Premenstrual syndrome (PMS) includes one or more of many symptoms in the areas of mood, the physical body and cognition. The most frequent symptoms are irritability, depression, fatigue, water retention, weight gain, breast tenderness, headaches, abdominal cramps and mood swings. About 80% of women may experience PMS and about 50% of women seek medical care for their symptoms.
The primary etiology of PMS has been thought to be the interplay of serotonin and hormones which is why conventional treatment of PMS most often includes SSRIs to increase serotonin levels and/or birth control pills to suppress ovarian hormone secretion.
High sensitivity C-reactive protein (hs-CRP) is an acute phase inflammatory marker that has been associated with risk for cardiovascular disease and menopausal hot flash symptoms. It has also been associated with some of the risk factors for PMS including depression, smoking, increased body mass index (BMI) and aging. Some studies have investigated the role of inflammation and PMS but only suggestive not significant connections have been observed. Select anti-inflammatory medications can also provide relief for some PMS symptoms.
Two studies highlight this possible contributing mechanism to PMS and premenstrual dysphoric disorder (PMDD).
One study used data on PMS symptoms from a much larger study called the Study of Women’s Health Across the Nation (SWAN), a racially and ethnically diverse study of midlife women from five racial/ethnic groups and at seven clinical sites nationwide. The goal was to determine if hs-CRP was associated with PMS. The proportion of women who reported each PMS symptom, except breast pain or headaches, was significantly increased (26%-41%) for women who had hs-CRP values > 3 mg/L. A hs-CRP level > 3 mg/L in women with PMS was associated with mood symptoms, abdominal cramps, back pain, appetite cravings, weight gain, and bloating, but not with headaches, breast pain for women with three or more PMS symptoms. [1]
Most symptoms, except for headaches and breast pain were reported by significantly more obese women, women who smoked or were exposed to passive smoke and by women with an elevation of depressive symptom scores.
Commentary: There has been very little literature that has focused on any relationship between inflammation and PMS. This study does observe a significant relationship with at least some PMS symptoms and in women who have less than 3 PMS symptoms suggests that inflammation may be involved in PMS. That said, I would not abandon the serotonin-hormone connection and would continue to recognize that PMS is likely a complex disorder with potentially different mechanisms for the etiologies of at least some of the symptoms. In addition to biology, there are numerous social, demographic and behavioral factors that are likely associated with PMS. The lifestyle and natural agents that have published research support that I rely on the most in clinical practice are aerobic exercise 4 or more times per week, St John’s wort, calcium, vitamin B6, chaste tree, magnesium, vitamin E and borage seed or evening primrose oil. For more difficult mood disorder PMS patients, those with PMDD, I add one or more of the following: tryptophan, theanine, lavender, GABA, SAMe and more.
The second study is one on curcumin and PMS, also from about 10 years ago. [2]
Curcumin studies demonstrate its ability to reduce prostaglandin synthesis and animal studies demonstrate an action of curcumin in modulating serotonin, dopamine and norepinephrine thus exerting an antidepressant effect. Based on these observations of curcumin and the role of prostaglandins and neurotransmitters in the etiology of PMS, a study on curcumin was conducted to evaluate the effects on the severity of premenstrual mood, behavior and physical symptoms.
This randomized, double-blind, placebo-controlled study was in healthy 21-35 years old women with regular menstrual cycles who had at least 5 symptoms of 19 on a PMS questionnaire. The women who met the criteria for a PMS diagnosis, were then randomly assigned to two groups with 35 in each. Group one received curcumin 100 mg every 12 hours from 7 days before and until 3 days after the onset of menstrual bleeding and for 3 consecutive menstrual cycles. Group two received placebo in the same regimen. Four women in the placebo group and 3 in the curcumin group did not complete the study.[2]
Total severity of PMS score reduced from 102.6 to 42.47 with a mean change of 59.59 in the curcumin group. In the placebo group, the total severity of PMS score changed from 106.06 to 91.60 with a mean change of 14.45. The difference between the two was significant.
Commentary: PMS is one of the most common health problems in women of reproductive age. Premenstrual mental/emotional symptoms of irritability, anxiety, aggression, depression and changes in concentration and are thought to be primarily due to the central role of serotonin changes in PMS. The normal progesterone and estradiol decline in the luteal phase of the menstrual cycle result in withdrawal of the hormonal effects on serotonin, dopamine and norepinephrine.
Laboratory studies and animal studies have confirmed that curcumin is able to modulate norepinephrine, dopamine and serotonin and affect the inflammatory pathways. In addition to the neurotransmitters, the production of prostaglandin E2 is likely involved in some of the physical PMS symptoms such as pain, swelling and inflammation such as breast pain and engorgement, headaches, extremity edema and others. It is the understanding of the role of neurotransmitters and prostaglandins in PMS, and the observation of the influence of curcumin on neurotransmitters and prostaglandins that led to the theory that curcumin could be helpful in treating PMS.
Curcumin has not been on my treatment option list for PMS. We have many excellent natural therapies that have been researched with good effects in PMS as I mentioned in the above study commentary. In addition to those, I will now be thinking of PMS cases in which I might add curcumin. I will likely start with cases in which there are significant premenstrual physical pains.
One of the disappointments of this study was too little information on the dosing or amount of curcuminoids. One thing I have come to do with curcumin products, is use those that are in a highly bioavailable delivery system.
References:
” Ellen B. Gold, PhD, Craig Wells, BA, and Marianne O’Neill Rasor, MA. The Association of inflammation with premenstrual syndrome. J Women’s Health 2016, Sept 1; 25(9): 865-874.
” Khayat S, Fanaei H, Kheirkhah M, et al. Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial. Complementary Therapies in Medicine 2015; 23: 318-324
