Premenstrual syndrome (PMS) and related menstrual
disorders are common sources of misery among menstruating
women. Symptoms range from mild to severe enough
to interfere with family and social activities and
work (Frackiewicz EJ et al 2001).
Identifying PMS can sometimes be difficult because
it covers such a wide range of symptoms. It is estimated
to affect up to 50 percent of menstruating women,
with symptoms sometimes beginning among young women
aged 16 to 18 and peaking when women are in their
20s and 30s (Cleckner-Smith CS et al 1998). Symptoms
of PMS tend to decrease with age (Freeman EW et al
2004), ceasing with menopause. Women who continue
to experience PMS symptoms at an older age are also
more likely to experience menopausal symptoms (Freeman
EW et al 2004).
PMS can affect a number of systems and produce a
wide variety of symptoms:
• Psychological symptoms. Tension, depression, irritability, fatigue, panic,
• Nervous system symptoms. Migraine, seizures, headaches, dizziness, fainting
• Symptoms affecting the skin. Acne, boils, hives
• Symptoms affecting the muscles and joints. Backache, joint pains, edema
• Respiratory symptoms. Asthma, allergies (Redmond AM et al 2004)
• Symptoms affecting the head and neck. Sinusitis, sore throat, hoarseness
• Urinary symptoms. Bladder infections
• Gastrointestinal symptoms. Bloating, gas, food cravings
• Symptoms affecting the breast. Tenderness, swelling
more severe form of PMS is called premenstrual
(PMDD). This disorder occurs in
2 to 9 percent of menstruating
women. Although the
of PMDD and PMS are similar, they are much more severe in PMDD. In fact,
PMDD is characterized by symptoms
that are severe enough to interfere
relationships, especially in the marital and family area (Freeman EW et al
Unfortunately, traditional medicine is not especially well equipped to deal
with PMS. There are no unique physical findings or lab tests that can diagnose
and few drugs that achieve consistent results without side effects. If symptoms
are mild, most women are told to use over-the-counter painkillers (usually
containing ibuprofen) and make dietary and lifestyle changes. In more serious
PMDD, antidepressants are sometimes prescribed.
Hormone-based birth control pills are also frequently recommended to produce
a state of anovulation (lack of ovulation). Until recently, however, evidence
concerning their effectiveness was mixed. Studies involving a new form of
synthetic progesterone (progestin) have shown some benefit. However, Life
that women take natural progesterones or phytoestrogens derived from plants
rather than synthetic progestin or estrogen.
Life Extension has also uncovered a number of nutrients that address underlying
deficiencies associated with premenstrual syndrome and excess levels of prostaglandins,
which have been linked to symptoms of PMS. Chief among the alternative therapies
for PMS is calcium, which has been used for more than 70 years in the treatment
of menstrual disorders. Other therapies include magnesium, vitamin E, vitamin
B6, and extract from fruit of the chaste tree.
The Menstrual Cycle, Hormones, and PMS
A normal menstrual cycle is characterized by the regular rise and fall of
sex hormones, most importantly estrogen and progesterone, culminating in
The cycle is usually divided into four phases:
phase. During this phase, a rise in follicle stimulating hormone
causes several follicles (each containing an egg) to begin growing
on the surface
of the ovary.
Under the influence of the pituitary luteinizing hormone, these follicles
secrete estradiol, a form of estrogen. This estrogen discourages
stimulating hormone by a negative feedback mechanism, causing a slowdown
in growth of
the follicles. The estrogen also encourages endometrial (uterine
lining) tissue to build up in preparation for a fertilized egg. Eventually,
follicle emerges as the dominant follicle.
In this phase, the dominant follicle bursts, releasing an egg
into the fallopian tube. This phase is caused by a burst in the
hormone. Ovulation usually occurs around day 14 in the cycle,
but the timing varies from woman to woman. Once the egg is in
the fallopian tube,
it is available for fertilization.
phase. After the egg has been released, the remaining follicle tissue
is known as the corpus luteum. During the next two weeks of the menstrual
the corpus luteum secretes an increasing amount of progesterone to
body for early pregnancy and reception of a fertilized egg. If the
egg is not fertilized, levels of progesterone decline.
