There is considerable evidence that a healthy diet, particularly one which is low in fat and high in fibre, can relieve PMS.

• Cut clown on all forms of fat that you use: this could be oil, butter. margarine, suet. lard or ghee. When using butter or margarine, spread it as thinly as possible.
• Measure any oil that you use with a spoon rather than just tipping an amount into the pan.
• Instead of frying or roasting, try to grill, poach, steam, bake, microwave or boil food.
• Cut down on pastries, pies. samosas, nuts. crisps. olives, croissants, cakes, biscuits and chocolate. All these have a high fat content.
• Before cooking, trim off all visible fat from meat and the skin from poultry.
• If you are making a casserole, spaghetti Bolognese, chilli con carne or any other dish containing mince or stewing meat, pour away any excess fat during the cooking process or once it has cooled.
• Choose the leanest cuts of meat and try to avoid salami, sausages, burgers, pâtés and processed meats. Try to replace one or two meat-based evening meals with fish or a pulse-based vegetarian dish.
• Use skimmed or semi-skimmed milk and loss fat cheese or cottage cheese. Replace cream in recipes with fromage frais, low-far natural yoghurt or crème fraiche.
• Limit the amount of sauces or dressings, e.g. tomato ketchup and mayonnaise, that you use as these are high in both sugar and or fat. Replace them with low sugar and or fat alternatives.

Sugar & PMS
Try to avoid sugary foods as these may cause your blood sugar Ievel to rise and then fall quickly.

• Try to cut down on fizzy drinks or squashes which contain a lot of sugar and choose sugar free varieties or water. Also reduce the number of teaspoons of sugar you add to tea and coffee, or use an artificial sweetener instead.
• Try to replace sugary puddings with fresh fruit for dessert as this will also increase your intake of fibre and essential vitamins.
• Choose low sugar jams and plain biscuits instead of sweets, chocolates and cakes.
• Tinned products and processed foods contain a lot of hidden sugar. Cheek the list of ingredients on products such as baked beans, tinned spaghetti and tomato ketchup to see how much sugar they contain.

Remember that the main ingredient is placed first in the list, so this will be an indicator of how much sugar is contained in the product.

Starch & PMS
Eating starchy foods at each meal may help reduce mood swings and sugar cravings as they provide a steady release of energy. It is also thought that starchy foods aid in the production of serotonin, a naturally occurring substance which conveys electrical signals in the brain and which is known to lift mood and relieve pain.

Starchy foods include bread, chapati, potatoes, porridge, breakfast cereal, jam, plantain, rice, pasta, cassasva and couscous.

Fibre & PMS
Eating plenty of fibre will reduce the likelihood of premenstrual constipation and will keep your bowels healthy. Foods that are high in fibre include fruits and vegetables, cereals and pulses.

• Choose wholegrain breakfast cereal and muesli, and use wholemeal flour, bread, rice and pasta instead of low-fibre white products.
• You should have at least three to five portions of fruit and vegetables a day, this will also increase your vitamin and mineral intake.
• Try using beans, peas and lentils in soups, casseroles and stews.

It is important to drink plenty of liquid (at least six to eight glasses of water per day) as this will allow the fibre to work properly and may help to lessen PMS bloating.

Vitamins & Minerals & PMS
All foods contain vitamins and minerals. but fruit and vegetables contain many of those which are significant in combating PMS. It is therefore important to try to eat at least five portions of fruit and vegetables a day.

• Produce should be eaten no more than two days after purchase and should be stored in a cool dry place.
• Frozen fruit and vegetables can be just as nutritious as fresh, so if you are unable to buy fresh produce every day or so. use these alternatives.
• Cooking vegetables for a long time and in a lot of water destroys the vitamins and minerals, so cook them in the minimum amount of water and for the minimum amount of time, or use a steamer.

Salt & PMS
Reducing the amount of salt in your diet may reduce bloatedness. You can reduce salt by not adding it to foods during cooking or at the table, and by using other spices and herbs to flavour your food. Some foods such as savory products and processed foods. e.g. pies and pasties. contain a high level of salt so try to avoid these or replace them with other snacks.

Caffeine & PMS
Over-consumption of caffeine can hinder your absorption of vitamins and minerals, so try not to drink more than five cups/glasses of tea, coffee or cola per day. Chocolate and cocoa, as well as some energy drinks, also contain caffeine, so drink water, herbal tea, decaffeinated coffee or tea, or diet carbonated drinks instead.

