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NMU – 201 Diet and Botanical Agents for Premenstrual Syndrome – PMS

Nutrition / Natural Medicine Update No 201 (April 28, 2021)

with Dr. James Meschino


Topic: Diet and Botanical Agents for Premenstrual Syndrome – PMS

Source: Multiple Peer-reviewed Research Papers (see References)


In the previous Lifestyle Medicine Update, I explained the research showing how and why certain vitamin and mineral supplements are shown to help reduce or eliminate the constellation of symptoms associated with premenstrual syndrome or PMS. But it’s not just vitamins and minerals that can be helpful. Certain dietary strategies, and the use of certain plant-based nutrients or botanicals, have also been shown to help many women who suffer from this condition. From a dietary standpoint, evidence suggests that reducing refined sugars, caffeine, and alcohol can help to prevent some of the inflammatory aspects of PMS, such as breast pain. But most strikingly, PMS appears to be largely caused by an imbalance between estrogen and progesterone in the final 7-10 days of the menstrual cycle leading up to the onset of menstruation. Normally progesterone is the dominant hormone in this part of the menstrual cycle, but when estrogen levels remain high (or more dominant), this is when PMS symptoms are likely to occur. Studies show that strategies to lower circulating estrogen or mitigate its impact on target tissue like breast and endometrial cells often help to reduce PMS symptoms.

As such, studies have shown that when women lower their intake of high-fat meat and dairy products, as well as deep-fried foods and breaded meats, and use lower-fat alternatives, and/or embrace a more plant-based diet, they begin to excrete more excess estrogen through the fecal route. Adding more dietary fiber, especially wheat bran, has also been shown to increase fecal excretion of excess estrogen. Together, these strategies have been shown to lower circulating levels of estrogen by up 50%, and in doing so, have helped many women reduce PMS symptoms. Exercising regularly also helps the body detoxify more estrogen in the liver and excrete it via the fecal route. Women who exercise regularly are shown to have a lower incidence of PMS. As well, supplementation with the botanical agent Black cohosh as well as Soy extract (standardized to isoflavone content), have been used successfully to reduce or eliminate many PMS problems, including often disabling menstrual cramps.

Black cohosh contains triterpene glycosides and soy extract contains isoflavones. These natural compounds essentially compete with the body’s more potent estrogens for binding to tissue sites. In turn, this reduces the overstimulation effect of estrogen on these tissues, reducing PMS symptoms in many cases. Thus, Black cohosh and Soy Isoflavone tone down the overstimulation effects of estrogen, helping to tame PMS problems. The dosage of Black cohosh shown to be effective is:

80 mg, twice daily (std to 2.5% triterpene glycosides)

For Soy extract, the effective dosage is:

125 mg, twice daily (std to 20% isoflavone content).

Some supplement companies combine Black cohosh and Soy extract into a single supplement product to make things more convenient and to capitalize on the synergistic effects these natural agents have on addressing underlying PMS issues. Some of these products contain other synergistic ingredients, such as Gamma-oryzanol, an extract from rice bran oil that has female hormone-balancing properties as well.

Other strategies to help detoxify excess estrogen, as well as estrogens from the environment known as xenoestrogens, is to regularly consume cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower, Bok choy, turnips), as they contain the indole-3-carbinol, which speeds up liver detoxification of estrogen and xenoestrogens. Ingesting soy products and a heaping tablespoon of ground flaxseed each day can also help to improve estrogen balance within the body.  In PMS cases where abdominal issues are a problem, such as bloating, constipation, diarrhea, taking a probiotic and/or prebiotic supplement may also be helpful, according to published data. Probiotics are combinations of living-friendly gut bacteria, which are sold in many pharmacies and health food stores. Prebiotics, like FOS (Fructo-oligosaccharide) and Inulin, are the type of soluble fiber that is the main food consumed by the gut-friendly bacteria.


Ingesting FOS and Inulin helps foster the replication of our gut-friendly bacteria, which usually then crowds out the problematic unfriendly gut bacteria, improving the gut microflora environment. Chiropractic care has also been shown to help reduce menstrual cramps and low back pain associated with PMS, as shown in various published studies. Combining this with acupuncture may be even more effective, according to some studies.

In summary, the holistic approach to the management of PMS entails the following:

Reduce the intake of refined sugars, caffeine, and alcohol.

Follow a lower fat, more plant-based diet that includes wheat bran and 1 tablespoon of ground flaxseed daily.

Consume cruciferous vegetables regularly and consider the inclusion of soy products in the diet as well.

Take a high potency multiple vitamin and mineral supplement, enriched with high doses of antioxidants (like vitamin E), a B-50 complex, 500 mg of calcium, and 200 mg of magnesium.

Take an essential fatty acid supplement containing a combination of fish, flaxseed, and borage seed oil, as an example.

Take a botanical supplement containing the right dosage and standardized grade of Black cohosh and Soy extract, as outlined previously in this update.

Also, consider a probiotic and/or prebiotic supplement if abdominal issues are a factor.

Have a chiropractor assess your low back function in cases of dysmenorrhea (menstrual cramps) or if PMS triggers low back pain symptoms.

Engage in regularly endurance-based aerobic exercise.


All these strategies working together can address many of the underlying factors that cause PMS, improving outcomes for many women who are looking for natural solutions for this common problem.

I hope this was helpful. I have included the references for this information in the text below.



Frachiewicz E, et al. Evaluation and management of premenstrual syndrome and premenstrual syndrome dysphoric disorder. J Am Pharm Assoc 2001;41(3):437-447.

Gorbach SL, et al. Diet and the excretion and enterohepatic cycling of estrogens. Prev Med 1987;16:525-531.

Goldin BR, et al. Estrogen patterns and plasma levels in vegetarian and omnivorous women. New Engl J Med 1982;307:1542-1547.

Longcape C, et al. The effect of a low-fat diet on oestrogen metabolism. J Clin Endocrinal Metab 1987; 64:1246-1250.

Woods MN, et al. Low-fat, high fiber diet and serum estrone sulfate in premenopausal women. Am J Clin Nutr 1989;49:1179-1183.

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Choi PY, et al. Symptom changes across the menstrual cycle in competitive sportswomen, exercisers, and sedentary women. Br J Clin Psychol 1995;34:447-460.

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Albertzazzi P, et al. The effect of dietary soy supplementation on hot flashes. Obstet Gynecol 1998;91: 6-11.

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Dalais FS, et al. Dietary soy supplementation increases vaginal cytology maturation index and bone mineral content in postmenopausal women. Am J Clin Nutr 1998;68(suppl):1519 (abstract).

London RS, et al. Effect of a nutritional supplement on premenstrual syndrome in women with PMS: a double-blind longitudinal study. J Am Cell Nutr 1991;10:494-499.

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Walsh MJ, Polus BI. A randomized, placebo-controlled clinical trial on the efficacy of chiropractic therapy on premenstrual syndrome. Journal of Manipulative Physiol Ther 1999 Nov-Dec;22(9):582-5

Liebl NA, Butler LM. A chiropractic approach to the treatment of dysmenorrhea. J Manipulative Physiol Ther 1990. Vol.13(2):101-106.

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de Vrese M. Health benefits of probiotics and prebiotics in women. Menopause International. 2009; 15(1):35-40


Eat Smart, Live Well, Look Great,

Dr. Meschino

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