Menstruation is characterized by low levels of both progesterone
and estrogen. It occurs when the egg has not been fertilized. In
the built-up portion of the uterine wall sloughs off and passes
through the vagina as blood, mucus, and tissue remnants. This sloughing
off is caused by contraction
of the arterioles that supply the thickened endometrium with blood,
as well as the contraction of endometrium smooth muscular wall. These
cause cramping and are under the control of cyclooxygenase (COX)
enzymes. COX enzymes are nonselectively inhibited by over-the-counter
women with PMS, some form of hormonal dysfunction
occurs during the luteal phase.
However, PMS is still not well understood,
and many theories
proposed to explain the underlying symptoms.
In fact, the clinical diagnosis of PMS
wasn’t even established until the
last 15 years or so. Until then, there
was significant disagreement as to whether
PMS existed as a legitimate
number of novel theories have been put forward
to help explain PMS. There is evidence
in severe cases, symptoms associated with
are caused by a derangement of serotonin,
an important neurotransmitter that regulates
and behavior (Clayton AH et al 2006).
Evidence also suggests decreased sensitivity
of brain gamma-aminobutyric acid (GABA)-alpha
receptors, increased sensitivity of brain
of the hypothalamic-pituitary-adrenal axis,
which controls stress hormone levels (Smith
MJ et al 2003; Sundstrom I et al 1998; Rabin
DS et al 1990).
is an inhibitory neurotransmitter associated
with relaxation and a decrease in anxiety.
Together, these effects might account for
some of the mood and motor problems so commonly
seen in PMS. There is also evidence that
runs in families,
and women with PMS also tend to have a personal
or family history of alcohol abuse
and mood-related psychiatric disorders (Berga
S 2005). Also, women with a history of sexual
abuse were found to be more likely to suffer
fact, studies have shown that up to 95 percent
of women who experienced sexual abuse,
often at early ages, were likely to suffer
from PMS (Golding JM et al 2000).
Finally, prostaglandins, hormone-like chemicals
that control various bodily functions, may
play a role in PMS. Prostaglandins are known
to promote smooth
and blood vessel dilation, both of which
are essential to the normal menstrual cycle.
have shown that prostaglandin excretion is
disordered in women
with PMS compared with women without PMS
(Piccoli A et al 1993). Prostaglandin production
to be significantly lower in the late luteal
women with PMS compared with controls, based
on a study of 20 women with PMS and
12 controls, while prostaglandin production
is much higher in the follicular phase
and early luteal phase (Koshikawa N et al
Hormone Modulation and Menstrual Syndromes
The influence of hormones on PMS and menstrual
syndromes has been studied extensively, often
with conflicting results. Women typically
PMS during the
luteal phase of their menstrual cycle, which
is characterized by increasing levels of
progesterone and fluctuating levels of other
steroid hormones. Hoping to unravel the connection
between hormones and premenstrual symptoms,
studied women with PMS to see whether they
have abnormal levels of various hormones
compared with women without PMS. In one study,
found that 20 women with
PMS had higher levels of dehydroepiandrosterone
and free testosterone during the
luteal phase of menstruation, along with
reduced levels of allopregnanolone, than
did 20 controls
(Lombardi I et al 2004). Allopregnanolone
is a metabolite
of progesterone and is an active neurosteroid
that has been shown to affect mood and behavior.
Many studies have examined the role of hormone
therapy, using conventional estrogen-progestin
(synthetic progesterone) contraceptives,
to control symptoms
PMS. These hormone preparations are used
to induce a state of anovulation (no ovulation),
which allows women to bypass the hormonal
during ovulation and thus the accompanying
symptoms (Mayo Clinic 2005). Unfortunately,
evidence of their effectiveness is mixed.
Some women attempt to control their symptoms
with progestins, or synthetic progesterone.
These drugs have consistently failed to show
In recent years, however,
a progestin called drospirenone has been
introduced for the treatment of PMS. Drospirenone
from a source (17-alpha spironolactone) different
the progestins usually used in oral contraception.
