4 alternative therapies for PMS: what the research actually shows

Premenstrual syndrome (PMS) affects somewhere between 20% and 40% of women during their reproductive years, depending on whose figures you trust. The symptoms vary considerably from one person to the next, ranging from mild inconvenience to genuinely disruptive. On the psychological side, women report anxiety, irritability, mood swings, depressed mood, difficulty concentrating, and sleep disturbances. Physically, there’s breast tenderness, bloating, headaches, fatigue, abdominal cramping, and water retention in the limbs.

About 3% to 8% of women experience a more severe form called premenstrual dysphoric disorder (PMDD), where the psychological symptoms become intense enough to interfere significantly with work, relationships, and daily functioning. This distinction matters because the treatments that help mild PMS may not be sufficient for PMDD.

What causes PMS?

Medical researchers have proposed various theories over the years: hormonal imbalances between progesterone and oestrogen, fluctuations in serotonin levels, changes in endorphins, alterations in aldosterone and the renin-angiotensin system, and nutritional deficiencies. None of these theories fully explains why some women are affected more than others.

The honest answer is that we still don’t have a complete understanding of PMS. What we do know is that symptoms are linked to the luteal phase of the menstrual cycle (the roughly two weeks between ovulation and menstruation) and that they resolve once menstruation begins. This cyclical pattern is actually what defines the condition.

Standard medical treatments

Before exploring alternative therapies, it’s worth knowing what mainstream medicine offers. The most commonly prescribed treatments include:

Selective serotonin reuptake inhibitors (SSRIs): Antidepressants like fluoxetine and sertraline have good evidence for reducing both psychological and physical PMS symptoms. They can be taken either continuously or just during the luteal phase.

Hormonal contraceptives: Some women find relief with combined oral contraceptives, though the evidence here is mixed.

Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen and similar medications help with cramping and headaches but don’t address the psychological symptoms.

Diuretics: Spironolactone can help with bloating and water retention.

For many women, these options either don’t work well enough or come with side effects they’d rather avoid. That’s where alternative therapies come in.

1. Chasteberry (Vitex agnus-castus)

Chasteberry comes from a shrub native to the Mediterranean region and Central Asia. It’s been used in traditional medicine for centuries, primarily for menstrual disorders. The plant contains various compounds including flavonoids, glycosides, and diterpenes, and it appears to influence dopamine receptors in ways that may reduce prolactin secretion.

What does the research show?

I’ve looked at the clinical evidence, and chasteberry probably has the strongest support among herbal remedies for PMS.

A systematic review and meta-analysis published in 2019 examined three randomised, double-blind, placebo-controlled trials involving 520 women with PMS [1]. The pooled results suggested that chasteberry preparations were about 2.5 times more likely to produce symptom relief compared to placebo, based on total symptom scores or PMS diary recordings.

An earlier meta-analysis from 2017 reviewed five trials with 944 participants and reached similar conclusions: chasteberry consistently outperformed placebo for reducing PMS symptoms [2].

The typical dose used in studies ranges from 20 to 40 mg daily of standardised extract, taken throughout the menstrual cycle rather than just during the symptomatic phase.

My honest assessment

The evidence here is actually reasonably good by herbal medicine standards. Three double-blind, placebo-controlled trials showing consistent benefit is more than most supplements can claim. The effect size isn’t massive, but it’s statistically significant.

The main caveats: we don’t know the optimal dose, treatment duration needed to see effects varies (most studies run 3 to 6 months), and the studies included women with moderate PMS rather than severe PMDD. If your symptoms are severe, chasteberry alone probably won’t be sufficient.

Safety considerations

Chasteberry is generally well tolerated. Reported side effects in clinical trials were mild: occasional headaches, gastrointestinal upset, skin reactions, and fatigue.

However, because chasteberry may influence hormone levels, women who are pregnant, breastfeeding, or taking hormonal contraceptives should avoid it. The same applies to women with hormone-sensitive conditions like certain breast cancers or endometriosis.

If you’re taking medications that affect dopamine (such as antipsychotics or medications for Parkinson’s disease), check with your doctor first.

2. Aromatherapy

Aromatherapy involves inhaling or topically applying essential oils extracted from plants. For PMS, the most commonly studied oils include lavender, clary sage, rose, and chamomile.

What does the research show?

A systematic review and meta-analysis from 2021 looked at eight randomised controlled trials involving 295 women with moderate to severe PMS [3]. The studies used various essential oils administered by inhalation.

The pooled results suggested aromatherapy reduced overall PMS symptom severity, with effects on both physical and psychological symptoms. Anxiety and depression scores showed improvement compared to control groups.

What gives me pause

The research quality here isn’t brilliant. Blinding is notoriously difficult in aromatherapy trials because people can smell whether they’re getting the real treatment. Many of the trials were small, and there was considerable variation in which oils were used, how they were delivered, and for how long.

That said, aromatherapy is low-risk and inexpensive. The mechanism might be as simple as relaxation from pleasant scents. If it helps you feel calmer during a difficult week each month, that’s not nothing.

How to try it

Most studies used inhalation rather than topical application. Common approaches include:

• Adding a few drops of essential oil to a diffuser
• Putting 2-3 drops on a tissue or cotton ball and inhaling periodically
• Adding oils to a warm bath

Lavender and chamomile are probably the most studied. If you’re using oils topically, always dilute them in a carrier oil first (such as jojoba or sweet almond oil) to avoid skin irritation.

3. Exercise

This is probably the easiest intervention to recommend because the benefits extend well beyond PMS. Regular physical activity improves mood, reduces stress, and helps with sleep, all of which are relevant to premenstrual symptoms.

