Diet Can Help Improve PMS, Menstrual Cramps, and Heavy Bleeding
If it’s that time of the month and you are once again enduring mood swings, low energy levels, menstrual cramps, and wondering what to eat on your period, you’re in good company.
Research sheds some light on just how common period symptoms are:
- Worldwide, 47.8% of women of reproductive age have PMS symptoms . For about 20% of these women, symptoms are severe enough to disrupt daily life.
- Up to 91% of women experience some cramping and pain with their periods . A smaller but significant number of women, 2%-29%, suffer from severe pain.
While it may be tempting to take comfort from your menstrual symptoms with a big bowl of ice cream, you may want to consider healthier options. Your dietary choices play a significant role in how you feel during menstruation.
In this article, we’ll take a look at the most common period symptoms and why you get them. We’ll explore what to eat on your period (and the rest of the month), and share other tips to help calm your monthly, hormonal roller coaster ride.
Common Period Symptoms
PMS, cramping pain, and heavy bleeding are the most common symptoms that women have just before and during their menstrual cycle. A smaller percentage of women suffer from a more extreme version of PMS, known as PMDD (premenstrual dysphoric disorder).
While these conditions often roll together into one uncomfortable menstrual cycle, they are distinct conditions. Let’s take a closer look.
While women often complain about “raging hormones” during their menstrual cycle, in fact, PMS symptoms are caused by the sudden drop in estrogen and progesterone levels in the days before your period begins.
Researchers have listed more than 150 possible physical, behavioral, psychological symptoms of PMS, or premenstrual syndrome . Women may experience multiple symptoms, either together or in sequence . PMS symptoms include, but are not limited to :
- Appetite changes
- Weight gain
- Breast swelling and tenderness
- Water retention
- Mood swings (crying, irritability, anger)
- Anxiety and/or depression
About 2.5%-3% of women with PMS have a severe version called premenstrual dysphoric disorder, or PMDD . The symptoms of PMDD are the same as PMS, but far more severe, especially in terms of the psychological symptoms.
Risk factors for PMDD include past trauma , cigarette smoking , and obesity .
Period pain, also known as dysmenorrhea or menstrual cramps, is most commonly caused by a hormonal imbalance. High levels of prostaglandins trigger painful uterine contractions as your body sheds the endometrial lining at menstruation [9, 10, 11, 12].
In a smaller number of cases, menstrual pain results from an underlying disease or condition, such as endometriosis, fibroids, adenomyosis, endometrial polyps, pelvic inflammatory disease, or use of an intrauterine device (IUD) [13, 9]. Hormonal imbalances also play a role in many of these conditions that cause period pain .
Menstrual pain shows up as abdominal pain or back pain. Women may also experience:
- Irritability 
- Headache 
- GI symptoms such as nausea, bloating, diarrhea, constipation, or both, vomiting, and indigestion 
- Tiredness and dizziness 
Researchers estimate that painful periods result in a 12% loss of school and work activities [2, 15].
Heavy Menstrual Bleeding
Heavy menstrual bleeding, also known as menorrhagia, is a complaint from 20-30% of women who seek gynecological care in the USA .
Heavy menstrual flow can result in low iron levels, anemia, and fatigue. Menorrhagia may also significantly affect the quality of life for women during their period.
The Real Reason Your Periods Are Difficult
PMS symptoms, period cramps, and heavy bleeding are clues that all is not well with your hormonal system. Female hormones rise and fall in a choreographed rhythm throughout your 28-day cycle. This delicate and complex dance can easily be thrown off balance.
Women’s hormones interact with other bodily functions, including the nervous system (responsible for mood and pain perception), digestive function, and other hormones such as cortisol . These complex interactions are the reason why female hormone imbalances can lead to such a wide range of symptoms, including period symptoms.
Digging a bit deeper, the two most common causes of hormonal imbalance in women are gut imbalances and stress. Let’s take a closer look:
The Gut-Hormone Connection
Research suggests that gut health affects women’s hormonal health:
- Early evidence suggests that gut dysbiosis (an unhealthy imbalance of the gut microorganisms) may impair the way the body processes and eliminates estrogen, leading to a buildup of estrogen, known as estrogen dominance [18, 19].