It has antimineralocorticoid
activity and is thus not associated with
weight gain and fluid retention, unlike some
Early results with an oral contraception
formulation including drospirenone have been
Multiple studies, examining both PMS and
using this combination. Overall, these studies
have shown that drospirenone reduces bloating,
cramps, breast tenderness, and other side
A drospirenone-containing pill called Yasmin® has been effective in treating
PMDD (Rapkin A 2003). In early 2006, a spin-off of this pill, called Yaz®,
was introduced as an oral contraceptive. Yaz® contains drospirenone in combination
with ethinyl estradiol (3 mg drospirenone/20 mcg ethinyl estradiol) and showed
benefit similar to Yasmin®.
When it comes to hormone modulation to control
symptoms of PMS, Life Extension advocates
a more natural approach than can be achieved
with synthetic estrogens
and progestins. Natural, safe progesterones
are derived from yams and can be used in
of progestins. In addition, phytoestrogens,
compounds derived from plants, have shown
some efficacy in relieving PMS symptoms.
recent double-blind, placebo controlled,
randomized study, phytoestrogens derived
from soy were
examined for their ability to reduce symptoms
months, researchers reported that the women
in the study experienced reduced headache,
breast tenderness, cramps, and swelling during
periods when they
took the soy products compared with periods
when they took placebo (Bryant M et al
The hormone melatonin, which is usually associated
with sleep and insomnia, may also play a
role in alleviating the symptoms of PMS and
in a variety of mood and anxiety disorders
and is intimately related to sex hormones
and other hypothalamic-pituitary-adrenal-axis
have shown that
levels of melatonin are low among women with
PMDD (Parry BL et al 1989).
Calcium and vitamin D. Calcium has a long
history in the treatment of PMS and menstrual
(Abraham GE 1983). In fact, its use in symptom
back to the 1930s, when women suffering menstrual
cycle problems routinely took supplemental
calcium. Since then, this “folk” remedy
has been tested in clinical trials with positive
In a study performed at Columbia University
in New York, calcium supplementation was
found to be a simple and effective treatment
(Thys-Jacobs S et al 1998). After calcium
supplementation for three consecutive menstrual
cycles, healthy menstruating women reported
a 48-percent reduction in total PMS-related
symptoms compared with menstruating women
the same period
(Thys-Jacobs S et al 1998).
A review study performed at Columbia found
that women who received calcium coupled with
vitamin D experienced significant relief
symptoms of PMS. This review confirmed for
the investigators that PMS represents a clinical
manifestation of calcium deficiency (Thys-Jacobs
S 2000; Thys-Jacobs
S et al 1995).
Magnesium. Among its many functions, magnesium
plays a role in maintaining parathyroid function
and hormone production (Ganong W 2003). Magnesium
implicated as a cause of premenstrual symptoms
(Abraham GE et al 1981).
Another double-blind, randomized study investigated
the effects of oral magnesium on premenstrual
symptoms (Facchinetti F et al 1991). This
study found significant
changes on the Menstrual Distress Questionnaire,
a measurement of menstrual distress, in patients
who had taken magnesium for two menstrual
Zinc. Researchers at the Baylor College of
Medicine in Houston, Texas, found that patients
with PMS had lower levels of zinc and higher
levels of copper
during the luteal phase of menstruation than
menstruating women without PMS. The researchers
concluded that zinc deficiency occurs in
PMS patients during the luteal phase
of menstruation, and elevated copper further
reduces the availability of zinc in PMS patients
during the luteal phase (Chuong CJ et al
B6 (pyridoxine, pyridoxal, pyridoxamine). A meta-analysis
was performed to evaluate
the efficacy of vitamin B6. Researchers
published trials representing 940 patients
with premenstrual syndrome in May 1999. Their
conclusions showed that up to 100 mg vitamin
B6 daily is
to be beneficial in treating premenstrual
symptoms and premenstrual depression (Wyatt
KM et al 1999).
