Premenstrual syndrome is a group of physical and psychological symptoms that recur in the days before menstruation and disappear within a few days of bleeding starting. Up to 90% of women experience at least one premenstrual symptom, but only 20-30% have true premenstrual syndrome, in which symptoms are severe enough to affect work, studies, or relationships. The most severe form, premenstrual dysphoric disorder, affects about 3% of women when diagnosis is confirmed with a symptom diary. If symptoms interfere with work, studies, or relationships, it is time to talk to a doctor.

In this guide, we explain how to recognize and address premenstrual syndrome, what causes it, when to see a doctor, and what current guidelines and research say about lifestyle, treatments, and supplements.

Reading time: 14 minutes

Last updated: October 2026

Scientific review: GP Nutraceuticals Team

Main sources: ACOG 2023 guideline on premenstrual disorders, RCOG Green-top Guideline No. 48, 2024 meta-analysis on PMDD prevalence, and peer-reviewed literature

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Premenstrual syndrome in brief

Premenstrual syndrome (SPM, or PMS in English, premenstrual syndrome) is neither an imaginary disorder nor simply “nervousness”: it is a condition recognized by leading gynecological medical societies. Symptoms occur in the luteal phase, the second half of the menstrual cycle after ovulation, and resolve when menstruation begins.

The causes are not fully understood. Blood tests in women with premenstrual syndrome can be completely normal: what seems to make the difference is increased brain sensitivity to normal fluctuations in estrogen and progesterone. That is why the first step is to recognize and track the condition, then choose the most suitable approach with a doctor, from lifestyle changes to treatment.

Key points

The guide’s central message in six points: premenstrual syndrome is common, can be identified with a diary, and is addressed by starting with lifestyle changes.

• Up to 90% of women experience at least one premenstrual symptom; 20-30% have premenstrual syndrome.
• The more severe form, PMDD, affects about 3% of women with a confirmed diagnosis.
• Symptoms are due to increased sensitivity to normal hormonal fluctuations, not to “wrong” hormones.
• Diagnosis is based on a symptom diary completed daily for at least two cycles.
• Physical activity, cognitive behavioral therapy, and adequate calcium intake are the first recommended interventions.
• Among supplements, calcium, chasteberry, and vitamin B6 have the best evidence; severe cases require medical care.

What you'll find in this guide

The guide begins with the definition and symptoms, moves on to causes and diagnosis, and concludes with lifestyle, treatments, supplements, and answers to frequently asked questions.

• What premenstrual syndrome is and how common it is.
• What the symptoms are and when they occur.
• What causes it.
• How it is diagnosed and when to see a doctor.
• What to do to relieve symptoms.
• What medical treatments are available.
• What studies say about supplements.
• Frequently asked questions.

This guide is for informational and educational purposes only and does not replace the advice of a doctor or other qualified healthcare professional.

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What is premenstrual syndrome, and how common is it?

Premenstrual syndrome is the cyclical occurrence of a range of physical, emotional, and behavioral symptoms during the luteal phase of the cycle, with three characteristics: it recurs from cycle to cycle, resolves within a few days of menstruation starting, and has a tangible impact on daily life. Without this last element, they are simply premenstrual symptoms, which are very common and not in themselves pathological.

According to the 2023 guideline from the American College of Obstetricians and Gynecologists (ACOG), up to 90% of women of reproductive age experience at least one premenstrual symptom, while 20-30% meet the criteria for premenstrual syndrome. Symptoms can begin in the years after menarche and continue until menopause, when ovulatory cycles cease.

What is the difference between premenstrual syndrome and premenstrual dysphoric disorder?

The main difference lies in the intensity of the symptoms and their impact. Premenstrual syndrome is characterized by physical and emotional symptoms that affect daily life; PMDD is dominated by mood symptoms, with marked and sometimes disabling distress.

Premenstrual dysphoric disorder (PMDD, premenstrual dysphoric disorder) is the most severe condition in the premenstrual spectrum and is classified among depressive disorders in the DSM-5 diagnostic manual. It requires at least five symptoms, including at least one mood symptom: marked mood swings, irritability or anger, depressed mood, anxiety or tension. Symptoms must be present during the week before menstruation in most cycles and cause significant distress.

