, consumption of caffeine -containing beverages was associated with increases in both the prevalence and severity of PMS.6 Moreover, the more caffeine women consumed, the more likely they were to suffer from PMS.7 A preliminary study showed that women with heavy caffeine consumption were more likely to have shorter menstrual periods and shorter cycle length compared with women who did not consume caffeine.8 Some doctors recommend that women with PMS avoid caffeine.

    Supplements

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    Supplement Why
    3 Stars
    Calcium
    1,000 to 1,200 mg daily
    Calcium appears to reduce the risk of mood swings, bloating, headaches, and other PMS symptoms.

    Women who consume more calcium from their diets are less likely to suffer severe PMS.9 A large double-blind trial found that women who took 1,200 mg per day of calcium for three menstrual cycles had a 48% reduction in PMS symptoms, compared to a 30% reduction in the placebo group.10 Other double-blind trials have shown that supplementing 1,000 mg of calcium per day relieves premenstrual symptoms.11 , 12

    3 Stars
    L-Tryptophan
    2 to 6 grams per day, during the second half of the menstrual cycle
    Some research suggests that L-tryptophan may help balance mood symptoms associated with PMS.
    Preliminary research suggests that imbalances of the neurotransmitter serotonin or its precursor, L-tryptophan, may be associated with PMS.13 In a double-blind trial, women with PMS who took 6 grams per day of L-tryptophan during the second half of their menstrual cycle reported a one-third reduction in the severity of abnormal mood symptoms.14 This confirmed the results of an earlier preliminary trial in which 2 grams per day of L-tryptophan taken during the second half of the menstrual cycle reduced depression and other symptoms associated with PMS.15
    3 Stars
    Vitamin B6
    100 to 200 mg per day on a regular basis
    Many clinical trials show that taking vitamin B6 helps relieve PMS symptoms.

    Many,16 , 17 , 18 , 19 , 20 though not all,21 clinical trials show that taking 50?400 mg of vitamin B6 per day for several months help relieve symptoms of PMS. A composite analysis of the best designed controlled trials shows that vitamin B6 is more than twice as likely to reduce symptoms of PMS as is placebo.22 Many doctors suggest 100?400 mg per day for at least three months. However, intakes greater than 200 mg per day can cause side effects and should never be taken without the supervision of a healthcare professional.

    3 Stars
    Vitex
    20 mg a day of a concentrated herbal extract
    Vitex has been shown to help balance of estrogen and progesterone during the menstrual cycle and may alleviate PMS symptoms.

    Vitex has been shown to help re-establish normal balance of estrogen and progesterone during the menstrual cycle. Vitex also blocks prolactin secretion in women with excessive levels of this hormone; excessive levels of prolactin can lead to breast tenderness and failure to ovulate. A double-blind trial has confirmed that vitex reduces mildly elevated levels of prolactin before a woman?s period.23 Studies have shown that using vitex once in the morning over a period of several months helps normalize hormone balance and thus alleviate the symptoms of PMS.24 Preliminary and double-blind research has found that vitex relieves PMS symptoms. The amount in most of these trials was 20 mg per day of a concentrated vitex extract for three menstrual cycles experience a significant reduction in symptoms of PMS.25 , 26 , 27

    Vitex has been shown to be as effective as 200 mg vitamin B6 in a double-blind trial of women with PMS.28Two surveys examined 1,542 women with PMS who had taken a German liquid extract of vitex for their PMS symptoms for as long as 16 years.29 With an average intake of 42 drops per day, 92% of the women surveyed reported the effectiveness of vitex as ?very good,??good,? or ?satisfactory.?

    Some healthcare practitioners recommend 40 drops of a liquid, concentrated vitex extract or one capsule of the equivalent dried, powdered extract once per day in the morning with some liquid. Vitex should be taken for at least four cycles to determine efficacy.

    2 Stars
    Evening Primrose Oil
    3 to 4 grams daily
    Women with PMS may have impaired conversion of linoleic acid to gamma linolenic acid (GLA). Evening primrose oil contains GLA and may reduce PMS symptoms.