In 1987, researchers conducted a double-blind
controlled study on the effects of vitamin
B6 supplementation on premenstrual symptoms
experienced by 55
women who reported moderate to severe premenstrual
mood changes. Study results suggested
that vitamin B6 improved premenstrual symptoms
related to autonomic reactions (e.g., dizziness
and vomiting) and behavioral changes (e.g.,
and decreased social activities) (Kendall
KE et al 1987).
Vitex. Extracts of the fruits of the chaste
tree (Vitex agnus castus) are widely used
to treat premenstrual symptoms. Double-blind,
indicate that one of the most common premenstrual
symptoms, breast tenderness, is beneficially
influenced by this extract, also called chasteberry.
numerous studies indicate that vitex extracts
have beneficial effects on other psychic
somatic symptoms of PMS (Wuttke W et al 2003).
A group of German researchers studied the
effects of chaste tree extract versus placebo
group of women diagnosed with PMS. Both prior
treatment period, women were asked to report
their symptoms of PMS and the degree of severity.
The researchers evaluated the changes in
reported symptoms. More than 50
percent of the women experienced a reduction
in their PMS-related symptoms. The results
of this study prompted the German government
to allow Vitex agnus castus to be approved
for menstrual irregularities, breast pain,
(Schellenberg R 2001).
In a study comparing the efficacy of chasteberry
extract with that of fluoxetine, a selective
serotonin reuptake inhibitor (SSRI), on mood
with PMDD, patients responded well to both
fluoxetine and chasteberry extract. However,
chasteberry proved better than fluoxetine
at improving physical
symptoms (Atmaca M et al 2003).
Researchers investigated the efficacy of
using chasteberry extract to reduce breast
to PMS. In a placebo-controlled, randomized
extract was effective and well tolerated
as a treatment agent for cyclical breast
(Halaska M et al 1998).
Ginkgo biloba. In a clinical study, Ginkgo
biloba was effective at reducing symptoms
of anxiety and headaches. A total of 165
ages 18 to 45 were
given 160 mg
ginkgo extract or placebo daily from day
16 of one menstrual cycle to day 5 of the
Symptoms of fluid retention, particularly
as were psychological parameters (Tamborini
A et al 1993).
Vitamin E. Vitamin E is a powerful antioxidant
and free radical scavenger that protects
the integrity of the cellular membranes in
the impact of D-alpha-tocopherol, a form
of vitamin E, on women suffering from PMS.
treatment with 400 IU D-alpha-tocopherol
three monthly cycles. A significant improvement
in physical symptoms was noted in participants
treated with D-alpha-tocopherol (London RS
et al 1987).
Theanine. Tea contains a unique amino acid,
known as theanine, that can lessen the effects
of PMS. Theanine readily crosses the blood-brain
exerts subtle changes in biochemistry. An
increase in alpha waves has been documented,
and the effect has been compared to getting
a massage or taking a hot bath. Theanine
not cause drowsiness, and unlike tranquilizers,
it does not
the ability to think. Studies of green tea,
which contains a high quantity of theanine,
have shown that when given to rats, theanine
modulated the release
of dopamine in the brain (Yamada T et al
2005). Theanine is now available as a dietary
in the United States.
Natural Methods to Modulate Serotonin
Among women with severe PMS, prescription
antidepressants called SSRIs are frequently
medications inhibit the uptake of serotonin,
thus making more
of it available. Serotonin is an important
neurotransmitter that is involved
in the regulation of mood.
Tryptophan is a precursor of serotonin that
is sometimes used by alternative physicians
to treat depression by increasing the amount
of serotonin. Based
on this, it is logical to assume that tryptophan
would also be effective among women
with PMS, and indeed, it has been shown to
significantly reduce symptoms if administered
during the luteal phase (Freeman FW 2004).
Similarly, the supplement 5-hyrdroxytryptophan
may help relieve symptoms by increasing the
production of serotonin. 5-Hyrdroxytryptophan
is the direct
serotonin. It is the intermediate step between
tryptophan and serotonin. Although
5-Hyrdroxytryptophan has not been studied
in PMS, it has been studied in the treatment
depression (Turner EH et al 2006).
