4 alternative therapies for PMS: what the research actually shows

Premenstrual syndrome affects roughly 75% of menstruating women at some point, though only about 20-40% experience symptoms bothersome enough to seek treatment [1]. The monthly recurrence of bloating, mood swings, breast tenderness, and fatigue can range from mildly annoying to genuinely disruptive. If you’ve tried standard approaches without much success, you might be curious about alternatives.

I’ve reviewed the clinical evidence on four therapies that get mentioned frequently: chasteberry (Vitex agnus-castus), aromatherapy, exercise, and reflexology. Some have reasonable support; others are more of a question mark.

What is premenstrual syndrome?

PMS refers to a collection of physical and psychological symptoms that appear in the luteal phase of the menstrual cycle, typically 7-10 days before menstruation begins. Symptoms usually resolve within a few days of the period starting.

The symptom list is long and varied:

Psychological symptoms: Irritability, anxiety, mood swings, difficulty concentrating, feeling overwhelmed, sleep disturbances, and in some cases depression.

Physical symptoms: Breast tenderness, bloating, headaches, fatigue, food cravings, weight gain from fluid retention, and digestive changes.

What separates PMS from ordinary monthly fluctuations is the timing and impact. According to the American College of Obstetricians and Gynecologists, PMS diagnosis requires at least one emotional and one physical symptom occurring in the five days before menstruation, across at least three consecutive cycles, with enough severity to interfere with normal activities [2].

A smaller percentage of women, perhaps 3-8%, experience premenstrual dysphoric disorder (PMDD), which involves the same timing pattern but with more severe emotional symptoms, sometimes including suicidal thoughts.

What causes PMS?

Nobody knows for certain. The leading theories involve hormonal fluctuations and how individual women respond to them.

During the luteal phase, both oestrogen and progesterone rise after ovulation, then drop sharply if pregnancy doesn’t occur. This hormonal shift appears to affect neurotransmitters, particularly serotonin. Women with PMS may be more sensitive to these normal cyclical changes rather than having abnormal hormone levels.

Other factors that seem to influence severity include:

• Genetic predisposition (if your mother or sister has PMS, your risk increases)
• Stress levels
• Nutritional deficiencies, particularly calcium, magnesium, and vitamin B6
• Smoking (doubles the risk of severe symptoms)
• BMI over 30 (triples the risk compared to normal weight)

Standard medical treatments

Before discussing alternatives, it’s worth noting what conventional medicine offers.

Hormonal contraceptives can reduce symptoms by suppressing ovulation and smoothing out hormonal fluctuations. Doctors sometimes prescribe diuretics for bloating, NSAIDs like ibuprofen for pain, and in severe cases, SSRIs (antidepressants that affect serotonin) during the luteal phase.

These work for many women. But they don’t work for everyone, and some prefer to try non-pharmaceutical approaches first.

1. Chasteberry (Vitex agnus-castus)

Chasteberry comes from the chaste tree, native to the Mediterranean and Central Asia. Traditional medicine has used it for menstrual disorders for centuries.

The proposed mechanism involves the pituitary gland. Chasteberry appears to inhibit prolactin secretion and may have dopaminergic effects, which could explain its impact on breast tenderness and mood symptoms.

What the research shows:

A systematic review and meta-analysis of three randomised, double-blind, placebo-controlled trials involving 520 women with PMS found that chasteberry was 2.57 times more likely to provide symptom relief compared with placebo [3]. That’s a reasonably impressive effect size for a botanical supplement.

The most commonly studied preparation uses a standardised extract. Doses in the trials ranged from 20-40mg daily, taken throughout the cycle.

My honest take:

This is probably the best-supported herbal option for PMS. Three decent trials isn’t overwhelming evidence, but it’s more than most supplements have. The effect appears genuine, though I wouldn’t expect dramatic improvements. If your symptoms are moderate and you’d prefer to avoid pharmaceuticals, chasteberry is worth trying for two or three cycles.

Precautions:

Chasteberry can interact with hormonal medications, including contraceptives and hormone replacement therapy. It may also affect dopamine, so caution is warranted if you’re taking medications for Parkinson’s disease or psychiatric conditions. Avoid during pregnancy.

2. Aromatherapy

Aromatherapy uses plant-derived essential oils, either inhaled or applied topically with a carrier oil. Lavender, eucalyptus, rosemary, and chamomile are the most commonly used.

The theory is that aromatic compounds affect the limbic system through olfactory pathways, potentially influencing mood and pain perception.

What the research shows:

A systematic review and meta-analysis of eight randomised controlled trials involving 295 women with moderate-to-severe PMS found that inhaled aromatherapy reduced both physical and psychological symptom severity [4]. The studies showed improvements in anxiety, depression, fatigue, and overall PMS scores.

Lavender was the most commonly tested oil. Some trials also used chamomile.

My honest take:

The evidence here is decent, though blinding in aromatherapy trials is difficult since people can smell what they’re getting. Still, even accounting for placebo effects, there seems to be something real happening. Aromatherapy is low-risk and low-cost. If you enjoy the scents, there’s little downside to trying it.

Practical approach:

Add a few drops of lavender oil to a diffuser for 15-20 minutes, or put a drop on your pillow. For topical use, dilute essential oils in a carrier oil like sweet almond or jojoba before applying to skin.