A 2024 meta-analysis of 44 studies and more than 50,000 women estimated a PMDD prevalence of 3,2% when the diagnosis is confirmed with a symptom diary kept for two cycles, and 7.7% when the diagnosis is only provisional. In general population samples with a confirmed diagnosis, the estimate drops to 1.6%: without prospective monitoring, prevalence tends to be overestimated.

Condition	How many women	Typical symptoms	Impact on daily life
Mild premenstrual symptoms	Up to 90%	Bloating, breast tenderness, mild irritability	Minimal or none
Premenstrual syndrome	20-30%	Recurring physical and emotional symptoms	Noticeable impact on work, studies, and relationships
PMDD (dysphoric disorder)	About 2-5% (3.2% with confirmed diagnosis)	At least 5 symptoms, predominantly mood-related	Pronounced, sometimes disabling

There is also premenstrual exacerbation: a worsening of an existing condition during the premenstrual phase, such as depression, anxiety, migraine, or irritable bowel syndrome. In this case, symptoms do not go away after the period, and management focuses mainly on the underlying condition.

What are the symptoms of premenstrual syndrome?

PMS can cause many different symptoms, but the most common fall into two groups: physical symptoms and psychological or behavioral symptoms. Each woman has her own range of symptoms, which tend to recur in a similar way from one cycle to the next.

Physical symptoms of PMS

• Abdominal bloating and a feeling of water retention.
• Breast tenderness and pain (mastalgia).
• Headaches or migraines.
• Muscle and joint pain, back pain.
• Fatigue and low energy.
• Increased appetite and cravings for sweets.
• Slight weight gain, acne, digestive problems.

Psychological and behavioral symptoms of PMS

• Irritability and outbursts of anger.
• Mood swings and crying easily.
• Anxiety, tension, feeling overwhelmed.
• Low mood and reduced interest in usual activities.
• Difficulty concentrating.
• Sleep problems: insomnia or, conversely, needing to sleep more.
• A tendency to withdraw from others.

When do symptoms occur during the menstrual cycle?

Symptoms usually appear in the week before your period, sometimes as early as ovulation, up to two weeks beforehand. They peak in the last few days before bleeding begins and ease within the first few days of your period. A symptom-free week after your period ends is typical: if symptoms last all month, they are likely caused by something else.

With PMDD, symptoms can be very intense, especially mood symptoms. If thoughts of self-harm occur in the days before your period, it is important to seek help immediately from your doctor or emergency services.

What causes premenstrual syndrome?

Premenstrual syndrome results from an abnormal response to normal hormone levels. The ovulatory cycle is the trigger: symptoms do not occur before menarche, during pregnancy, or after menopause, and disappear when ovulation is suppressed with medication.

Hormones and estrogen in the luteal phase: a different sensitivity

In a study published in the New England Journal of Medicine, pharmacological suppression of the menstrual cycle eliminated symptoms in women with premenstrual syndrome. Reintroducing estradiol or progesterone made them recur, but only in these women and not in others. The problem is therefore not the amount of hormones, but the way the brain reacts to their fluctuations.

Allopregnanolone, a progesterone metabolite that acts on GABA receptors, which are also involved in anxiety regulation, seems to play a central role. In predisposed women, its fluctuations in the second half of the cycle can have a paradoxical effect, causing irritability and tension instead of the usual calming effect.

Serotonin and mood

Serotonin, the neurotransmitter that regulates mood, appetite and sleep, is also involved. Estrogen modulates its activity, and medications that increase serotonin levels (SSRIs) improve symptoms within days, much more quickly than they do in depression.

PMS risk factors

Twin studies indicate a hereditary component in the development of premenstrual syndrome. Other factors associated with a higher risk of premenstrual syndrome include:

• chronic stress and traumatic experiences;
• personal history of anxiety or depression;
• cigarette smoking;
• overweight and obesity;
• a diet low in calcium and vitamin D, according to data from large observational studies;
• alcohol consumption, especially heavy drinking.

These are associations, not proven causes, but many of these factors can be modified.

Diagnosing premenstrual syndrome: how is it done, and when should you see a doctor?

