Top 6 Natural Treatments for Premenstrual Mood Symptoms

Natural treatments for PMS and PMDD.

Are premenstrual mood symptoms caused by progesterone or helped by progesterone? And why do antihistamines give such relief?

In episode seven of my podcast/YouTube video, I discuss the irritability, sensitivity, sleep disturbance, and even rage you could experience leading up to your period.

And what you can do about it.

Also available wherever you get your podcasts.

Transcript

Are premenstrual mood symptoms caused by progesterone or helped by progesterone? And why do antihistamines give such relief? Join me today for some new treatment ideas for the irritability, sensitivity, sleep disturbance, and even rage you might experience leading up to your period.

Welcome back to the podcast. I’m your host Lara Briden, a naturopathic doctor and author of the books Period Repair Manual and Hormone Repair Manual.

I’m currently still in Christchurch, New Zealand where I live but I’m gearing up to go over to Canada where I’m from and one of my first stops will be Vancouver where I hope to give a little public presentation and book signing. For more info, make sure you’re on my mailing list, which you can join from the link in the show notes.

Okay. Onto the topic of premenstrual mood symptoms. I’ll start by saying that premenstrual mood is my favourite thing to treat because in most cases, it responds so well and so quickly to some pretty basic strategies. And if that has not been your experience with the conventional treatments of SSRIs and hormonal birth control, I encourage you to keep listening because there are other options.

Some of the treatments I’ll discuss today have been clinically trialled but some have not and that’s largely because of the rather startling lack of research on this topic. For example, there is still no clear understanding of what causes premenstrual mood symptoms. What little science there is points to an abnormal response of the brain to the normal fluctuations in estrogen and progesterone. Probably because of inflammation.

And, importantly, what little science there is suggests there is not one single mechanism to explain premenstrual mood symptoms in all women. Instead, there are probably at least several different things going on with different women. Which means that different treatments work for different people and I’ve definitely found that to be true with my patients. So, you might just need to just try a few treatments, or combination of treatments, until you find the one that works for you. In my 25 years with patients, I’ve had a chance to try a lot of premenstrual treatments. And today, I’ll share the six treatments I’ve found to be most effective. Before I do that, however, I want to get a few things out of the way.

First, these are treatments for mood symptoms that occur in the second half of a natural menstrual cycle. Mood symptoms on hormonal birth control are side effects of hormonal birth control and a separate topic.

Second, the same treatments can relieve physical premenstrual symptoms such as headaches and breast pain.

Third, these six treatments are by no means the only natural treatments. Like so many aspects of the menstrual cycle, premenstrual mood symptoms are an expression of general health, so anything you do to improve general health will also improve premenstrual mood. That includes moving the body, getting outside and getting more rest, fixing the gut, reducing inflammation, avoiding alcohol, and being fully nourished in every way including protein, B-vitamins, zinc, essential fatty acids, and more.

Finally, I just want to acknowledge the existence of severe premenstrual mood symptoms, which may be diagnosed as premenstrual dysphoric disorder or PMDD. Natural treatment can relieve PMDD, especially the antihistamine treatment, but not necessarily in every case. So, please check with your doctor.

Okay. Let’s go.

Treatment #1 is an antihistamine approach, which can mean first trying an over-the-counter antihistamine medication to see if that gives relief. Talk to your pharmacist about non-drowsy vs drowsy medication depending on what time of day you’re planning to take it. If that works, you could then try natural antihistamine treatments such as quercetin, SAM-e, vitamin B6, which we’ll come to, and a dairy-free diet. By which I mean specifically avoiding A1 casein, which is the protein found in milk from Holstein or Friesian cows. Goat, sheep and A2 dairy are usually fine. And interestingly, there is a study currently underway at Deakin University in Australia to assess how A1 versus A2 casein might cause inflammation and psychological distress in women.

You probably know histamine as the amine that causes allergies and inflammation—but it’s also a stimulating neurotransmitter that affects the brain. And histamine goes up and down with the menstrual cycle because it’s influenced by estrogen and progesterone. Signs of high histamine or mast cell activation include irritability, anxiety, insomnia, brain fog, headaches, and breast pain—all classic premenstrual symptoms. Other signs of high histamine include hives, nasal congestion, joint pain, fluid retention, and nausea. So, if you have those symptoms as well as premenstrual mood symptoms, you probably want to start with an antihistamine approach.

Treatment #2 is magnesium, wonderful magnesium. Which reduces inflammation and calms the brain and according to a 2017 literature review, is evidence-based treatment for premenstrual mood symptoms. I’ll put a link to that paper in the show notes. Some researchers think that the mechanism for magnesium giving such relief is that it “normalizes the action of progesterone on the central nervous system.” I usually prescribe 300 mg of magnesium glycinate to be taken during the week or two leading up to the period. And I sometimes give it in combination with the amino acid taurine which also calms the brain. For more about how to take and troubleshoot magnesium and taurine, see my magnesium and taurine blog posts.