- Hormone-related health conditions in women, such as PCOS, obesity, endometriosis, cardiovascular disease, and breast cancer are associated with low bacterial diversity in the digestive tract .
Research also suggests that that the gut-hormone connection is a two-way street:
- Twice as many women as men have IBS in the West, which suggests sex hormones play a role in digestive health .
- Estrogen and progesterone levels impact gut motility (the movement of waste through your digestive tract) , abdominal pain, and bloating , and it may be an underlying cause of IBS .
- Estrogen and progesterone levels may play a role in fluctuating markers of leaky gut [23, 24] and gut bacteria populations [25, 26, 27, 18] at different stages of the menstrual cycle.
So, improving your gut health is a fundamental step for better hormonal health.
The Stress-Hormone Connection
Female hormones are part of your body’s overall hormonal system.
Stress hormone production requires the same raw materials (such as dietary fats) needed to produce female hormones. Chronic stress leads to an overproduction of stress hormones and disrupts overall hormone production in the hypothalamus, the pituitary gland, and adrenal glands [28, 29, 30, 31].
And just like the gut-hormone connection, the stress-hormone connection appears to be a two-way street. Research suggests that unbalanced levels of estrogen can make you hypersensitive to stress .
If your job or family life includes constant high levels of stress, your hormonal balance pays the price. Other stressors are not as well-recognized but have the same effect. This includes internal stressors like undetected gut infections, chronic inflammation, and uncontrolled blood sugar fluctuations.
Balancing stress, whether external or internal, is a key strategy for improving hormonal balance.
What To Eat on Your Period
Since diet plays such an important role in overall gut health, dietary improvements are an important part of an overall plan to rebalance hormones and have healthier periods.
And while you may be wondering what to eat on your period, your dietary habits throughout the month are just as important for keeping hormones balanced. Rather than focusing on a strict diet plan or and a list of the best foods for your period, think in terms of incorporating these healthy dietary principles into your daily routine.
Eat a Whole Foods Diet
A whole-foods diet, also known as an anti-inflammatory diet, includes lots of fresh fruits and veggies, fish, meat, dairy products, whole grains, nuts, and seeds. It significantly reduces or eliminates processed foods, sugars, and refined carbohydrates. Research supports this approach:
- A 2019 systematic review (highest quality of research evidence) found that higher consumption of fruits and vegetables, fish, milk, and dairy products were associated with less menstrual pain .
- One study of 100 nurses with PMS found that those who replaced at least four servings of refined grains in their daily diets with whole grains had a significant drop in PMS symptoms compared with controls .
A whole foods diet provides a higher intake of micronutrients, which can help significantly with menstrual symptoms:
- A 2020 systematic review of 16 clinical trials found that vitamins D, K, B1, and E, calcium, magnesium, zinc sulfate, and boron effectively helped manage period pain .
- Several studies have shown that B vitamins (specifically vitamin B6, B2, and B1) can help reduce PMS symptoms [35, 36]. In one study, women with a high intake of vitamin B1 and B2 from food sources had a 35% lower risk of developing PMS.
If you’d like to use a whole foods diet template, the paleo diet is a great option.
Eat To Control Blood Sugar
That hangry feeling you get when you haven’t eaten (or when you’ve eaten poorly) means your blood sugar is low and your stress levels are high. High stress levels can throw your female hormones out of balance.
A 2019 systematic review found that skipping meals, high sugar consumption, and weight-loss diets were associated with more severe period pain .
Keeping your blood sugar steady throughout the day is important for keeping your hormones balanced. Eat regular, balanced meals that include a portion of protein and some healthy fats and keep your sugar consumption low.
Get Enough Healthy Fats
Hormones are made from dietary fats [37, 31]. If your diet is too low in healthy fats, you may have trouble producing enough hormones.
Research shows that supplementing with omega-3 fatty acids (usually in the form of fish oil) helped to reduce PMS symptoms and moderately improved period pain [38, 39, 40].
Another study found that high saturated fat consumption was associated with menstrual pain. Low-fat diets were associated with significantly less menstrual pain . However, the question of high- or low-fat diets is tricky, because the quality of dietary fats matters. For example, a diet that is too high in trans fats (most often found in processed foods) is certain to be unhealthy. At the same time, not getting enough of the right kinds of fats is also unhealthy.