    Women with PMS have been shown to have impaired conversion of linoleic acid (an essential fatty acid) to gamma linolenic acid (GLA).30 Because a deficiency of GLA might, in theory, be a factor in PMS and because evening primrose oil (EPO) contains significant amounts of GLA, researchers have studied EPO as a potential way to reduce symptoms of PMS. In several double-blind trials, EPO was found to be beneficial,31 , 32 , 33 , 34 whereas in other trials it was no more effective than placebo.35 , 36

    Despite these conflicting results, some doctors consider EPO to be worth a try; the amount usually recommended is 3?4 grams per day. EPO may work best when used over several menstrual cycles and may be more helpful in women with PMS who also experience breast tenderness or fibrocystic breast disease .37

    2 Stars
    Krill Oil
    2 grams daily for one month; after that, 2 grams per day beginning eight days prior to menstruation and continuing for two days after the start 
    Krill oil has been shown in a double-blind trial to be an effective treatment for premenstrual syndrome, including emotional symptoms and breast tenderness.
    Krill oil from Antarctic krill (a zooplankton crustacean) has been shown in a double-blind trial to be an effective treatment for premenstrual syndrome. Krill oil was significantly more effective than similar amounts of regular fish oil in relieving emotional symptoms and breast tenderness related to premenstrual syndrome. The amount of krill oil used in this study was 2 grams per day for the first month. In the second and third months the women took 2 grams per day beginning eight days prior to menstruation and continuing for two days after the start of menstruation.38
    2 Stars
    Magnesium
    200 to 400 mg daily
    Supplementing with magnesium may help reduce the risk of mood swings, bloating, breast tenderness, headaches, and other symptoms.

    Women with PMS have been reported to be at increased risk of magnesium deficiency.39 , 40 Supplementing with magnesium may help reduce symptoms.41 , 42 In one double-blind trial using only 200 mg per day for two months, a significant reduction was reported for several symptoms related to PMS ( fluid retention , weight gain, swelling of extremities, breast tenderness, and abdominal bloating).43 Magnesium has also been reported to be effective in reducing the symptoms of menstrual migraine headaches.44 While the ideal amount of magnesium has yet to be determined, some doctors recommend 400 mg per day.45 Effects of magnesium may begin to appear after two to three months.

    2 Stars
    Multivitamin
    Follow label directions to use a product containing extra 600 mg vitamin B6, 500 mg magnesium, and 200 IU vitamin E daily
    One study found that a multivitamin-mineral supplement containing vitamin B6, magnesium, vitamin E, vitamin A, B-complex vitamins relieved PMS symptoms.

    Some of the nutrients helpful for premenstrual syndrome appear together in multivitamin-mineral supplements. One double-blind trial used a multivitamin-mineral supplement containing vitamin B6 (600 mg per day), magnesium (500 mg per day), vitamin E (200 IU per day), vitamin A (25,000 IU per day), B-complex vitamins, and various other vitamins and minerals.46 This supplement was found to relieve each of four different categories of PMS symptoms. Related results have been reported in other clinical trials.47 , 48

    2 Stars
    Potassium Gluconate
    600 mg daily
    A preliminary trial found that women with severe PMS who took potassium supplements had complete resolution of PMS symptoms within four menstrual cycles.

    A preliminary, uncontrolled trial found that women with severe PMS who took potassium supplements had complete resolution of PMS symptoms within four menstrual cycles.49 Most participants took 400 mg of potassium per day as potassium gluconate plus 200 mg of potassium per day as potassium chloride for the first two cycles, then switched to solely the gluconate form (600 mg potassium per day) for the remainder of the year-long trial. Without exception, all of the women found their symptoms (i.e., bloating, fatigue, irritability, etc.) decreasing gradually over three cycles and disappearing completely by the fourth cycle. Controlled trials are needed to confirm these preliminary observations.

    2 Stars
    Vitamin B6 (Depression)
    Take under medical supervision: 100 to 300 mg daily
    Several studies indicate that supplementing with vitamin B6 helps alleviate depression, including depression associated with PMS.

    Oral contraceptives can deplete the body of vitamin B6 , a nutrient needed for maintenance of normal mental functioning. Double-blind research shows that women who are depressed and who have become depleted of vitamin B6 while taking oral contraceptives typically respond to vitamin B6 supplementation.51 In one trial, 20 mg of vitamin B6 were taken twice per day. Some evidence suggests that people who are depressed?even when not taking the oral contraceptive?are still more likely to be B6 deficient than people who are not depressed.52

    Several clinical trials also indicate that vitamin B6 supplementation helps alleviate depression associated with premenstrual syndrome (PMS),53 although the research remains inconsistent.54 Many doctors suggest that women who have depression associated with PMS take 100?300 mg of vitamin B6 per day?a level of intake that requires supervision by a doctor.

