Natural supplements that might ease the effects of PMS

Q: I get horrible PMS symptoms every month. I feel bloated and really cranky. I don't want to take prescription medications, and I'm not interested in a birth-control pill — which is what my doctor offered me. Any natural approaches you could suggest?

A: I would start by supplementing with 600 mg of calcium twice a day. There have been three small studies suggesting that women who take 1,000 to 1,200 mg of calcium a day have less bloating, depression and pain than those who don't. Remember that you can't absorb more than 600 mg of calcium at a time, which is why I recommend taking it twice a day.

In addition to the calcium, you could add magnesium. Besides helping with bloating, magnesium at 600 mg per day may also help prevent premenstrual migraines, which can be a big problem for many women.

Downsides include loose stools for some people. Don't use this if you have heart or kidney problems without talking to your doctor.

You could also try chasteberry, otherwise known as Vitex agnus castus. According to some historians, monks used the berries from this tree to keep their celibacy. Several small studies suggest that it helps decrease breast tenderness, mood changes, constipation and bloating around menses. Some people will develop nausea or headache with it though, and you shouldn't use it if you are pregnant, or have cancer.

Another option is vitamin B6, otherwise known as pyridoxine. One study found that in combination with magnesium, pyridoxine lessened PMS-related anxiety. There is a big range in the doses that have been used, but you could start at 50 mg per day. Above 100 mg per day, some people can develop numbness and tingling in their hands and feet, which usually resolves after stopping the vitamin. Some research suggests that this may be less likely if you take the pyridoxal-5-phosphate form of the vitamin, rather than the more common one, pyridoxine hydrochloride.

If menstrual cramps are a concern, I definitely recommend trying fish oil, in addition to calcium and magnesium. Usually, I start with two capsules of fish oil per day. I have seen this to be very effective for many women. It can take about two cycles to work, because it takes time for the types of fats in the cell membranes of your body to switch over, so don't give up if you don't see results right away.

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. Send questions to apujari@seattletimes.com for possible use in future columns. All information is intended for education and not a substitute for medical advice. Consult your doctor before following any suggestions given here.