Reducing the amount of caffeine that you drink may alleviate breast pain, enable you to get a good nights sleep and consequently reduce your stress levels.

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Alcohol & PMS
Although the recommended maximum weekly intake for women is 21 units, experts recommend that PMS sufferers should drink no more than 14 units. A unit consists of:

½ PINT OF LAGER OR BEER
or
1 SMALL GLASS OF WINE
or
1 MEASURE OF SPIRIT.

These measurements are based on pub measures so, if you are pouring you own glass of wine or spirit, they will probably be larger.

• Alcohol can suddenly lower your blood sugar.
• Women who have PMS may tend to drink more before a period.
• Alcohol can affect your sleep and tension levels, and you are less tolerant to alcohol intake when you are premenstrual.
• It is better to drink one or two units a day rather than your entire recommended weekly units in one or two days ever the weekend.
• You are more likely to become dehydrated if you binge drink: to avoid this, you should include some soft drinks.

Hormone treatment & PMS
Progesterone: - Progesterone is one of the principal hormones involved in controlling the menstrual cycle.

Some women appear to need larger quantities of progesterone than others, and these women may he more likely to suffer from PMS,

There are many anecdotal reports and some clinical trials which suggest that progesterone is effective in relieving symptoms of PMS, particularly if used in combination with a good diet. In the body, progesterone is broken down into compounds which enhance the activity of particular nerves in the brain and can help to relieve symptoms of PMS such as:

· Irritability
· Tension 
· Feeling low
· Breast tenderness
· Bloating.

Progesterone cannot be taken by mouth because it would be destroyed in the liver. It is therefore administered as a pessary (Cyclogest) and is put into the rectum or vagina. If the pessaries are not effective, progesterone can he given by means of a vaginal gel (Crinone) or injection (Gestone). While Gestone is not currently licensed for the treatment of PMS, it is still prescribed for many women.

Progesterone may alter the length of your normal cycle and has been associated with acne and changes in libido, but these can be improved by altering the dose. If you suffer from thrush, the pessaries can make this worse: in such cases, it is best to use them rectally.

Progesterone pessaries (Cyclogest) are available on prescription from your doctor. Absorption rates vary but a starting dose of 4OO mg twice a day for suppositories or pessaries, but only 100 mg or less needs to be injected daily. The usual dose for Crinone is one applicator of 4% gel every other day from day 15 to day 25 of the cycle.

Progestogen: - This is a synthetic or man-made hormone that mimics the effect of naturally occurring progesterone in that it causes a withdrawal bleed. There are several different types of progestogen, including:

• Norethisterone (Primolut N)
• Medroxyprogesterone acetate (Provera)
• dydrogesterone (Duphaston).

These can be taken orally. Unfortunately , progestogen may also lower the level of natural progesterone in the body and this may make symptoms worse. There is no evidence to suggest that taking progestogen will help to relieves the symptoms of PMS, and there may also be unpleasant side effects such as breast tenderness, water retention and changes in libido. Oral contraceptives always contain progestogen and, because some progestogen is needed to protect the lining of womb, it is usually found in hormone replacement therapy (HRT).

Oral contraceptives: - As cyclical hormonal activity is an obvious factor in PMS, a logical treatment would seem to lie to suppress the normal function of the ovaries. GPs often prescribe the contraceptive pill to alleviate PMS, but no trials have been carried out to test its effectiveness.

Combined oral contraceptives contain oestrogen and progestogen, which regulate the menstrual cycle and prevent ovulation.

A few women find their symptoms improve when they are taking the pill, but starting or stopping the pill can often be the trigger factor that starts PMS in the first place. Side effects of the pill include premenstrual breast pain, weight gain. headaches and dizziness.

Oestrogen: - Oestrogen is known to exert a profound effect on mood and mental state. Rapidly falling Ievel’s of oestrogen are associated with PMS, postnatal depression and postmenopausal depression.

Doctors at Chelsea and Westminster Hospital in London have developed a treatment for PMS based on giving natural oestrogen by means of skin patches. This has the effect of suppressing ovulation and eliminating fluctuations in the menstrual cycle. The patches are like sticky’ cling-film and women can swim, bathe or shower as usual. It is one of the few treatments proven scientifically in prospective randomised studies to he highly effective in the treatment of PMS,

Unfortunately’. oestrogen cannot be given on its own as there is a slight increase in the risk of uterine and endometrial cancer. A small close of progestogen or progesterone guards against this risk, but progestogen may cause women to develop PMS-like symptoms. Oestrogen can also cause side effects such as:

• Breast pain
• Nausea
• Weight gain.