    2 Stars
    Vitamin E
    300 IU daily
    Vitamin E may decrease PMS symptoms, according to one study.

    Although women with PMS do not appear to be deficient in vitamin E ,55 a double-blind trial reported that 300 IU of vitamin E per day may decrease symptoms of PMS.56

    1 Star
    Bee Pollen
    Refer to label instructions
    One small study found that 2 tablets twice daily of a dietary supplement containing bee pollen extract and royal jelly may decrease PMS symptoms including water retention, weight gain, and irritability.
    One small study conducted over two menstrual cycles found that 2 tablets twice daily of a dietary supplement containing 36 mg of bee pollen extract, 120 mg of bee pollen plus pistil extract, and 6 mg of royal jelly may decrease PMS symptoms including edema (water retention), weight gain, and irritability.
    1 Star
    Black Cohosh
    Refer to label instructions
    Black cohosh has been historically used to treat PMS.

    Black cohosh is approved in Germany for use in women with PMS.57 This approval appears to be based on historical use as there are no modern clinical trials to support the use of black cohosh for PMS.

    1 Star
    Dong Quai
    Refer to label instructions
    In Traditional Chinese medicine, dong quai is typically used in combination with herbs such as peony and osha for menopausal symptoms and menstrual cramps.

    In Traditional Chinese Medicine, dong quai is rarely used alone and is typically used in combination with herbs such as peony (Paeonia officinalis) and osha (Ligusticum porteri) for menopausal symptoms as well as for menstrual cramps.58 However, no clinical trials have been completed to determine the effectiveness of dong quai for PMS.

    1 Star
    Evening Primrose Oil (Irritable Bowel Syndrome)
    Refer to label instructions
    In one trial, women with IBS who experienced worsening symptoms before and during their menstrual period were helped by taking evening primrose oil.

    In one trial, women with IBS who experienced worsening symptoms before and during their menstrual period were helped by taking enough evening primrose oil (EPO) to provide 360?400 mg of gamma linolenic acid (GLA) per day.59 In that trial more than half reported improvement with EPO, but none was helped in the placebo group. The effects of EPO in other groups of IBS sufferers have not been explored.

    1 Star
    Ginkgo
    Refer to label instructions
    Standardized herbal Ginkgo extract has been shown to alleviate PMS symptoms.

    A double-blind trial has shown that standardized Ginkgo biloba extract, when taken daily from day 16 of one menstrual cycle to day 5 of the next menstrual cycle, alleviates congestive and psychological symptoms of PMS better than placebo.60 The trial used 80 mg of a ginkgo extract two times per day.

    1 Star
    Peony
    Refer to label instructions
    In Traditional Chinese medicine, dong quai is used in combination with herbs such as peony and osha for menopausal symptoms and menstrual cramps.

    In Traditional Chinese Medicine, dong quai is rarely used alone and is typically used in combination with herbs such as peony (Paeonia officinalis) and osha (Ligusticum porteri) for menopausal symptoms as well as for menstrual cramps.61 However, no clinical trials have been completed to determine the effectiveness of dong quai for PMS.

    1 Star
    Progesterone
    Refer to label instructions
    Anecdotal reports suggest that progesterone may be effective against PMS symptoms.

    Most well-controlled trials have not found vaginally applied natural progesterone to be effective against the symptoms of premenstrual syndrome.62 Only anecdotal reports have claimed that orally or rectally administered progesterone may be effective.63 Progesterone is a hormone, and as such, there are concerns about its inappropriate use. A physician should be consulted before using this or other hormones. Few side effects have been associated with use of topical progesterone creams, but skin reactions may occur. The effect of natural progesterone on breast cancer risk remains unclear; some research suggests the possibility of increased risk, whereas other research points to a possible reduction in risk.

    1 Star
    Soy
    Refer to label instructions
    Supplementing with soy protein may help relieve premenstrual swelling and cramping.

    In a double-blind trial, supplementing with soy protein (providing 68 mg of isoflavones per day) for two menstrual cycles was significantly more effective than a placebo at relieving premenstrual swelling and cramping.64 The placebo used in this study was cow's milk protein. Some doctors believe that cow's milk, because of its estrogen content, can worsen premenstrual symptoms. If that is the case, then the beneficial effect of soy protein may have been overestimated in this study.

    1 Star
    Vitamin A
    Refer to label instructions
    Very high amounts of vitamin A have reduced PMS symptoms in some studies.

    Very high amounts of vitamin A?100,000 IU per day or more?have reduced symptoms of PMS,65 , 66 but such an amount can cause serious side effects with long-term use. Women who are or who could become pregnant should not supplement with more than 10,000 IU (3,000 mcg) per day of vitamin A. Other people should not take more than 25,000 IU per day without the supervision of their doctor. As yet, no trials have explored the effects of these safer amounts of vitamin A in women suffering from PMS.