A good rule of thumb is to include a small portion of healthy fat with every meal. Extra virgin olive oil, avocado or avocado oil, flaxseed or flaxseed oil, fatty fish, nuts, chia seeds, coconut oil, eggs, and full-fat yogurt are all good options for healthy hormone production (and help to manage blood sugar levels too).
If you’re not getting enough healthy fat in your diet, a fish oil supplement can also be helpful.
Eat Iron-Rich Foods
You lose a certain amount of iron with every menstrual cycle. Iron loss may be excessive if you tend to have heavy bleeding. Iron-rich foods can help to restore your body’s iron levels and include:
- Leafy greens
- Fish and seafood
- Red meat (especially liver and organ meat)
- Legumes, like lentils, and chickpeas
- Dark chocolate
Eat Calcium-Rich Foods
Research suggests that dietary calcium intake can also help to reduce period symptoms:
- One study found significantly fewer painful periods among university students who consumed three or four servings of dairy when compared to those who consumed no dairy .
- A 2021 systematic review found that low calcium levels may increase uterine muscle contractions, causing pain. The study also suggests that poor calcium absorption in the gut may be a problem for some. Researchers suggest that increased calcium intake and vitamin D (to help with calcium absorption) can reduce the severity of menstrual cramping and reduce the need for painkillers .
- A 2020 systematic review found evidence that women with PMS have lower calcium levels when compared to women without PMS .
Some good choices for boosting the calcium in your diet include:
- Dairy products
- Leafy greens
- Sardines and canned salmon (make sure to eat the bones)
- Almonds and other nuts
- Beans and lentils
Spice Things Up
Many culinary herbs and spices are anti-inflammatory, have antioxidant properties, and contain high levels of micronutrients. While researchers generally study herbs as supplements, dietary sources contain similar properties but in significantly smaller quantities.
One supplement that is well-studied for its anti-inflammatory properties is curcumin, the substance that gives turmeric its color and flavor. One clinical trial involving 70 women with PMS found that curcumin, taken as a supplement, lessened the severity of PMS symptoms .
While you can always opt to take curcumin and other herbs as supplements, adding plenty of herbs and spices to your diet is a healthy practice.
Limit Your Alcohol Intake
Too much alcohol may make PMS worse.
A very large systematic review with 47,447 participants found evidence that alcohol intake, particularly heavy drinking, increases the risk for PMS . Researchers were not able to establish a threshold for how much alcohol consumption is problematic.
Research into the overall health risks of alcohol consumption may provide some helpful guidelines. In general, occasional drinking and “low-volume” drinking are not associated with significant health risks , but consuming more than 25 grams of alcohol per day (about 1.5 glasses of wine) is associated with increased health risks.
And while we’re talking about vices, research also suggests that smoking may worsen PMS symptoms .
An Action Plan for Healthy Periods
For women with symptoms of hormonal imbalance, I recommend a simple yet comprehensive action plan that is backed by research and has been effective for countless patients. This action plan includes taking steps to:
- Improve gut health
- Reduce stress
- Nudge hormones back into balance
Improve Gut Health
Poor gut health leads to poor hormonal health and vice-versa. This two-way interaction between the gut microbiome and your hormones can become a self-feeding, unhealthy cycle. Break the cycle by taking the two most fundamental steps for better gut health:
Chronic stress can result in hormonal imbalances. Struggling with pain and PMS symptoms creates more stress. This is potentially another self-feeding, unhealthy cycle.
While it’s not realistic to eliminate all sources of stress, focus on the things you can control. For example:
- Get 7-8 hours of sleep every night.
- Go for a daily walk and spend time outdoors.
- Renegotiate responsibilities at home or on the job.
- Schedule time for activities you enjoy.
Nudge Hormones Back Into Balance
The right herbal formulation can boost your progress while you take steps towards better gut health and less stress. Research shows that these herbs are helpful for restoring hormonal health:
- A large number of studies have found that chasteberry (also known as chaste tree or vitex) is safe and effective for reducing symptoms of PMS and PMDD [47, 48, 49, 50, 51, 52].
