May 22, 2000 -- As a physician, Mary Hardy, MD, was trained to view herbal medicine with a healthy dose of skepticism. But her patients kept gushing about the remedies they were using for premenstrual syndrome (PMS). "I'd had so many patients come in with dramatic stories," she says. "One woman told me 'these herbs are like magic.' "
So when she herself fell victim to a bad case of PMS, Hardy decided to try the two herbs most commonly used for the problem -- evening primrose oil and chaste tree berry (also known as vitex). To her delight, they eased her symptoms, and when Hardy praised the herbs at a March 2000 conference of the American Pharmaceutical Association, national news reports carried her remarks.
Hardy was more open than many physicians to the idea of herbal remedies; as the medical director of the Cedars-Sinai Integrative Medicine Medical Group in Los Angeles, her clinic melds conventional Western medicine with complementary methods like herbs, osteopathy, and acupuncture. After discovering that herbs relieved her own symptoms, Hardy hit the library to see what researchers had learned.
What she found highlights the dilemma of many women seeking alternative treatments to ease PMS. While self-help books and Internet sites trumpet the power of herbal remedies, there's scant scientific evidence to support the claims.
Fortunately, herbs aren't the only treatment available for PMS sufferers who want to avoid hormones and anti-depressants with their side effects. Researchers have found solid evidence for some vitamins and minerals -- so much that the American College of Obstetricians and Gynecologists (ACOG) in April revised its recommendations on PMS to include them.
The Truth About Herbs
Most of the evidence for botanical PMS remedies is made up of individual anecdotes like Hardy's. And many studies have suggested that the placebo effect -- a patient's belief in the power of a medicine -- may be the reason so many women report relief from these herbs.
For example, PMS sufferers have reported feeling much better in studies using evening primrose oil. But in the August 1990 issue of the Medical Journal of Australia, researchers reported a more careful approach: They divided 38 women in two groups. One took primrose oil and one took a placebo. But groups reported the same improvement.
As for chaste tree berry, most tests haven't compared it to a placebo. And scientists have yet to scrutinize dong quai, another herb said to offer PMS relief.
Vitamins and Minerals to the Rescue
Does this mean women must rely on hormones and antidepressants -- the standard treatments -- for PMS? No, says Susan Johnson, a gynecologist at the University of Iowa who helped develop the new ACOG standards. If you're in the throes of PMS and in search of supplements that work, Johnson says you may benefit from calcium, magnesium, and vitamin E.
Here's the evidence:
- Calcium. Many PMS symptoms resemble those of calcium deficiency, says Susan Thys-Jacobs, an endocrinologist at St. Lukes Roosevelt Hospital in New York City. Though no one fully understands what causes PMS, Thys-Jacobs hypothesizes that for many women the problem may signal an underlying calcium shortage.
In a study of 466 PMS sufferers, published in the August 1998 issue of the American Journal of Obstetrics and Gynecology, Thys-Jacobs and her colleagues found that calcium supplements of 1,200 milligrams per day -- the calcium equivalent of four glasses of milk -- significantly eased PMS symptoms.
Calcium was no instant cure; the results only kicked in after about two months of use. But by the third month of treatment, women taking the supplements had only about half the PMS symptoms of those who took a placebo. The only symptoms calcium didn't curb, says Thys-Jacobs, were fatigue and insomnia.
Thys-Jacobs recommends that women concentrate first on boosting the calcium in their diets. But if you can't stomach that much yogurt or tofu, go ahead and take a supplement. Aim for a total calcium intake of 1,200 to 1,500 milligrams per day, and be sure you take the supplements along with food so they're properly absorbed, says Thys-Jacobs.
- Magnesium. In March of this year, nutritionist Ann Walker and her colleagues at the University of Reading in England published a study in the Journal of Women's Health and Gender-Based Medicine comparing magnesium to a placebo. The results suggest that modest amounts -- 200 milligrams per day -- could reduce water retention and bloating. A follow-up study, Walker says, showed that the same dose of magnesium paired with 50 milligrams of vitamin B-6 reduced mood symptoms like anxiety.
- Vitamin E. A dose of 400 IUs of vitamin E per day allayed PMS symptoms more than a placebo in at least one small study published in the June 1987 Journal of Reproductive Medicine. Because vitamin E is an antioxidant with other health benefits and minimal side effects, Johnson says there's little harm in women trying this supplement.
- Vitamin B-6. In the May 22 issue of the British Medical Journal, researchers reviewed nine published studies of vitamin B-6 for PMS and concluded that a dose of 100 milligrams per day may relieve a wide range of symptoms, including depression. However, Johnson warns that B-6 is harmful in doses above 100 milligrams per day.
As for Hardy, she readily agrees with these recommendations. But she still stands by her suggestion that PMS sufferers give herbs a try, too. "There isn't any one thing that's going to solve this," she says.
Christie Aschwanden is a freelance science writer in Nederland, Colo. Her work has appeared in Health, New Scientist, The New England Journal of Medicine Weekly Briefings, and Modern Drug Discovery.
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