Premenstrual Syndrome (PMS) has been reported in up to 40% of the reproductive female population. Other studies characterize PMS as affecting 95% of women of reproductive age, with severe or disabling symptoms occurring in 5% of these women.
A constellation of symptoms that occur around a woman’s menstruation cycle during the luteal phase of menses, including psychological symptoms such as irritability, anxiety, depression, and tearfulness, and physical symptoms such as bloating, breast tenderness, and migraine headaches, PMS is widespread.
One variant of severe PMS is classified as premenstrual dysphoric disorder (PMDD), which can present with the aforementioned symptoms as well as any the following:
- feelings of guilt or hopelessness
- mood swings
- persistent anger
- anhedonia (lack of interest)
- impaired concentration
- poor coordination
- lethargy or malaise
- increased appetite or food cravings
- disrupted sleep
- aches or headaches
- abdominal distention, water retention or weight gain
- breast tenderness
Potential causes include hormonal imbalances, such as estrogen dominance, as well as micronutrient deficiencies or excess levels of inflammation.
Serotonin is also theorized to play a role in premenstrual syndrome (PMS). Other
Hence, drugs within the class of antidepressant drugs known as SSRIs—selective serotonin reuptake inhibitors—are oftentimes prescribed based upon the speculated role of serotonin in the etiology of PMS symptoms.
SSRIs, however, come with a host of deleterious side effects, including potential suicidal and homicidal ideation.
Because St. John's Wort influences serotonergic neurotransmission, its use for PMS has been investigated.
Introducing, St. John Wort
Hypericum perforatum (St John's Wort) is a sprawling, leafy, perennial herb native to Europe, North Africa, and western Asia, the use of which dates back to ancient Greece.
It was used in traditional Greek medicine by Hippocrates, Theophrastus, Dioscorides, and Galen, with diverse applications as a vulnerary (wound healing), diuretic, and as a remedy for neuralgia, whereas American Eclectic physicians used it for hysteria and nervous affections during the 1800s and 1900s.
Today, St. John's Wort is officially recognized in the pharmacopeias of Czechoslovakia, France, Poland, Romania, and Russia, is catalogued in the GermanDrug Codex, and constitutes an approved medicine in the Commission E monographs.
It contains biologically active substances such as the flavonoids rutin, quercetin, and kaempferol as well as active ingredients like hypericin and hyperforin.
St. John's wort influences the serotonergic system, and has been widely used in Europe to treat depression. In fact, in German pediatric populations, St. John's Wort is combined with valerian to treat depression, and is formulated with lavender, lemon balm and passion flower in a sedative tea for children.
"Although additional research is warranted, the modern therapeutic application of SJW for mild to moderate depression is supported by its history of use in traditional medicine, in vitro studies...in vivo experiments in animals...pharmacodynamic studies in humans...pharmacokinetic studies in humans...human clinical studies...meta-analyses...and extensive phytochemical investigations" (American Botanical Council, 2000).
St. John's Wort for PMS
St. John's Wort has likewise been investigated for its effectiveness in ameliorating PMS.
In one randomized, double-blind, placebo-controlled, crossover study published in CNS Drugs, 36 women aged 18-45 years with regular menstrual cycles and mild PMS were administered St. John’s Wort or placebo for 2 menstrual cycles.
They were given 900 mg/day (standardized to 0.18% hypericin; 3.38% hyperforin) and then after a wash out period, were given the alternate treatment.
Symptoms were tallied using the Daily Symptom Report as well as inventories such as the State Anxiety Inventory, Beck Depression Inventory, Aggression Questionnaire and Barratt Impulsiveness Scale.
Although no improvement was found for mood- and pain-related PMS symptoms, researchers concluded that, “Daily treatment with Hypericum perforatum was more effective than placebo treatment for the most common physical and behavioural symptoms associated with PMS” (Canning et al., 2010).
In another study, a double-blind, randomized controlled trial, 30 women suffering from premenstrual symptoms were treated with an extract of St. John’s Wort called hypericin at a dose of 600 mg/day.
They recorded their PMS symptoms throughout 3 menstrual cycles, and took the St. John’s Wort for two months, during the latter two cycles.
Researchers concluded, “The results suggest that SJW [St. John’s Wort] affects emotional lability, hostility or anger, and impulsivity related to premenstrual syndrome in single women” (Ryoo et al., 2010).
Safety & Considerations
According to the Commission E monographs, some evidence has come forth that photosensitization is possible with St. John's Wort, but the amount suggested to generate phototoxic effects are extremely large doses.
Of note, is that St. John’s Wort may decrease the efficacy of contraceptive pills due to its influence on estrogen metabolism. Numerous interactions with other drugs have been observed, as constituents within St. John's Wort have the capacity to induce intestinal or hepatic enzymes that influence drug metabolism.
No herb is a panacea or substitute for addressing the upstream causes of PMS or any other disorder, and taking an isolated supplement in a vacuum--apart from dietary and lifestyle factors aimed at the root cause--is unlikely to be effective.
Consult with a licensed medical provider, preferably a naturopathic physician or licensed functional medicine doctor familiar with a root cause resolution approach, for a comprehensive and customized regimen catered to your personalized needs--and always check with a licensed medical doctor for contraindications before taking any supplement.
American Botanical Council. Herbal Medicine: Expanded Commission E Monographs. St. John's Wort. Retrieved from http://cms.herbalgram.org/expandedE/StJohn27swort.html?ts=1594159509&signature=c8269f40c8bfe387d957719efeac0823
Canning, S. Et al. (2010). The Efficacy of Hypericum Perforatum (St John's Wort) for the Treatment of Premenstrual Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. CNS Drugs, 24(3), 207-225.
Direkvand-Moghadam, A. Et al. (2014). Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. Journal of Clinical & Diagnostic Research, 8(2), 106-109.
Klemow, K.M. et al. (2011). Chapter 11 Medical Attributes of St. John’s Wort (Hypericum perforatum). Retrieved from Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis.
Kwan, I. (2015). Premenstrual syndrome. BMJ Clinical Evidence, 0806.
Ryoo, J-G. Et al. (2010). The Effects of St. John's Wort on Premenstrual Syndrome in Single Women: A Randomized Double-Blind, Placebo-Controlled Study. Clinical Psychopharmacology & Neuroscience, 8(1), 30-37.