3. Exercise

This one won’t surprise anyone who’s heard general health advice. Regular physical activity helps with almost everything, and PMS appears to be no exception.

Exercise affects endorphins, serotonin, and stress hormones. It may also reduce water retention and improve sleep quality.

What the research shows:

The relationship between physical activity and mortality risk has been documented since the 1950s. A 1 MET increase in fitness or an additional 1000 kcal per week of activity is associated with roughly 20% reduction in mortality [5].

For PMS specifically, observational studies consistently show that physically active women report fewer and less severe symptoms. The NHS recommends at least 150 minutes of moderate-intensity activity per week for general health [6].

The research on exercise for PMS is somewhat circular, though. Women with severe symptoms may find it harder to exercise, making it difficult to separate cause from effect.

My honest take:

Exercise probably helps, though we can’t be certain how much is direct physiological benefit versus general improvements in wellbeing and stress management. The good news is that the recommendation aligns with what you should be doing anyway. Aim for 30 minutes of moderate activity on most days. Walking counts. Swimming counts. You don’t need to run marathons.

Practical approach:

If you’re currently inactive, start with 10-15 minute walks and build up. Some women find that maintaining activity during the premenstrual phase is more effective than stopping when symptoms appear.

4. Reflexology

Reflexology involves applying pressure to specific points on the feet, hands, or ears that supposedly correspond to other body parts and organs.

The theoretical basis is speculative at best. Proponents suggest it improves circulation, stimulates lymphatic drainage, and promotes relaxation. The more straightforward explanation might be that foot massage is pleasant and relaxing, which could help with stress-related symptoms.

What the research shows:

A systematic review and meta-analysis of nine randomised controlled trials with 475 PMS participants found that foot reflexology reduced overall PMS scores as well as physical and psychological symptoms [7]. Longer sessions appeared more effective.

My honest take:

The evidence here is harder to interpret. Reflexology studies struggle with proper blinding and placebo controls. The specific “reflex zone” theory lacks plausible mechanism, but that doesn’t mean massage-type interventions can’t help through general relaxation effects.

If you enjoy foot massage and find it relaxing, it might help. I wouldn’t recommend it as a primary treatment, but as part of stress management, it’s harmless.

Other supplements worth mentioning

Several other supplements have research support for PMS:

Calcium: A landmark trial gave 1200mg daily of calcium carbonate to women with PMS. After three cycles, 48% in the calcium group had at least 50% reduction in symptoms, compared with 30% on placebo [8]. That’s a meaningful difference. Calcium is worth considering if your dietary intake is low. See our full guide to calcium supplements.

Vitamin B6: Several trials have shown modest benefits at doses of 50-100mg daily. Don’t exceed 200mg daily due to risk of nerve damage at high doses.

Magnesium: May help with fluid retention and mood symptoms. Doses of 200-360mg daily have been studied.

Evening primrose oil: Traditional use for breast pain, though the clinical evidence is mixed. See our evening primrose oil guide.

What probably doesn’t help

Local honey for PMS: No evidence.

High-dose vitamin C: Not studied specifically for PMS and won’t address hormonal causes.

Homeopathy: No plausible mechanism and poor quality evidence.

When to see a doctor

You should seek medical advice if:

• Your symptoms are severe enough to interfere with work, relationships, or daily activities
• You experience symptoms of depression or anxiety that don’t resolve after your period starts
• Simple self-care measures haven’t helped after several months
• You’re unsure whether your symptoms are PMS or something else

GPs can rule out other conditions, discuss hormonal treatments, and refer to specialists if needed.

Putting it together

If you want to try natural approaches for PMS, here’s a reasonable order:

1. Start with lifestyle basics: regular exercise, adequate sleep, stress management, and a balanced diet with sufficient calcium
2. Consider chasteberry, particularly if breast tenderness and mood symptoms are prominent
3. Try aromatherapy with lavender if you find it pleasant and relaxing
4. Ensure adequate calcium, magnesium, and B6 intake, through diet or supplements

Keep a symptom diary for at least three cycles to track what helps. PMS varies between women, and what works for one person may not work for another.

Related reading

• 4 alternative therapies for PMS: chasteberry, aromatherapy, exercise, and reflexology
• Evening primrose oil: benefits and side effects
• Calcium supplements: benefits and precautions

References

1. Yonkers KA, O’Brien PM, Eriksson E. Premenstrual syndrome. Lancet. 2008;371(9619):1200-1210.
2. American College of Obstetricians and Gynecologists. Management of Premenstrual Disorders. ACOG Clinical Practice Guideline No. 7. Obstet Gynecol. 2023;142(6):1516-1533.
3. Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. 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.
4. Sut N, Kahyaoglu-Sut H. Effect of aromatherapy massage on pain in primary dysmenorrhea: A meta-analysis. Complement Ther Clin Pract. 2017;27:5-10.
5. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793-801.
6. NHS. Physical activity guidelines for adults aged 19 to 64. https://www.nhs.uk/live-well/exercise/
7. Hasanpour SE, Akhavan Amjadi M, Kheirkhah M, Sharifnia H. The effects of foot reflexology on premenstrual syndrome: A systematic review and meta-analysis. Int J Community Based Nurs Midwifery. 2019;7(1):10-21.
8. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol. 1998;179(2):444-452.