There is no blood test that can diagnose premenstrual syndrome: diagnosis is based on a symptom diary completed every day for at least two consecutive cycles, as recommended by both ACOG and the Royal College of Obstetricians and Gynaecologists (RCOG). The diary shows whether symptoms are indeed concentrated in the luteal phase and whether there is a symptom-free week after menstrual flow.

How to keep a symptom diary

Simply note each evening which symptoms occur and how severe they are, for example on a scale of 1 to 6, along with the days of menstrual flow. Validated questionnaires are available, such as the Daily Record of Severity of Problems, as are many period-tracking apps. Recalling symptoms after the fact, on the other hand, often leads to overestimating them or confusing them with symptoms that are present all month.

Which conditions should be ruled out?

The doctor assesses whether the symptoms could be due to or worsened by other conditions: depression and anxiety disorders, thyroid disorders, anemia, endometriosis, migraine, irritable bowel syndrome and, after age 40, perimenopause. Blood tests can help rule out these causes; measuring sex hormone levels is not useful for diagnosis.

When to talk to your doctor

• Symptoms interfere with work, study, relationships, or social life.
• Mood symptoms are severe: deep sadness, marked anxiety, anger that is difficult to control.
• There is no improvement after two or three cycles of lifestyle changes.
• The problems do not go away after menstruation or appear for the first time after age 40.
• Thoughts of self-harm occur: in this case, seek help immediately.

Managing premenstrual syndrome: what can you do to ease the symptoms?

For mild to moderate symptoms, the first step is lifestyle changes, supplemented when needed by targeted psychological support. These interventions are safe, low-cost, and recommended by guidelines, although the available studies are often small.

Regular physical activity

A meta-analysis of 15 randomized studies found that exercise programs lasting at least eight weeks reduce overall physical and psychological symptoms. However, the quality of the studies is low, and ACOG makes a conditional recommendation. Brisk walking, running, swimming, yoga, and Pilates practiced at least three times a week are the activities studied most often.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is the non-drug intervention with the strongest recommendation in the ACOG guidelines. It includes information about the disorder, relaxation techniques, stress management, and working on thoughts that amplify distress. It is especially useful when emotional symptoms predominate.

Diet and PMS: what to eat

There is no specific diet supported by strong evidence, but some guidelines may help ease symptoms and are consistent with a healthy diet:

• ensure a good intake of calcium from milk, yogurt, cheese, leafy green vegetables, and calcium-rich water;
• choose regular meals with whole grains, legumes, fruit, and vegetables;
• limit salt, simple sugars, alcohol, and coffee, especially in the days before your period, when they can worsen bloating, irritability, and sleep;
• maintain a healthy weight, as being overweight is associated with more frequent symptoms.

Sleep and stress management

Regular sleep schedules and relaxation techniques, such as breathing exercises, mindfulness, or yoga, help ease many symptoms associated with tension and irritability. Keeping a symptom diary is also useful: knowing when the most difficult days are coming allows you to plan ahead, manage symptoms, and reduce the most stressful commitments.

Treating premenstrual syndrome: what medical therapies are available?

When symptoms are moderate or severe, or lifestyle changes are not enough, a doctor may suggest drug treatment. The options with the best evidence are two types: SSRI antidepressants and some birth control pills. The choice depends on the main symptoms, whether the woman wants contraception, and her health profile.

• SSRIs (selective serotonin reuptake inhibitors). They are the first-line treatment for severe cases and PMDD, with a strong recommendation in the ACOG guideline. A Cochrane review of 31 studies confirms their effectiveness, both when taken continuously and only during the second half of the cycle. The most common side effects are nausea and fatigue, and they depend on the dose.
• Combined oral contraceptives. By suppressing ovulation, they reduce hormonal fluctuations. The evidence mainly concerns formulations containing drospirenone and ethinylestradiol 20 µg, which, according to the 2023 Cochrane review, may improve PMDD symptoms, with a small to moderate effect.
• Other options. Anti-inflammatory drugs to treat painful symptoms and, in severe cases that do not respond to other treatments, GnRH analogues under specialist supervision.

Any drug treatment must be prescribed and monitored by a doctor, who assesses its benefits, contraindications, and interactions.

Natural remedies and supplements: what works for premenstrual syndrome?