Treatment #3 is vitamin B6, which was actually my personal eureka moment for PMS when I first tried it thirty years ago. I was in naturopathic college at the time and thought it was normal to feel a little edgy or irritable leading up to my period. And then I tried vitamin B6 and the symptoms just evaporated and I thought “Oh, my goodness. This stuff really works.” I also realized: “Okay…So It’s possible for the period to just arrive with no symptoms.” Possible for me and possible for many, many of my patients since then.

Vitamin B6 has done well in at least one clinical trial and probably works via several mechanisms including boosting serotonin and GABA, as well as lowering histamine and prolactin. There are some safety considerations around the dose of vitamin B6, which I discuss on my blog. I’ll just say here that I usually prescribe B6 in the range of 30 to 60 mg but only during the luteal phase. Taking B6 for only part of the month is one way to reduce the potential but rare risk of nerve damage; another way is to use the form pyridoxal-5-phosphate or P5P rather than pyridoxine. Check with your clinician or pharmacist.

Treatment #4 is iodine, preferably molecular iodine, at the dose of 1 to 3 mg, which can be an absolute game-changer, not just for premenstrual mood symptoms but also for endometriosis and especially for breast pain. In fact, if you have breast pain, iodine is the first PMS treatment to try.

Like vitamin B6, there are some safety considerations. Mainly that if you have existing thyroid disease, especially autoimmune thyroid disease then you cannot use 1 to 3 mg of iodine but must stay at a lower dose of 300 mcg. That thyroid safety issue is why I always screen my patients for thyroid antibodies or TPO antibodies before prescribing iodine. A negative result for thyroid antibodies means it’s probably safe to try higher dose iodine. And please don’t let that precaution put you off. When iodine is the right treatment, it can make a dramatic difference to premenstrual mood symptoms.

Treatment #5 is the oh-so-popular vitex or chaste tree, which is the herbal medicine most people try first for premenstrual mood. And it can be helpful. In fact, vitex is one of the better researched natural treatments and works by a few mechanisms including directly calming the brain, increasing progesterone, and most importantly, lowering prolactin. With my patients, I sometimes test prolactin to try to determine if vitex is going to be the right treatment. If you have very high prolactin, of course, speak to your doctor. But if your prolactin is just on the high end of normal then vitex could be helpful for premenstrual mood, headaches, and breast pain.

I generally avoid vitex for PCOS because I find it can sometimes worsen androgen symptoms.

And as an aside, the other great herbal medicine for premenstrual mood is bupleurum.

Finally, treatment #6 is natural progesterone or body-identical progesterone. Which is entirely different from the progestins of hormonal birth control as I explain in episode 5. Progesterone can be calming and soothing because it has a natural antihistamine effect and because it converts to a tranquilising neurosteroid called allopregnanolone, which is usually calming to the GABA receptors in the brain. I say “usually” because about 1 in 20 women seem to experience a paradoxical anxiety effect from allopregnanolone probably because of something unusual going on with their GABA receptors—something that might involve inflammation and histamine.

If you have that kind of progesterone sensitivity, you might find your premenstrual mood symptoms kick in early, just a few days after ovulation when progesterone starts to climb. In other words, premenstrual mood symptoms potentially caused or triggered by progesterone. For most women, however, premenstrual mood symptoms typically kick in a little later about eight or nine days after ovulation when progesterone starts to drop. So, for most women, premenstrual mood symptoms are, at least in part, the result of withdrawal from progesterone. And can therefore be relieved by taking progesterone either a cream or an oral capsule as I describe in my books. If you take a body-identical progesterone capsule, be sure to take it at bedtime because it can make you very sleepy.

And yes, conceptually, there is quite a big difference between

  • premenstrual mood symptoms being caused by progesterone, which is the conventional view, and
  • premenstrual mood symptoms being caused by withdrawal from progesterone, which seems to be the case for most women.

Thankfully, the research is starting to look a little more closely at the withdrawal theory and I’ll just finish by saying that natural progesterone capsules can be worth trying even if you think you have progesterone sensitivity. Sometimes, it just requires a higher dose to calm and stabilize the GABA receptors. And possibly over a few cycles before things start to improve.

As always, there’s a section in my forum to discuss the episode. Please chime in there with your experience.

I hope that’s been helpful and thanks so much for listening. Please share and leave a review. And I’ll see you next time when I’ll discuss how to prevent and treat post-pill acne.

20 thoughts on “Top 6 Natural Treatments for Premenstrual Mood Symptoms”

  1. Hi mam , I am taking combined pill mercilon which I feel is similar to yasmin.My libido is totally down otherwise there was no side effect.Is there any way to increase libido while on pill.