    1 Star
    Vitamin B-Complex
    Refer to label instructions
    Research has linked B vitamin deficiencies to PMS, so some women may benefit from supplementing with B-complex vitamins for symptom relief.

    Many years ago, research linked B vitamin deficiencies to PMS in preliminary research.67 , 68 Based on that early work, some doctors recommend B-complex vitamins for women with PMS.69

    1 Star
    Yarrow
    Refer to label instructions
    Based on anecdotal evidence, yarrow tea may be beneficial when the main symptom of PMS is spastic pain.

    Based on anecdotal evidence, yarrow tea has been used by European doctors when the main symptom of PMS is spastic pain.70 Combine 2?3 teaspoons of yarrow flowers with one cup of hot water, then cover and steep for 15 minutes. Drink three to five cups per day beginning two days before PMS symptoms usually commence. In addition, 1?3 cups of the tea added to hot or cold water can be used as a sitz bath.

    References

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    2. Werbach MR. Nutritional Influences on Illness, 2d ed. Tarzana, CA: Third Line Press, 1993, 540?1 [review].

    3. Rossignol AM, Bonnlander H. Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. J Reprod Med 1991;36:131?6.

    4. Halliday A, Bush B, Cleary P, et al. Alcohol abuse in women seeking gynecologic care. Obstet Gynecol 1986;68;322?6.

    5. Rossignol AM, Zhang J, Chen Y, Xiang Z. Tea and premenstrual syndrome in the People?s Republic of China. Am J Public Health 1989;79:67?6.

    6. Rossignol AM. Caffeine-containing beverages and premenstrual syndrome in young women. Am J Public Health 1985;75(11):1335?7.

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    8. Fenster L, Quale C, Waller K, et al. Caffeine consumption and menstrual function. Am J Epidemiol 1999;149:550?7.

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    10. Thys-Jacobs S, Starkey P, Bernstein D, et al. Calcium carbonate and the premenstrual syndrome: Effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol 1998;179:444?52.

    11. Thys-Jacobs S, Ceccarelli S, Bierman A, et al. Calcium supplementation in premenstrual syndrome. J Gen Intern Med 1989;4:183?9.

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    14. Steinberg S, Annable L, Young SN, Liyanage N. A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria. Biol Psychiatry 1999;45:313-20.

    15. Steinberg S, Annable L, Young SN, Belanger MC. Tryptophan in the treatment of late luteal phase dysphoric disorder: a pilot study. J Psychiatry Neurosci 1994;19 :114-9.

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    22. Wyatt KM, Dimmock PW, Jones PW, Shaughn O?Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ 1999;318:1375?81.

    23. Milewicz A, Gejdel E, Sworen H, et al. Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia: Results of a randomized, placebo-controlled double-blind study. Arzneimittelforschung 1993;43:752?6 [in German].

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    25. Loch EG, Selle H, Boblitz N. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus. J Women Health Gender-Based Med 2000;9:315?20.

    26. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ 2001;20:134?7.

    27. Ma L, Lin S, Chen R, et al. Evaluating therapeutic effect in symptoms of moderate-to-severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese women. Aust N Z J Obstet Gynaecol 2010;50:189?93.

    28. Lauritzen C, Reuter HD, Repges R, et al. Treatment of premenstrual tension syndrome with Vitex agnus castus. Controlled, double-blind study versus pyridoxine. Phytomed 1997;4:183?9.

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    30. Horrobin DF, Manku MS, Brush M, et al. Abnormalities in plasma essential fatty acid levels in women with premenstrual syndrome and with nonmalignant breast disease. J Nutr Med 1991;2:259?64.

    31. Puolakka J, Makarainen L, Viinikka L, Ylikorkola O. Biochemical and clinical effects of treating the premenstrual syndrome with prostaglandin synthesis precursors. J Reprod Med 1985;30:149?53.

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    33. Massil H, O?Brien PMS, Brush MG. A double blind trial of Efamol evening primrose oil in premenstrual syndrome. 2nd International Symposium on PMS, Kiawah Island, Sep 1987.

    34. Casper R. A double blind trial of evening primrose oil in premenstrual syndrome. 2nd International Symposium on PMS, Kiawah Island, Sep 1987.

    35. Khoo SK, Munro C, Battisutta D. Evening primrose oil and treatment of premenstrual syndrome. Med J Aust 1990;153:189?92.

    36. Collins A, Cerin A, Coleman G, Landgren B-M. Essential fatty acids in the treatment of premenstrual syndrome. Obstet Gynecol 1993;81:93?8.