Among the nutrients studied, calcium has the most consistent evidence, followed by chaste tree and vitamin B6. Evidence for the others is weak or absent. Overall, studies are small and vary in quality: a 2024 systematic review of 31 randomized studies found only one at low risk of bias.

Scientific evidence and regulatory claims are two different things. A claim permitted on a label describes a physiological function recognized by an authority and does not prove that a product treats premenstrual syndrome. Likewise, a favorable study alone does not authorize a claim.

Remedies for premenstrual syndrome: what the studies suggest

Nutrient or herb	Doses in studies	What the studies say	Quality of evidence
Calcium	1000-1200 mg per day	In a study of 466 women, symptoms decreased by 48% with calcium and 30% with placebo by the third cycle. A 2025 meta-analysis confirms the benefit. ACOG recommends it conditionally	Moderate
Chaste tree (Vitex agnus-castus)	Standardized dry extracts, 20-40 mg per day	In the most frequently cited study, published in the BMJ, 52% of women had their symptoms cut in half, compared with 24% taking a placebo. The EMA recognizes a dry extract as having well-established medicinal use; ACOG says more studies are needed	Moderate-low
Vitamin B6	50-100 mg per day	A review of 9 studies involving 940 women suggests a probable benefit, but the studies are low quality	Low
Zinc	30-50 mg per day	A 2025 meta-analysis of 4 studies found a small to moderate effect on overall and emotional symptoms	Moderate-low
Vitamin D	High doses in women with a deficiency	Benefits observed mainly in women with a deficiency; no clear effect in others	Very low
Magnesium	200-360 mg per day	Inconsistent results; a possible effect on water retention and, together with B6, on anxiety symptoms	Low
Saffron	Extract, 30 mg per day	A randomized study of around 50 women found an improvement compared with placebo	Low
Omega-3	1-2 g per day	One positive randomized study, with a greater effect at 2 g	Low
Evening primrose oil	1500 mg per day	No evidence of benefit	Not available

For other ingredients found in many menstrual supplements, such as rhodiola, low-dose tryptophan, birch, or bromelain, there are no specific studies on premenstrual syndrome.

Why doses matter

The effects observed in studies apply to the doses studied. Vitamin B6 is one example: studies have used 50-100 mg per day, but in 2023 the European Food Safety Authority (EFSA) set the maximum safe intake for adults at 12 mg per day, due to the risk of peripheral neuropathy with prolonged use. High doses of B6 or zinc should therefore be taken only on a doctor’s advice.

What a supplement can claim

In the European Union, no authorized claim applies to premenstrual syndrome as such: a supplement cannot claim to treat or prevent it. However, Regulation (EU) 432/2012 permits some functional claims that can help guide you:

• vitamin B6 contributes to the regulation of hormonal activity;
• magnesium, vitamin B6, and vitamin B12 contribute to normal psychological function and the normal functioning of the nervous system;
• Magnesium, vitamin C, B6, and B12 contribute to the reduction of tiredness and fatigue;
• calcium contributes to normal muscle function and normal neurotransmission;
• vitamin E, selenium, and zinc contribute to the protection of cells from oxidative stress.

For botanicals, Italy recognizes the physiological effects listed in the Ministry’s botanicals register. For saffron, for example, the approved claims are “normal mood” and “counteracting menstrual cycle disorders.” These refer to physiological functions, not treatment.

Frequently asked questions about premenstrual syndrome

Brief answers to the questions women ask most often, from how long symptoms last to supplements.

How many days before a menstrual period do premenstrual symptoms begin?

Usually in the days before your period, especially during the last week, and sometimes as early as ovulation, which is up to two weeks beforehand. Symptoms ease within the first few days of your period.

Is premenstrual syndrome normal?

Having a few mild premenstrual symptoms is very common and is not an illness. It is considered premenstrual syndrome when symptoms recur every cycle and interfere with daily life: in this case, it’s worth talking to your doctor.

How can you distinguish premenstrual symptoms from pregnancy symptoms?

Some symptoms, such as breast tenderness, fatigue, and bloating, can occur in both cases. The most reliable sign is a late period: if in doubt, a pregnancy test taken from the first day of the missed period can clarify the situation.

What’s the difference between premenstrual syndrome and menstrual pain?