Finally, the herb Saint-John’s-wort is sometimes recommended for premenstrual
syndrome. Saint-John’s-wort (Hypericum perforatum) has gained attention
as a natural antidepressant because of its role in serotonin modulation. It appears
to work by multiple mechanisms, each of which is relatively weak on its own but
contributes to the herb’s overall effectiveness. These mechanisms include
inhibiting monoamine oxidase-A and -B activity and inhibiting the uptake of serotonin,
dopamine, and noradrenaline (Butterweck V 2003). In one case study, a patient
with PMDD who was unable to tolerate standard antidepressant treatment was given
900 mg Saint-John’s-wort daily and experienced substantial improvement
in her symptoms (Huang KL et al 2003). Another observational study examined the
use of Saint-John’s-wort among women with PMS. Participants took 300 mg
Saint-John’s-wort daily, standardized to contain 900 mcg, for one menstrual
cycle. The women experienced improvements in all their symptom scores (Stevinson
C et al 2000).
The Role of Fatty Acids in PMS
Omega-3 fatty acids. Fatty acids play a role
in mediating prostaglandins (Horrobin DF
1983). Supplementation with the right proportions
of fatty acids
the production of anti-inflammatory prostaglandins
(E1 and E3) while suppressing pro-inflammatory
prostaglandin E2 and leukotriene B4. In addition
saturated fats and high glycemic foods that
contribute to chronic inflammation, eating
omega-3 foods, which provide eicosapentaenoic
acid (EPA) and docosahexaenoic
acid (DHA), can help control inflammation
bringing balance to the essential fatty acids.
In clinical studies, supplementation with
omega-3 fatty acids
reduced symptoms associated with PMS, including
cramps (Sampalis F et al 2003; Harel
Z et al 1996). Flax seed oil, which is derived
from flax, is rich in alpha-linolenic acid.
In the body, alpha-linolenic acid is converted
into EPA, providing
another possible source of EPA.
Gamma-linoleic acid. Gamma-linoleic acid
(GLA) is a long-chain polyunsaturated fatty
found in evening primrose oil and borage
seed oil. Like levels
of omega-3 fatty acids, levels of GLA are
abnormal among women with PMS. For example,
one study found that levels of linoleic acid
are normal or elevated in women with PMS,
the levels of gamma-linoleic acid, a metabolite
acid, are low. This implies a problem with
the conversion of linoleic acid to gamma-linoleic
acid (Brush MG et al 1984).
Conventional treatment for mild PMS usually
focuses on NSAIDs, which reduce smooth muscle
contractions and cramping. In addition, some
of the drugs that
benefit, such as benzodiazepines, have risk
for addiction and abuse.
Antidepressants. Antidepressants such as
SSRIs are commonly used for the depression
with PMS and PMDD (Freeman EW et al 2004;
Baldessarini R 2001).
Serotonin reuptake inhibitors that are commonly
used to treat PMS include
and Zoloft® (sertraline) (Berga S 2005). These drugs typically require a
two- to three-week phase-in period before they reach maximum effectiveness. If
they are prescribed, they should be used continuously until both patient and
physician agree to stop using them, and then they should be phased out gradually.
They cannot be used on an “as needed” basis. Side effects associated
with SSRIs include nausea, diarrhea, tremor, weight loss, and headache.
Benzodiazepines. This class of medications
is used to induce sedative, muscle-relaxant,
and anticonvulsant effects (Baldessarini
R 2001). Benzodiazepines have effects similar
to allopregnanolone, a metabolite of progesterone
that acts at the
brain receptor sites at which benzodiazepines
operate. Alprazolam is a commonly prescribed
benzodiazepine. However, these drugs have
serious risk of addiction and
NSAIDs. Over-the-counter (OTC) medicines
such as ibuprofen (Motrin®) and
naproxen sodium (Aleve®) are commonly used to ease uterine cramping and breast
tenderness (Mayo Clinic 2005). These drugs inhibit prostaglandin synthesis (Neal
Others. Bromocriptine, an ergot alkaloid
that blocks the release of prolactin from
gland, is often given to treat breast tenderness
with PMS (Meden-Vrtovec et al 1992).