- A combination of white peony (AKA Chinese peony) and chasteberry was found to be effective for regulating menstrual cycles in women whose menstrual cycles are absent or infrequent .
- White peony and licorice significantly improved symptoms in women with PCOS (polycystic ovary syndrome) .
Progest-Harmony is a convenient herbal formula and a good choice for women with period symptoms. It contains chasteberry, white peony, and licorice.
Your Next Period Can Be Better
It’s possible to start seeing symptom improvements in just one monthly cycle.
Dietary changes are one of the cornerstones for restoring hormonal balance. Combine dietary changes with stress reduction and two key supplements, probiotics and herbal hormonal support for a comprehensive approach.
If you are wondering what to eat on your period, think more broadly about your wellness and follow a healthy diet every day of the month.
Opt for an anti-inflammatory diet that’s built around fresh, whole foods instead of convenience meals and sugary snacks. Include a small portion of healthy fats with every meal to balance blood sugar and support hormone production. Leafy greens, sardines, canned salmon, beans, and lentils include both iron and calcium, which are important for hormonal health. Finally, add some herbs and spices and don’t overdo the alcohol.
If you need help in implementing these changes, a dietician, nutritionist, or health coach can support you on the road to better hormonal health.
- A DM, K S, A D, Sattar K. Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. J Clin Diagn Res. 2014 Feb;8(2):106-9. doi: 10.7860/JCDR/2014/8024.4021. Epub 2014 Feb 3. Erratum in: J Clin Diagn Res. 2015 Jul;9(7):ZZ05. PMID: 24701496; PMCID: PMC3972521.
- Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev. 2014;36:104-13. doi: 10.1093/epirev/mxt009. Epub 2013 Nov 26. PMID: 24284871.
- Fatemi M, Allahdadian M, Bahadorani M. Comparison of serum level of some trace elements and vitamin D between patients with premenstrual syndrome and normal controls: A cross-sectional study. Int J Reprod Biomed. 2019 Sep 22;17(9):647-652. doi: 10.18502/ijrm.v17i9.5100. PMID: 31646259; PMCID: PMC6804325.
- Chiaramonte D, Ring M, Locke AB. Integrative Women’s Health. Med Clin North Am. 2017 Sep;101(5):955-975. doi: 10.1016/j.mcna.2017.04.010. Epub 2017 Jul 14. PMID: 28802473.
- Gudipally PR, Sharma GK. Premenstrual Syndrome. [Updated 2020 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560698/
- Wittchen HU, Perkonigg A, Pfister H. Trauma and PTSD – an overlooked pathogenic pathway for premenstrual dysphoric disorder? Arch Womens Ment Health. 2003 Nov;6(4):293-7. doi: 10.1007/s00737-003-0028-2. PMID: 14628182.
- Bertone-Johnson ER, Hankinson SE, Johnson SR, Manson JE. Cigarette smoking and the development of premenstrual syndrome. Am J Epidemiol. 2008 Oct 15;168(8):938-45. doi: 10.1093/aje/kwn194. Epub 2008 Aug 13. PMID: 18701443; PMCID: PMC2727205.
- Bertone-Johnson ER, Hankinson SE, Willett WC, Johnson SR, Manson JE. Adiposity and the development of premenstrual syndrome. J Womens Health (Larchmt). 2010 Nov;19(11):1955-62. doi: 10.1089/jwh.2010.2128. Epub 2010 Sep 27. PMID: 20874240; PMCID: PMC2971655.
- Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 13;332(7550):1134-8. doi: 10.1136/bmj.332.7550.1134. PMID: 16690671; PMCID: PMC1459624.
- Lundström V, Gréen K, Svanborg K. Endogenous prostaglandins in dysmenorrhea and the effect of prostaglandin synthetase inhibitors (PGSI) on uterine contractility. Acta Obstet Gynecol Scand Suppl. 1979;87:51-6. doi: 10.3109/00016347909157790. PMID: 111466.
- Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999 Aug;60(2):489-96. PMID: 10465224.
- Ylikorkala O, Dawood MY. New concepts in dysmenorrhea. Am J Obstet Gynecol. 1978 Apr 1;130(7):833-47. doi: 10.1016/0002-9378(78)90019-4. PMID: 25021.