What does the research show?

A systematic review and meta-analysis from 2020 examined 15 randomised controlled trials involving 717 women with PMS [4]. The interventions varied (aerobic exercise, yoga, stretching) but the overall finding was that exercise reduced psychological, physical, and behavioural symptoms.

The effect sizes were moderate, and benefits were seen for overall PMS symptom scores as well as specific domains like anxiety and bloating.

Earlier research suggested that aerobic exercise in particular might help by increasing endorphin levels and improving serotonin function, though the exact mechanisms remain unclear.

The practical reality

The catch is that many women feel least motivated to exercise precisely when PMS symptoms are at their worst. The research doesn’t specify whether you need to exercise during the symptomatic phase or whether regular exercise throughout the month provides protection.

My interpretation: aim for consistent physical activity (30 minutes most days) rather than trying to force yourself into intense workouts when you’re already feeling drained. Activities like walking, swimming, or gentle yoga might be more sustainable during symptomatic days.

What type of exercise works best?

The studies used various exercise types, so we can’t say definitively that one is better than another. Aerobic exercise (walking, cycling, swimming) has the most research. Yoga has shown promise in several trials, possibly because it combines physical movement with relaxation techniques.

The NHS recommends at least 150 minutes of moderate aerobic activity per week for general health [5]. Meeting this baseline throughout the month may help reduce PMS severity.

4. Reflexology

Reflexology is a complementary therapy where pressure is applied to specific points on the feet, hands, or ears. Practitioners believe these points correspond to different organs and systems in the body. The theory is that stimulating these areas can promote healing and balance.

What does the research show?

A systematic review and meta-analysis from 2019 included nine randomised controlled trials with 475 women experiencing PMS [6]. The pooled results suggested reflexology reduced overall PMS scores, including both physical and psychological symptoms.

One interesting finding: longer massage sessions (more time per appointment) appeared to produce better results.

Honest caveats

Reflexology trials have the same blinding problem as aromatherapy, arguably worse. It’s essentially impossible to conduct a proper double-blind trial because the practitioner knows whether they’re performing real reflexology or a sham treatment.

Most studies compared reflexology to no treatment rather than to a convincing placebo, which inflates the apparent benefit. When you’re receiving 30-60 minutes of relaxing hands-on attention each week, you’d expect some improvement in stress-related symptoms regardless of specific technique.

I’m not dismissing reflexology entirely. If it relaxes you and you enjoy it, there’s nothing wrong with incorporating it into your self-care routine. Just don’t expect it to outperform other relaxation methods.

Other approaches worth mentioning

Beyond the four therapies above, a few other interventions have some evidence for PMS:

Calcium: Several studies suggest 1000-1200 mg of calcium daily may reduce PMS symptoms. The mechanism might involve calcium’s role in neurotransmitter function [7].

Vitamin B6: Doses up to 100 mg daily have shown benefit in some trials, though high-dose B6 can cause nerve damage with long-term use.

Magnesium: Some evidence suggests magnesium supplementation may help with bloating, mood symptoms, and headaches associated with PMS.

Evening primrose oil: Popular for PMS and breast pain, though the clinical trial evidence is actually quite mixed.

What the evidence doesn’t support

A few things commonly recommended for PMS don’t have good evidence:

High-dose vitamin supplements: Beyond the specific nutrients mentioned above, there’s no good evidence that megadoses of vitamins help PMS.

Certain herbal remedies: Black cohosh, dong quai, and St John’s wort are sometimes suggested but lack convincing trial data specifically for PMS.

Putting it together

If I were advising someone with moderate PMS, here’s what I’d suggest based on the available evidence:

1. Start with exercise: It’s free, has extensive benefits beyond PMS, and the evidence is reasonably solid. Aim for regular activity throughout the month.

2. Consider chasteberry: If symptoms persist despite exercise, this has the best herbal evidence. Give it 2-3 months to see effects.

3. Add calcium if not getting enough from diet: Particularly if you experience breast tenderness or mood symptoms.

4. Try aromatherapy if you find it relaxing: Low risk, potentially helpful, and doesn’t interfere with other treatments.

5. Consider reflexology as a treat: If you enjoy massage and can afford regular sessions, it might help with stress and relaxation.

For severe symptoms or PMDD, these complementary approaches probably won’t be enough on their own. Speak with a doctor about prescription options.

Related reading

• Chamomile benefits and side effects
• Magnesium benefits and side effects
• Evening primrose oil benefits and side effects

References

1. Verkaik S, et al. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(2):150-166. PMID: 28237870

2. Csupor D, et al. Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 2019;47:102190. PMID: 31780016

3. Lotfipur-Rafsanjani SM, et al. Effects of aromatherapy on premenstrual syndrome: A systematic review and meta-analysis of randomized clinical trials. J Psychosom Obstet Gynaecol. 2021;42(3):246-254. PMC7769645

4. Yesildere Saglam H, Orsal O. Effect of exercise on premenstrual symptoms: A systematic review. Complement Ther Med. 2020;48:102272. PMC7465566

5. NHS. Physical activity guidelines for adults aged 19 to 64. https://www.nhs.uk/live-well/exercise/exercise-guidelines/physical-activity-guidelines-for-adults-aged-19-to-64/

6. Abdi S, et al. The Effect of Reflexology on Premenstrual Syndrome: A Systematic Review and Meta-Analysis. Am J Obstet Gynecol MFM. 2019;1(4):100053. PMC6815051

7. Thys-Jacobs S, et al. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol. 1998;179(2):444-452. PMID: 9731851