Lifestyle Changes to Reduce PMS Symptoms
Stress reduction. Stress reduction is important
to reduce symptoms of PMS and PMDD. One study
determined that women with significant PMS
stress and a lower quality of life than women
with low-grade or no PMS symptoms (Lustyk
M et al 2004). Stress has an effect on the
axis by causing an increase in “stress” hormones with wide-ranging
effects throughout the body (Young EA et al 2002).
Women who suffer from high PMS may benefit
from psychotherapy, massage therapy, yoga,
and other alternative methods to reduce stress.
Smoking cessation. In a study of behavior
and lifestyle factors associated with menstrual
symptoms, researchers found that cigarette
smoking was the
lifestyle factor most highly associated with
all types of measured menstrual symptoms
cycle disorders (Kritz-Silverstein D et al
1999). Many strategies are available to help
people quit, including group therapy, nicotine
gums, hypnotism, and support lines.
Exercise. Exercise seems to help reduce PMS
symptoms. Both aerobic and other forms of
exercise appear to be helpful (Fugh-Berman
A et al 2003).
also helps reduce weight. Although obesity
is not consistently associated with menstrual
symptoms, endometrial hyperplasia and other
gynecological disorders are associated
with overweight and obese women. Women who
suffer from PMS and other menstrual disorders
and who are overweight should seriously consider
a weight reduction
program. Mineral supplementation with chromium
picolinate, which helps stabilize blood sugar
levels, has been shown to help women who
suffer from PMS reduce
their cravings for sugar. Chromium picolinate
has also been found to help with weight
reduction (Bell SJ et al 2002). For more
information, see the chapter Obesity.
Life Extension Foundation Recommendations
Women who suffer from PMS are encouraged
to reduce stress if possible. Methods might
massage or cutting back on activities whenever
their PMS arises.
Daily exercise and weight loss (if necessary)
might also help. In addition, the following
supplements are suggested for women suffering
to 250 milligrams (mg) magnesium two times daily. The last dose should
be taken at bedtime.
to 2000 mg daily, divided into two doses, the last to be taken
E—400 IU alpha-tocopherol, including at least 200 mg
cream—1/4 teaspoon twice daily, starting on day 12
of the menstrual cycle and continuing up to day 28
mcg nightly is recommended, increasing to 10 mg if necessary
isoflavones—55 to 110 mg daily
to 1425 mg daily in two divided doses
mg EPA and 1000 mg DHA daily
with lignans—1 to 3 tablespoons daily
extract—(standardized to 0.5 percent) a minimum of
625 micrograms (mcg) Angusides once or twice daily
extract—120 mg daily
to 200 mg daily to induce a state of relaxation
to 1000 mg once or twice daily on an empty stomach
with PMDD: up to 900 mg daily; women with PMS: 300 mg standardized
extract daily. NOTE: Please read the safety caveats
the end of this chapter.
women may also benefit from drospironone, a progestin
that has been effective in reducing
symptoms of PMDD and PMS. Drospironone is
gain and fluid retention. It is available
in combination birth control pills, including
Yasmin® and Yaz®, both of which are
available by prescription.
All the nutrients and supplements discussed
in this section are available through the
Life Extension Foundation Buyers Club, Inc.
anytime toll-free 1-800-544-4440, or visit
us online at www.LifeExtension.com.
The blood tests discussed in this section
are available through Life Extension National
Inc. For ordering information, call anytime
1-800-208-3444, or visit us online at www.LifeExtension.com.
Premenstrual Syndrome Safety Caveats
An aggressive program of dietary supplementation
should not be launched without the supervision
of a qualified physician. Several of the
in this protocol may have adverse effects.
• Do not take calcium if you have hypercalcemia.
• Do not take calcium if you form calcium-containing kidney stones.
• Ingesting calcium without food can increase the risk of kidney stones
in women and possibly men.
• Calcium can cause gastrointestinal symptoms such as constipation, bloating,
gas, and flatulence.
• Large doses of calcium carbonate (12 grams or more daily or 5 grams or
more of elemental calcium daily) can cause
milk-alkali syndrome, nephrocalcinosis, or renal insufficiency.
• Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin).