- Mrugacz G, Grygoruk C, Sieczyński P, Grusza M, Bołkun I, Pietrewicz P. Etiopatogeneza zespołu bolesnegomiesiączkowania [Etiopathogenesis of dysmenorrhea]. Med Wieku Rozwoj. 2013 Jan-Mar;17(1):85-9. Polish. PMID: 23749700.
- Alsaleem MA. Dysmenorrhea, associated symptoms, and management among students at King Khalid University, Saudi Arabia: An exploratory study. J Family Med Prim Care. 2018 Jul-Aug;7(4):769-774. doi: 10.4103/jfmpc.jfmpc_113_18. PMID: 30234051; PMCID: PMC6131986.
- Zannoni L, Giorgi M, Spagnolo E, Montanari G, Villa G, Seracchioli R. Dysmenorrhea, absenteeism from school, and symptoms suspicious for endometriosis in adolescents. J Pediatr Adolesc Gynecol. 2014 Oct;27(5):258-65. doi: 10.1016/j.jpag.2013.11.008. Epub 2014 Apr 18. PMID: 24746919.
- Walker MH, Coffey W, Borger J. Menorrhagia. [Updated 2020 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536910/
- Meleine M, Matricon J. Gender-related differences in irritable bowel syndrome: potential mechanisms of sex hormones. World J Gastroenterol. 2014 Jun 14;20(22):6725-43. doi: 10.3748/wjg.v20.i22.6725. PMID: 24944465; PMCID: PMC4051914.
- Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45-53. doi: 10.1016/j.maturitas.2017.06.025. Epub 2017 Jun 23. PMID: 28778332.
- Fuhrman BJ, Feigelson HS, Flores R, Gail MH, Xu X, Ravel J, Goedert JJ. Associations of the fecal microbiome with urinary estrogens and estrogen metabolites in postmenopausal women. J Clin Endocrinol Metab. 2014 Dec;99(12):4632-40. doi: 10.1210/jc.2014-2222. PMID: 25211668; PMCID: PMC4255131.
- Goedert JJ, Jones G, Hua X, Xu X, Yu G, Flores R, Falk RT, Gail MH, Shi J, Ravel J, Feigelson HS. Investigation of the association between the fecal microbiota and breast cancer in postmenopausal women: a population-based case-control pilot study. J Natl Cancer Inst. 2015 Jun 1;107(8):djv147. doi: 10.1093/jnci/djv147. PMID: 26032724; PMCID: PMC4554191.
- Palomba S, Di Cello A, Riccio E, Manguso F, La Sala GB. Ovarian function and gastrointestinal motor activity. Minerva Endocrinol. 2011 Dec;36(4):295-310. PMID: 22322653.
- Moore J, Barlow D, Jewell D, Kennedy S. Do gastrointestinal symptoms vary with the menstrual cycle? Br J Obstet Gynaecol. 1998 Dec;105(12):1322-5. doi: 10.1111/j.1471-0528.1998.tb10014.x. PMID: 9883927.
- Zhou Z, Zhang L, Ding M, Luo Z, Yuan S, Bansal MB, Gilkeson G, Lang R, Jiang W. Estrogen decreases tight junction protein ZO-1 expression in human primary gut tissues. Clin Immunol. 2017 Oct;183:174-180. doi: 10.1016/j.clim.2017.08.019. Epub 2017 Sep 1. PMID: 28867253; PMCID: PMC5673541.
- Roomruangwong C, Carvalho AF, Geffard M, Maes M. The menstrual cycle may not be limited to the endometrium but also may impact gut permeability. Acta Neuropsychiatr. 2019 Dec;31(6):294-304. doi: 10.1017/neu.2019.30. Epub 2019 Oct 14. PMID: 31364524.
- Nuriel-Ohayon M, Neuman H, Ziv O, Belogolovski A, Barsheshet Y, Bloch N, Uzan A, Lahav R, Peretz A, Frishman S, Hod M, Hadar E, Louzoun Y, Avni O, Koren O. Progesterone Increases Bifidobacterium Relative Abundance during Late Pregnancy. Cell Rep. 2019 Apr 16;27(3):730-736.e3. doi: 10.1016/j.celrep.2019.03.075. PMID: 30995472.