Premenstrual syndrome occurs before your period and goes away when bleeding starts. Menstrual pain (dysmenorrhea), on the other hand, occurs during your period and is caused by uterine contractions. The two conditions can coexist.

Does premenstrual syndrome get worse with age?

Many women report more intense symptoms between the ages of 30 and 40 and during perimenopause, when cycles become more irregular. With menopause, in the absence of ovulatory cycles, premenstrual syndrome disappears.

Does the birth control pill help?

Some combined oral contraceptives, particularly those containing drospirenone, may reduce symptoms in more severe cases because they suppress ovulation. The choice should be made with a gynecologist, taking contraindications and individual risks into account.

What should you eat when you have premenstrual syndrome?

A varied diet with good sources of calcium, whole grains, legumes, fruit, and vegetables, while limiting salt, sugar, alcohol, and coffee in the days before your period. There is no specific diet backed by strong evidence, but these choices may help reduce PMS symptoms linked to bloating and energy fluctuations.

How does alcohol affect the menstrual cycle and premenstrual syndrome?

Alcohol does not cause premenstrual syndrome, but it is associated with more frequent symptoms. A meta-analysis of 19 observational studies estimated a 45% higher risk among those who drink and a 79% higher risk with heavy consumption. It can also worsen sleep and mood: cutting back, especially in the second half of the cycle, is a simple and safe measure.

How long does it take for a supplement to work?

In studies, nutrients were assessed for at least two or three consecutive cycles. So, to judge whether an approach works, it’s helpful to keep a symptom diary for a few months and compare the scores.

Can chasteberry be taken with the pill or during pregnancy?

Chasteberry acts on the axis that regulates prolactin and may interact with contraceptives and dopaminergic medications. It should not be taken during pregnancy or breastfeeding and, if you use the pill or other medications, it is best to ask your doctor or pharmacist first.

When is premenstrual syndrome severe?

When severe symptoms occur, especially mood symptoms that impair work, study, or relationships, it may be premenstrual dysphoric disorder (PMDD). This is a recognized and treatable condition: the first step is to keep a symptom diary to show your doctor.

In summary: symptoms, causes, and remedies

Premenstrual syndrome is common, real, and treatable. It arises from individual sensitivity to normal cycle variations and can be identified by keeping a symptom diary for at least two cycles.

For mild and moderate cases, the first step is lifestyle: regular physical activity, a calcium-rich diet, sleep, and stress management, with cognitive behavioral therapy when psychological symptoms predominate. Among nutrients, calcium, chasteberry, and vitamin B6 have the strongest evidence, always at the studied doses. Severe cases, such as PMDD, require medical care because effective treatments are available.

The GP Nutraceuticals nutraceutical approach

A supplement does not replace medical evaluation or the treatments recommended for moderate and severe cases. However, it can complement a healthy lifestyle with nutrients that have recognized physiological functions.

SinPrem® is a food supplement in sachets that combines magnesium, vitamins B6, B12, C, D, and E, zinc, selenium, and L-tryptophan with extracts of chasteberry, saffron, rhodiola, and birch, along with bromelain. Vitamin B6 is present at the nutritional dose of 1.4 mg, well below the safety limit set by EFSA.

Among the authorized claims for its components:

• Vitamin B6 contributes to the regulation of hormonal activity;
• Magnesium, vitamin B6, and vitamin B12 contribute to normal psychological function and the normal functioning of the nervous system;
• Magnesium, vitamin C, B6, and B12 contribute to the reduction of tiredness and fatigue;
• Saffron promotes normal mood and helps counter menstrual cycle disorders;
• Birch promotes the drainage of body fluids;
• Vitamin E and selenium contribute to the protection of cells from oxidative stress.

Due to the presence of chasteberry, if you are taking the contraceptive pill or other medications, or are pregnant or breastfeeding, you should consult your doctor or pharmacist. Do not use if you have liver dysfunction or disease.

Scientific sources and references

This guide was prepared based on the main international guidelines and peer-reviewed scientific literature available at the time of the update.