Taking EPA/DHA with warfarin may increase
the risk of bleeding.
• Discontinue using EPA/DHA 2 weeks before any surgical procedure.
• Flaxseed has blood-thinning, anticlotting properties.
• Discontinue using flaxseed before any surgical procedure.
• Consult your doctor before taking flaxseed if you have hemophilia or
if you take warfarin (Coumadin).
• Flaxseed can cause gastrointestinal symptoms such as nausea and diarrhea.
• Do not take ginkgo biloba if you have a known risk factor for intracranial
hemorrhage such as systematic arterial hypertension,
diabetes, or amyloid senile plaque.
• Ginkgo biloba can cause allergic skin reactions, elevated blood pressure,
and gastrointestinal symptoms such as nausea
• Consult your doctor before taking GLA if you take warfarin (Coumadin).
Taking GLA with warfarin may increase the
risk of bleeding.
• Discontinue using GLA 2 weeks before any surgical procedure.
• GLA can cause gastrointestinal symptoms such as nausea and diarrhea.
• Do not take L-tryptophan if you have carcinoid tumors.
• Do not take L-tryptophan while taking monoamine oxidase inhibitors (MAOIs)
(type A) or within 2 weeks of discontinuing
• Do not take L-tryptophan with any antidepressant medications, including
selective serotonin reuptake inhibitors (SSRIs),
tricyclic antidepressants or MAOIs.
• Do not take L-tryptophan with serotonin 5-HT receptor agonists, including
naratriptan, sumatriptan and zolmitriptan.
• Do not take L-tryptophan if you have ischemic heart disease (e.g., a
history of myocardial infarction, angina
pectoris or documented silent ischemia), coronary artery spasm (e.g., Prinzmetal
sangina), uncontrolled hypertension or
any other significant cardiovascular disease.
• L-tryptophan can trigger excess serotonin formation in tissues other
than the target organ and cause significant
• L-tryptophan can cause nausea, diarrhea, loss of appetite, vomiting,
difficulty breathing, pupil dilation, abnormally
sensitive reflexes, loss of muscle coordination, blurry vision and cardiac dysrhythmia.
• Do not take magnesium if you have kidney failure or myasthenia gravis.
• Do not take melatonin if you are depressed.
• Do not take high doses of melatonin if you are trying to conceive. High
doses of melatonin have been shown to inhibit
• Melatonin can cause morning grogginess, a feeling of having a hangover
or a “heavy head,” or gastrointestinal
symptoms such as nausea and diarrhea.
• Do not take progesterone if you could be pregnant or are breastfeeding.
• Consult your doctor before taking progesterone if you have cancer of
the reproductive organs.
Saint John’s Wort
• St. John's wort can increase sensitivity to sunlight. To avoid a sunburn
while taking St. John’s wort, minimize
your exposure to the sun.
• St. John's wort can cause bloating and constipation.
• Do not take vitamin D if you have hypercalcemia.
• Consult your doctor before taking vitamin D if you are taking digoxin
or any cardiac glycoside.
• Only take large doses of vitamin D (2000 international units or 50 micrograms
or more daily) if prescribed by your doctor.
• See your doctor frequently if you take vitamin D and thiazides or if
you take large doses of vitamin D. You may
• Chronic large doses (95 micrograms or 3800 international units or more
daily) of vitamin D can cause hypercalcemia.
• Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
• Consult your doctor before taking high doses of vitamin E if you have
a vitamin K deficiency or a history of liver
• Consult your doctor before taking vitamin E if you have a history of
any bleeding disorder such as peptic ulcers,
hemorrhagic stroke, or hemophilia.
• Discontinue using vitamin E 1 month before any surgical procedure.
• High doses of zinc (above 30 milligrams daily) can cause adverse reactions.
• Zinc can cause a metallic taste, headache, drowsiness, and gastrointestinal
symptoms such as nausea and diarrhea.
• High doses of zinc can lead to copper deficiency and hypochromic microcytic
anemia secondary to zinc-induced copper deficiency.
• High doses of zinc may suppress the immune system.
to Menopause & PMS Tips Newsletter
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