- Edwards SM, Cunningham SA, Dunlop AL, Corwin EJ. The Maternal Gut Microbiome During Pregnancy. MCN Am J Matern Child Nurs. 2017 Nov/Dec;42(6):310-317. doi: 10.1097/NMC.0000000000000372. PMID: 28787280; PMCID: PMC5648614.
- Sasaki H, Kawamura K, Kawamura T, Odamaki T, Katsumata N, Xiao JZ, Suzuki N, Tanaka M. Distinctive subpopulations of the intestinal microbiota are present in women with unexplained chronic anovulation. Reprod Biomed Online. 2019 Apr;38(4):570-578. doi: 10.1016/j.rbmo.2018.12.026. Epub 2018 Dec 22. PMID: 30773302.
- Tilbrook A, Turner A, Clarke I. Effects of stress on reproduction in non-rodent mammals: the role of glucocorticoids and sex differences. Rev Reprod. 2000;5:105–113.
- Cable JK, Grider MH. Physiology, Progesterone. [Updated 2020 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558960/
- Hariri L, Rehman A. Estradiol. [Updated 2021 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549797/
- Nassar GN, Leslie SW. Physiology, Testosterone. [Updated 2021 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526128/
- Bajalan Z, Alimoradi Z, Moafi F. Nutrition as a Potential Factor of Primary Dysmenorrhea: A Systematic Review of Observational Studies. Gynecol Obstet Invest. 2019;84(3):209-224. doi: 10.1159/000495408. Epub 2019 Jan 10. PMID: 30630172.
- Esmaeilpour M, Ghasemian S, Alizadeh M. Diets enriched with whole grains reduce premenstrual syndrome scores in nurses: an open-label parallel randomised controlled trial. Br J Nutr. 2019 May;121(9):992-1001. doi: 10.1017/S0007114519000333. Epub 2019 Feb 14. PMID: 30761961.
- Saei Ghare Naz M, Kiani Z, Rashidi Fakari F, Ghasemi V, Abed M, Ozgoli G. The Effect of Micronutrients on Pain Management of Primary Dysmenorrhea: a Systematic Review and Meta-Analysis. J Caring Sci. 2020 Mar 1;9(1):47-56. doi: 10.34172/jcs.2020.008. PMID: 32296659; PMCID: PMC7146731.
- Efficacy of vitamin B-6 in the treatment of premenstrual syndrome:systematic review
- Retallick-Brown H, Blampied N, Rucklidge JJ. A Pilot Randomized Treatment-Controlled Trial Comparing Vitamin B6 with Broad-Spectrum Micronutrients for Premenstrual Syndrome. J Altern Complement Med. 2020 Feb;26(2):88-97. doi: 10.1089/acm.2019.0305. Epub 2020 Jan 10. PMID: 31928364.
- Delgado BJ, Lopez-Ojeda W. Estrogen. [Updated 2020 Aug 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538260/
- Behboudi-Gandevani S, Hariri FZ, Moghaddam-Banaem L. The effect of omega 3 fatty acid supplementation on premenstrual syndrome and health-related quality of life: a randomized clinical trial. J Psychosom Obstet Gynaecol. 2018 Dec;39(4):266-272. doi: 10.1080/0167482X.2017.1348496. Epub 2017 Jul 14. PMID: 28707491.
- Prego-Dominguez J, Hadrya F, Takkouche B. Polyunsaturated Fatty Acids and Chronic Pain: A Systematic Review and Meta-analysis. Pain Physician. 2016 Nov-Dec;19(8):521-535. PMID: 27906932.
- Hosseinlou A, Alinejad V, Alinejad M, Aghakhani N. The effects of fish oil capsules and vitamin B1 tablets on duration and severity of dysmenorrhea in students of high school in Urmia-Iran. Glob J Health Sci. 2014 Sep 18;6(7 Spec No):124-9. doi: 10.5539/gjhs.v6n7p124. PMID: 25363189; PMCID: PMC4796395.