The skin patches can also cause slight irritation and rashes, although recent patch technology has minimised these side effects.

Women who have had a hysterectomy can take oestrogen without the progestogen.

Anti-depressants & PMS
A new generation of antidepressants has been developed, called selective serotonin reuptake inhibitors (SSRIs), which clinical studies suggest can be of significant benefit to some PMS sufferers,

Many people are reluctant to consider taking antidepressants, particularly when they believe they are not depressed, but suffering from a hormonal illness. Some people may also be concerned about becoming addicted or stigmatised to taking this kind of medicine.

Fortunately, attitudes towards psychological and emotional problems have changed greatly. and the new antidepressants, which include Prozac (fluoxetine) and Seroxat (paroxetine), are not addictive. They work to increase levels of serotonin and restore emotional balance. Studies have shown that SSRIs work faster in PMS than in depression.

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Evening Primrose Oil & PMS
Evening primrose oil contains GLA (gamma linolenic acid) which, in torn, produces certain prostaglandins which are sensitive to PMS. These make certain body tissues, particularly breast tissue, less sensitive to female hormone changes and therefore help to alleviate breast pain. Linoleic acid, an essential fatty acid, also produces GLA. but the production of GLA from linoleic acid may be slow in PMS sufferers.

Consistent benefit has only been found for the specific symptom of premenstrual Breast pain. Evening primrose oil can be brought from the chemist or obtained on prescription for cyclical breast pain from your GP. Three or four tablets of standard strength (500 mg) should be taken twice a day. When breast pain has eased, this dose can be reduced to one capsule daily.

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Vitamin B6 (pyridoxine) & PMS
Vitamin B6 (pyridoxine) is one of the B group of vitamins. These are water-soluble so cannot he stored in the body. B6 is found widely in food, especially meat and fish, eggs. wholemeal bread and some vegetables. It has been suggested that oral contraceptives increase the body’s requirement for B6.

It has been claimed that vitamin B6 can help reduce symptoms of PMS and, in the past, it has been used in dosages up to 100 mg per day. However, the evidence is still controversial.

High doses of B6 taken over a period of time can cause nerve damage and stomach upset. In the summer of 1998, the Department of Health issued a directive that doses of B6 above 10 mg should be supervised by a doctor. However, this directive has since been suspended while the Department of Health awaits further evidence. Doses of over 50 mg are required for the possible relief of symptoms of PMS and can be obtained from your pharmacist or GP. It is also recommended that, if there is no improvement in symptoms after four months, B6 supplements should be stopped. This guideline applies equally to any supplement you are taking. You should also stop taking B6, immediately if you notice any tingling in the hands and feet. Taking B6 with a magnesium supplement may reduce the chances of side effects and increase its effectiveness against PMS.

Mineral Supplements & PMS
Magnesium levels have been found to be lower in some women with PMS, although this research has not been substantiated. A good balanced diet, including wholemeal bread, pasta and brown rice together with green vegetables, should provide a sufficient intake. Some clinics use a supplement of 250 mg daily with some evidence of effectiveness against PMS but, if there is no improvement in symptoms, this should he stopped after four months. It has also been found that the benefits of magnesium may he increased by taking vitamin B6.

Calcium (1000 mg day) and vitamin D (10 mcg) taken together may have some benefit in treating pre-menstrual pain and migraine along with general behavioural symptoms associated with PMS.

Zinc (7 mg day) coupled with vitamin A (600 mcg day) may be effective in the treatment of acne associated with PMS. However; women who are planning a pregnancy should not take vitamin A supplements.

St Johns wort & PMS
St John’s wort is a natural remedy used to treat a range of conditions including anxiety and depression. and may be of use in alleviating the psychological symptoms of PMS. It is thought to have an effect similar to SSRIs. Many people take 500 mg per day. It is advisable to avoid foods such as red wine, cheese. yeast and pickled herring. St Johns wort should not be taken at the same time as prescription antidepressants such as Prozac and Nardil, and should not he used during pregnancy and breast-feeding.

Evidence for the effectiveness of extra vitamins and minerals in PMS is still sparse, but clinical trials are still taking place. We know that large doses of vitamins and minerals above the recommended does intake could do more harm than good by upsetting the balance of nutrients or causing toxicity. If you want to experiment with taking mineral supplements, it may be best to consult your doctor or dietitian.

Source: - N.A.P.S (National Association for Premenstrual Syndrome)

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