    37. McFayden IJ, Forrest AP, Chetty U, Raab G. Cyclical breast pain - some observations and the difficulties in treatment. Br J Clin Pract 1992; 46:161?4.

    38. Sampalis F, Bunea R, Pelland MF, et al. Evaluation of the effects of Neptune Krill Oil on the management of premenstrual syndrome and dysmenorrhea. Altern Med Rev 2003;8:171?9.

    39. Abraham GE, Lubran MM. Serum and red cell magnesium levels in patients with premenstrual tension. Am J Clin Nutr 1981;34:2364?6.

    40. Sherwood RA, Rocks BF, Stewart A, Saxton RS. Magnesium and the premenstrual syndrome. Ann Clin Biochem 1986;23:667?70.

    41. Nicholas A. Traitement du syndrome pre-menstruel et de la dysmenorrhee par l?ion magnesium. in First International Symposium on Magnesium Deficit in Human Pathology, ed. J Durlach. Paris: Springer-Verlag, 1973, 261?3.

    42. Facchinetti F, Borella P, Sances G, et al. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol 1991;78:177?81.

    43. Walker AF, De Souza MC, Vickers MF, et al. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health 1998;7:1157?65.

    44. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991;31:298?301.

    45. Werbach MR. Premenstrual syndrome: magnesium. Int J Alternative Complementary Med 1994;Feb:29 [review].

    46. London RS, Bradley L, Chiamori NY. Effect of a nutritional supplement on premenstrual symptomatology in women with premenstrual syndrome: a double-blind longitudinal study. J Am Coll Nutr 1991;10:494?9.

    47. Stewart A. Clinical and biochemical effects of nutritional supplementation on the premenstrual syndrome. J Reprod Med 1987;32:435?41.

    48. Chakmakjian Z, Higgins C, Abraham G. The effect of a nutritional supplement, Optivite for women, on premenstrual tension syndrome: effect of symptomatology, using a double-blind crossover design. J Appl Nutr 1985;37:12.

    49. Takacs BE. Potassium: A new treatment for premenstrual syndrome. J Orthomolec Med 1998;13:215?22.

    50. 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. BJOG 2008;115:515?9.

    51. Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine hydrochloride (Vitamin B6) upon depression associated with oral contraception. Lancet 1973;1:897?904.

    52. Russ CS, Hendricks TA, Chrisley BM, et al. Vitamin B-6 status of depressed and obsessive-compulsive patients. Nutr Rep Int 1983;27:867?73.

    53. Gunn ADG. Vitamin B6 and the premenstrual syndrome (PMS). Int J Vitam Nutr Res 1985;(Suppl 27):213?24 [review].

    54. Kleijnen J, Riet GT, Knipschild P. Vitamin B6 in the treatment of the premenstrual syndrome?a review. Br J Obstet Gynaecol 1990;97:847?52.

    55. Chuong CJ, Dawson EB, Smith ER. Vitamin E levels in premenstrual syndrome. Am J Obstet Gynecol 1990;163:1591?5.

    56. 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.

    57. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 90.

    58. Qi-bing M, Jing-yi T, Bo C. Advance in the pharmacological studies of radix Angelica sinensis (oliv) diels (Chinese danggui). Chin Med J 1991;104:776?81.

    59. Cotterell CJ, Lee AJ, Hunter JO. Double-blind cross-over trial of evening primrose oil in women with menstrually-related irritable bowel syndrome. In Omega-6 Essential Fatty Acids: Pathophysiology and roles in clinical medicine, Alan R Liss, New York, 1990, 421?6.

    60. 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;88:447?57 [in French].

    61. Qi-bing M, Jing-yi T, Bo C. Advance in the pharmacological studies of radix Angelica sinensis (oliv) diels (Chinese danggui). Chin Med J 1991;104:776?81.

    62. Freeman E, Rickels K, Sondheimer SJ, Polansky M. Ineffectiveness of progesterone suppository treatment for premenstrual syndrome. JAMA 1990;264:349?53.

    63. Martorano JT, Ahlgrimm M, Colbert T. Differentiating between natural progesterone and synthetic progestins: clinical implications for premenstrual syndrome and perimenopause management. Comp Ther 1998;24:336?9.

    64. Bryant M, Cassidy A, Hill C, et al. Effect of consumption of soy isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome. Br J Nutr 2005;93:731?9.

    65. Block E. The use of vitamin A in premenstrual tension. Acta Obstet Gynecol Scand 1960;39:586?92.

    66. Argonz J, Abinzano C. Premenstrual tension treated with vitamin A. J Clin Endocrinol 1950;10:1579?89.

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