- Abdul-Razzak KK, Ayoub NM, Abu-Taleb AA, Obeidat BA. Influence of dietary intake of dairy products on dysmenorrhea. J Obstet Gynaecol Res. 2010 Apr;36(2):377-83. doi: 10.1111/j.1447-0756.2009.01159.x. PMID: 20492391.
- Abdi F, Amjadi MA, Zaheri F, Rahnemaei FA. Role of vitamin D and calcium in the relief of primary dysmenorrhea: a systematic review. Obstet Gynecol Sci. 2021 Jan;64(1):13-26. doi: 10.5468/ogs.20205. Epub 2021 Jan 7. PMID: 33406811; PMCID: PMC7834752.
- Arab A, Rafie N, Askari G, Taghiabadi M. Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature. Int J Prev Med. 2020 Sep 22;11:156. doi: 10.4103/ijpvm.IJPVM_243_19. PMID: 33312465; PMCID: PMC7716601.
- Khayat S, Fanaei H, Kheirkhah M, Moghadam ZB, Kasaeian A, Javadimehr M. Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial. Complement Ther Med. 2015 Jun;23(3):318-24. doi: 10.1016/j.ctim.2015.04.001. Epub 2015 Apr 9. PMID: 26051565.
- Fernández MDM, Saulyte J, Inskip HM, Takkouche B. Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis. BMJ Open. 2018 Apr 16;8(3):e019490. doi: 10.1136/bmjopen-2017-019490. PMID: 29661913; PMCID: PMC5905748.
- Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T, Chikritzhs T. Do “Moderate” Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality. J Stud Alcohol Drugs. 2016 Mar;77(2):185-98. doi: 10.15288/jsad.2016.77.185. PMID: 26997174; PMCID: PMC4803651.
- Rafieian-Kopaei M, Movahedi M. Systematic Review of Premenstrual, Postmenstrual and Infertility Disorders of Vitex Agnus Castus. Electron Physician. 2017 Jan 25;9(1):3685-3689. doi: 10.19082/3685. PMID: 28243425; PMCID: PMC5308513.
- Freeman EW, Rickels K, Sondheimer SJ, Polansky M, Xiao S. Continuous or intermittent dosing with sertraline for patients with severe premenstrual syndrome or premenstrual dysphoric disorder. Am J Psychiatry. 2004 Feb;161(2):343-51. doi: 10.1176/appi.ajp.161.2.343. PMID: 14754784.
- Cerqueira RO, Frey BN, Leclerc E, Brietzke E. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2017 Dec;20(6):713-719. doi: 10.1007/s00737-017-0791-0. Epub 2017 Oct 23. PMID: 29063202.
- Csupor D, Lantos T, Hegyi P, Benkő R, Viola R, Gyöngyi Z, Csécsei P, Tóth B, Vasas A, Márta K, Rostás I, Szentesi A, Matuz M. Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 2019 Dec;47:102190. doi: 10.1016/j.ctim.2019.08.024. Epub 2019 Aug 30. PMID: 31780016.
- Maleki-Saghooni N, Karimi FZ, Behboodi Moghadam Z, Mirzaii Najmabadi K. The effectiveness and safety of Iranian herbal medicines for treatment of premenstrual syndrome: A systematic review. Avicenna J Phytomed. 2018 Mar-Apr;8(2):96-113. PMID: 29632841; PMCID: PMC5885324.
- 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 Aug;217(2):150-166. doi: 10.1016/j.ajog.2017.02.028. Epub 2017 Feb 22. PMID: 28237870.
- Moini Jazani A, Hamdi K, Tansaz M, Nazemiyeh H, Sadeghi Bazargani H, Fazljou SMB, Nasimi Doost Azgomi R. Herbal Medicine for Oligomenorrhea and Amenorrhea: A Systematic Review of Ancient and Conventional Medicine. Biomed Res Int. 2018 Mar 18;2018:3052768. doi: 10.1155/2018/3052768. PMID: 29744355; PMCID: PMC5878906.
- Arentz S, Smith CA, Abbott J, Fahey P, Cheema BS, Bensoussan A. Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytother Res. 2017 Sep;31(9):1330-1340. doi: 10.1002/ptr.5858. Epub 2017 Jul 7. PMID: 28685911; PMCID: PMC5599989.