    Reply
  2. Hi Lara, I first heard about you on the SHE podcast and I found your conversation about periods very informational. As someone who has ALWAYS struggled with irritability and mood swings during PMS, I was very encouraged by this podcast. What you said about progesterone sensitivity totally sounds like me! I tend to start feeling more sensitive and irritable a couple days after ovulation. I’m 42 and I plan to get your book “hormone repair manual” for women over 40.

    Reply
  3. Hi Lara, Great post thank you! I’ve had very bad PMS mood issues & period pain symptoms for the past years & from reading your work think it is inflammation & perimenopause. I’ve cut dairy & gluten from my diet for 3 months now. The first two cycles were greatly improved but this third period & pms phase has been really bad again. Is that something that can happen? Like a 3 monthly cycle?
    I’m yet to try the magnesium and antihistamine & will this cycle.

    Reply
  4. Lara, do you have any thoughts on Oxaloacetate for PMS (sold in the US under the brand name Jubilance)? The research is very interesting and people give it rave reviews but I’m wondering if there are any downsides.

    Reply
  5. Hi Lara! Thank you for all that you do. I have been following for several years, read the period repair manual and have recommended to several friends.
    My question relates to breastfeeding and postpartum depression. I struggled with PPD and quickly recognized that it was progesterone withdrawal. I started taking B6 which was a miracle for my symptoms, but because it lowers prolactin, it also lowered my supply. This was about 2 years ago.I continue to take 5P5 for PMS
    This seems like a sad choice to have to make. I was already taking magnesium at the time. I don’t think I tried the antihistamine.

    An interesting question that would probably help a lot of women. Thanks!

    Reply
  6. Hi Lara,

    Is it best to take magnesium separately from Zinc? Im on 30mg of zinc with dinner daily to support my skin (acne) and endometriosis – is it ok to take my magnesium at the same time? If not, what time of day is best? Bedtime?

    Thanks for the article and all your valuable work- don’t know what we’d do without you!

    Rebecca

    Reply
  7. Hi, doctor Lara.
    I have terrible migraines and sore breasts before period. I have tried everything you mention except antihistamines. Is there a specific brand/ dose you recommend?

    Also, I have Gilbert syndrome which I have read in scientific papers has a relation to high estrogen and histamine? Any thoughts? My doctors just stare at me as if I were crazy when I mention this.

    Reply
  8. Hi Dr. Briden. I’ve always been acne prone, but it worsened to severe hormonal acne after having Mirena placed 3 years ago. I was prescribed spironolactone which completely cleared it up, and I had the Mirena removed 2 years ago (not on any B.C. since), but stayed on spiro. I started tapering off spiro and finally stopped taking it in April, and I’m having symptoms now of what looks like post-pill PCOS from reading Period Repair Manual (acne, hair loss, hirsutism, my periods are only spotting). I’m 21, was put on the pill for acne at 14, then Mirena at 18, and spiro since then, so I’ve never really just had my own healthy cycle or hormones. I’m hoping that given time, my body will adjust on its own, like you’ve written about post-pill PCOS.

    Reply
  9. Thanks for this article, Dr. Briden. I’ve been reading your blog & Period Repair Manual, trying to get to the bottom of my androgen excess symptoms. I’m wondering, can I have post-pill PCOS after stopping spironolactone? (which I was on for 3 years to treat hormonal acne caused by Mirena, which I removed 2 years ago) Since it’s so similar to Yaz? Many of the symptoms are lining up for me.

    Reply
  10. Hi Dr. Briden, how many days per month should I use cream of progesterone?, Regarding the others options, should be all of them taken only during the lutea phase?

    I’ll appreciate your replay.

    Reply
    • In general, the timing with the menstrual cycle is luteal phase for magnesium, b6, taurine, progesterone, and antihistamines; from day 5 for vitex; and ALL cycle for dairy-free and iodine. But it’s never necessary to try all treatments at the same time.

      Reply
  11. Great article, I have been really battling with anxiety and now a bit of depression over the last year which I have come to think is all hormonal! 10 days before my period starts my anxiety shoots through the roof and I become really sad, I’ve been told my my doctor that I have no progesterone and DHEA and that my morning cortisol levels are abnormally high, which is when my anxiety is at its worst, about two days before my period I get terrible headaches and feel nauseous! I have felt like I’m going crazy! I’m definitely going to try what you have recommended!! I am so desperate at the moment for great advice like your article thank you so much!
    Carmen
    42yrs xx

    Reply
    • yes, and if your doctor prescribes natural progesterone and/or DHEA, it’s probably worth trying. But check with your doctor.

      Reply
      • Thank you so much for the advice! I just wanted to ask should I take the progesterone all month or just at certain times in the month I haven’t been advised on that? Thank you again Carmen xx

        Reply
  12. I have endometrosis and every time I have my period is very painful and I have problems with going to the bathroom! What supplement do you think I need to take , thank you.

    Reply

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