Guidelines and official documents

1. American College of Obstetricians and Gynecologists. Management of Premenstrual Disorders. Clinical Practice Guideline No. 7. Obstet Gynecol. 2023. acog.org
2. Royal College of Obstetricians and Gynaecologists. Management of Premenstrual Syndrome. Green-top Guideline No. 48. BJOG. 2017;124(3):e73-e105. PMID: 27900828
3. European Medicines Agency, Committee on Herbal Medicinal Products. Agni casti fructus – herbal medicinal product. ema.europa.eu
4. EFSA Panel on Nutrition, Novel Foods and Food Allergens. Scientific opinion on the tolerable upper intake level for vitamin B6. EFSA Journal. 2023;21(5):8006. PMC10189633

Epidemiology and causes

5. Reilly TJ, et al. The prevalence of premenstrual dysphoric disorder: systematic review and meta-analysis. J Affect Disord. 2024;349:534-540. PMID: 38199397
6. Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338(4):209-216. PMID: 9435325
7. Fernández MDM, Saulyte J, Inskip HM, Takkouche B. Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis. BMJ Open. 2018;8(3):e019490. PMID: 29661913

Lifestyle and therapies

8. Pearce E, Jolly K, Jones LL, et al. Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials. BJGP Open. 2020;4(3). PMID: 32522750
9. Marjoribanks J, Brown J, O'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013;(6):CD001396. PMID: 23744611
10. Ma S, Song SJ. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev. 2023;(6):CD006586. PMID: 37365881

Nutrients and supplements

11. Robinson J, Ferreira A, Iacovou M, Kellow NJ. Effect of nutritional interventions on the psychological symptoms of premenstrual syndrome in women of reproductive age: a systematic review of randomized controlled trials. Nutr Rev. 2024. PMID: 38684926
12. Whelan AM, Jurgens TM, Naylor H. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol. 2009. PMID: 19923637
13. 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. PMID: 9731851
14. Yildirim Bayraktar BN, Ilcioglu K, Demirhan Kayacik A. The effect of calcium on premenstrual syndrome: a meta-analysis study. J Clin Med Kaz. 2025. doi:10.23950/jcmk/15827
15. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. 2001;322(7279):134-137. PMID: 11159568
16. Csupor D, Lantos T, Hegyi P, et al. Vitex agnus-castus in premenstrual syndrome: a meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 2019. PMID: 31780016
17. 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. PMID: 28237870
18. Wyatt KM, Dimmock PW, Jones PW, O'Brien PMS. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999;318(7195):1375-1381. PMID: 10334745
19. Kim YM, Baek J. Effect of zinc supplementation on premenstrual symptoms: a systematic review and meta-analysis. Women Health. 2025. PMID: 40737185
20. Zainab A, Tageldin R, Patel R, et al. Efficacy of vitamin D supplementation to alleviate premenstrual syndrome symptoms: a systematic review and meta-analysis of randomized controlled trials. J Clin Med. 2026;15(12):4828. PMID: 42355996
21. Walker AF, De Souza MC, Vickers MF, et al. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998;7(9):1157. PMID: 9861593
22. De Souza MC, Walker AF, Robinson PA, Bolland K. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms. J Womens Health Gend Based Med. 2000. PMID: 10746516
23. Agha-Hosseini M, Kashani L, Aleyaseen A, et al. Crocus sativus L. (saffron) in the treatment of premenstrual syndrome: a double-blind, randomised and placebo-controlled trial. BJOG. 2008;115(4):515-519. PMID: 18271889
24. Rocha Filho EA, Lima JC, Pinho Neto JS, Montarroyos U. Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reprod Health. 2011;8:2. PMID: 21241460

Regulatory references

25. Commission Regulation (EU) No 432/2012 establishing a list of permitted health claims made on foods. eur-lex.europa.eu
26. Ministry of Health. Regulation of the use of substances and herbal preparations in food supplements, Ministerial Decree of 10 August 2018, as subsequently amended (Annex 1).

Update history

We update this guide when new guidelines or relevant studies are published.

Version 1.0 – October 2026

First published. Main sources: 2023 ACOG guideline, RCOG Green-top Guideline No. 48, a 2024 meta-analysis on the prevalence of premenstrual dysphoric disorder, and 2024-2026 systematic reviews on calcium, chasteberry, vitamin B6, zinc, and vitamin D.