Premenstrual discomfort is increasingly common, with over 30% of individuals experiencing premenstrual syndrome (PMS), and almost 10% experiencing premenstrual dysphoric disorder (PMDD). PMDD is more severe than PMS and often negatively affects abilities to attend work, school, or interpersonal relationships. 

Premenstrual discomfort has been linked to hormone imbalances, changes in thyroid health, and nutritional insufficiencies, including vitamin B6 deficiencies. Imbalances in antioxidative status linked to estrogen secretion may also influence menstrual comfort. Certain lifestyle factors may also influence premenstrual discomfort, including psychological stress and physical activity. A randomized clinical trial (RCT) involving 65 menstruating individuals assessed the efficacy of physical exercise on parameters related to PMS. The intervention involved 3 sessions of aerobic exercise (20 minutes per session) each week for 8 weeks. Significant reductions in common complaints associated with PMS including headache, nausea, and digestive irregularities were observed in the intervention group when compared with the placebo group at the study terminus. Similar studies have reported decreases in abdominal pain and bloating in the presence of physical activity. 

Nutritional status may also influence parameters related to menstrual comfort. A pilot double-blind RCT by Retallick-Brown and colleagues compared vitamin B6 with other micronutrients to potentially support menstrual comfort. Over 70 individuals were randomized to either a multivitamin or 80 mg of vitamin B6 daily for three menstrual cycles. Both arms experienced similar improvements in complaints related to PMS. Clinical research exploring the efficacy of vitamin B6 on parameters related to PMS has curiously fallen out of vogue in recent years. However, studies like the above RCT by Retallick-Brown and colleagues indicate that more research is warranted. In particular, newer studies comparing vitamin B6 to a placebo for at least three menstrual cycles are needed. 

Clinical studies have also explored the relationship between fish oil administration and menstrual comfort. A double-blind parallel-group RCT involving 21 female basketball players randomized participants to either a placebo or 3600 mg of fish oil, containing 900 mg of eicosapentaenoic acid (EPA) and 403 mg of docosahexaenoic acid (DHA), daily for two menstrual cycles. Significant differences in reactive oxygen metabolites (d-ROMS) were observed during the follicular phase in the treatment group. This suggests that fish oil administration may support antioxidative status related to menstrual health. 

Other clinical studies involving fish oil supplementation and premenstrual discomfort have observed improvements in pain scores often associated with PMS. This is thought to be due to fish oil’s potential to modulate prostaglandin and leukotriene activity. However, clinical studies involving fish oil often vary in the standardization of amounts administered and other critical elements of study design. More research involving consistent primary outcomes and achievable variables is needed.

Evidence suggests that lifestyle changes such as physical activity may influence menstrual health. Micronutrients such as vitamin B6 and fish oil may help promote menstrual comfort.

By Dr. C. Ambrose, ND, MAT