Premenstrual syndrome (PMS) is one of the major health issues for childbearing-age women, as both physical and psychological symptoms can affect health and quality of life.1 Epidemiological studies show that 75% of fertile women have mild to moderate symptoms of PMS; 3-8% may present severe symptoms.1 Hormonal dysfunction can impact mood, sleep, and appetite and lead to symptoms such as anxiety, pain, hot flashes, and even memory impairment. How can Functional Medicine practitioners help patients with these concerns?

“There’s no ‘one’ hormone involved in [PMS]—this is a complex dance and interaction between hormones,” says IFM Educator Margaret Christensen, MD. “What we want to do from a functional standpoint is address the actual underlying hormonal imbalances and triggers. Is it high stress hormones? That’s one of the number one contributors to PMS, and it is lack of things like sleep, lack of adequate nutrients like B vitamins and magnesium, which are critically important in hormonal balancing pathways.”

Margaret Christensen, MD, discusses the Functional Medicine approach to balancing female hormones to reduce PMS. A board-certified OB/GYN for 23 years, Dr. Christensen first became interested in Functional Medicine 13 years ago when trying to solve her own health challenges.

There are many treatments for PMS capable of bringing some physical relief, but most come with side-effects. The Functional Medicine approach is to look first toward lifestyle factors, including nutrition.1 Both calcium and magnesium have been shown to help by decreasing pain and alleviating the severity of PMS symptoms.1,2 Studies suggest that magnesium can attenuate anxiety, which is also associated with PMS.2 A 2017 systematic review of the effects of magnesium supplementation on anxiety and stress showed a positive role for magnesium supplementation in women reporting PMS symptoms, both in isolation and when combined with vitamin B6.2

Vitamin D is another nutrient reported to have beneficial effects on PMS. A 2018 study found that vitamin D supplementation was associated with a reduction in the incidence of several symptoms of PMS in adolescent women, such as backaches and fluctuations in mood, as well as a decrement in pain severity.3 A different study found that the combination of a calcium supplement plus vitamin D, together with cognitive behavioral therapy, was beneficial for PMS.4

The Functional Medicine approach to PMS that we use in our office looks at the whole patient through the lens of systems biology and examines the underlying cause of hormonal dysregulation. This is different then simply prescribing birth control or hormones for PMS. Lifestyle factors, including nutrition, are often addressed first to help alleviate symptoms.


  1. Saeedian KA, Amani R, Cheraghian B. The association between the risk of premenstrual syndrome and vitamin D, calcium, and magnesium status among university students: a case control study. Health Promot Perspect. 2015;5(3):225-230. doi:15171/hpp.2015.027.
  2. Boyle NB, Lawton C, Dye L. The effects of magnesium supplementation on subjective anxiety and stress – a systematic review. Nutrients. 2017;9(5):E429. doi:3390/nu9050429.
  3. Bahrami A, Avan A, Sadegihnia HR, et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents [published online February 15, 2018]. Gynecol Endocrinol. doi:1080/09513590.2017.1423466.
  4. Karimi Z, Dehkordi MA, Alipour A, Mohtashami T. Treatment of premenstrual syndrome: appraising the effectiveness of cognitive behavioral therapy in addition to calcium supplement plus vitamin D [published online February 1, 2018]. Psych J. doi:1002/pchj.206.
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