Thank you to my nutrition professor, who first taught me about vitamin B6 (pyridoxine or pyridoxal-5-phosphate) for PMS. It is an effective, reliable treatment for premenstrual mood problems, including PMDD.
Back then (35 years ago), vitamin B6 relieved my own premenstrual symptoms so dramatically that it was my eureka moment in natural health and menstrual health. Thanks to B6, I realised that although period symptoms are common, they’re not normal.
What causes premenstrual mood symptoms?
Premenstrual mood symptoms are the result of one or more factors, including 1) high histamine or mast cell activation, 2) high-normal prolactin, 3) iodine deficiency, 4) gut issues, and 5) neurosteroid change sensitivity (progesterone sensitivity).
đź’ˇTip: An over-the-counter antihistamine can relieve premenstrual mood symptoms.
How vitamin B6 relieves premenstrual mood symptoms
Vitamin B6, also called pyridoxine, pyridoxal 5-phosphate, or P5P helps to relieve premenstrual symptoms via several mechanisms:
- It can improve the responsiveness to hormones, particularly progesterone.
- It supports neurotransmitters, such as GABA, dopamine, and serotonin.
- It lowers prolactin.
- It promotes anti-inflammatory prostaglandins.
- It assists with healthy estrogen metabolism.
- It can reduce histamine, a common cause of PMS.
Vitamin B6 is found in foods such as fish, poultry, and nuts, but you may want to try a supplement.
What dose of vitamin B6?
Take care because long-term use of high-dose vitamin B6 can cause nerve damage. Some clinical trials have used daily doses as high as 200 mg with no problems, but, unfortunately, there are case reports of nerve damage from only 20 mg.
According to nutritional biochemist Chris Masterjohn, the issue may not be toxicity in the conventional sense, but rather that even moderate doses of B6 can deplete coenzyme A (CoA)—especially in the context of deficiencies in other key nutrients, especially vitamin B5. This CoA depletion can disrupt energy metabolism and contribute to neuropathy.
I typically prescribe B6 in the range of 30 to 50 mg per day, and only during the luteal phase. Taking B6 only some of the time (luteal phase) is one way to reduce risk. Other strategies include using pyridoxal-5′-phosphate (P5P) instead of pyridoxine and ensuring an adequate intake of vitamins B2, B5, B12, magnesium, and glycine, all of which support metabolic pathways that help prevent B6-related nerve issues.
Other natural treatments for PMS and PMDD:
As I discuss in my 2023 podcast/YouTube video/article, other strategies include:
- Magnesium to support GABA, regulate the stress response, and normalize the action of progesterone on the central nervous system.
- Body-identical progesterone. Read Guide to natural progesterone.
- The herbal medicine vitex or chaste tree is the most famous herbal medicine for premenstrual mood symptoms and has done well in clinical trials. It works by lowering prolactin.
- Keep your gut bacteria healthy so they can do their job of removing estrogen and estrogen metabolites. Healthy gut bacteria also enhance GABA activity.
- Reduce or quit alcohol because it depletes the body of progesterone’s calming neurosteroid allopregnanolone.
- Try avoiding A1 dairy because it activates mast cells, increases histamine, and disrupts the GABA receptor.
