Written by Nandan Roongta, Medical Expert and Gynecologist
Premenstrual syndrome (PMS) is defined as the occurrence of cyclic physical and behavioral symptoms that appear in the days preceding menses and interfere with work or lifestyle, followed by a symptom-free interval.
To be classified as PMS, symptoms must be relieved by the onset of, or during menstruation. Indeed a symptom free week after menstruation is necessary for differential diagnosis from other gynecological or psychiatric disorders. It is a common disorder of menstruating women, which can cause stress in familial relationships, strained inter-personal relationships, and abnormalities in functioning and daily work. These result in direct and indirect economic burden for the society.
The large number of symptoms described in association with this condition, make accurate diagnosis of the condition somewhat difficult. The different symptoms have been categorized by American Clinician and researcher Guy Abraham, into four main categories, i.e. symptoms related to Anxiety, Water retention, Food Cravings and Depression. The symptoms of the first category (Anxiety, irritability, mood swings and nervous tension) are generally the first to present clinically. He contended that each category may exist alone or in combination with other categories. The diagnosis rests primarily on the collection of objective evidence (A menstrual diary or menstrual questionnaire), indicating that the patients symptoms are clearly cyclic, over an interval spanning at least three consecutive menstrual cycles.
Magnesium role in PMS
Magnesium is the fourth most abundant mineral found in the human body and is essential to good health. It has been implied in several important functions such as enzyme activity, DNA and protein synthesis, and neuromuscular excitability. Enzyme activity is required for digestion, absorption of nutrients and cellular mechanisms. DNA and proteins are building blocks for the tissues in our body. Neuromuscular functions relate to nerve and muscle interaction, required for movement and performing daily tasks. Approximately 99% of the total body magnesium is stored intracellular, predominantly in bones, muscles, and soft tissues.
A number of physiological and pathological conditions may cause a deficiency of magnesium, defined as hypomagnesaemia or low Magnesium levels in the blood. Severe magnesium deficiency is characterized by a progressive muscle weakness; failure to thrive or poor health and nutrition; neuromuscular dysfunction or difficulty in ordinary movements and tasks; tachycardia or irritated heart muscle activity. Symptoms of marginal deficiency are more subtle, and the condition may be asymptomatic in some. It has been reported, however, that low magnesium status has been associated with chronic inflammatory stress conditions. Magnesium levels noted in blood samples do not seem to correlate with symptoms.
A growing amount of evidence suggests that magnesium deficiency may play an important role in premenstrual syndrome, as also in several other conditions affecting women's health. Studies have found that intracellular magnesium concentrations are lower in women with PMS than in asymptomatic women. Though further studies are yet needed, most thus far have highlighted a positive correlation between magnesium supplementation and relief or prevention of the PMS symptoms.
Diet and PMS
Various reports, many of a preliminary nature, suggest that women suffering from PMS consume more sugar, refined carbohydrates and dairy products, and less fiber, B-complex vitamins, iron, zinc and magnesium, than normal women. The Dietary Reference Intake for magnesium for adults is 310–420 mg/d; magnesium intake is often below these recommendations, particularly as people age. Most Western diets high in refined cereals lack magnesium. Decreased intake, absorption or an increased renal excretion in PMS may lead to a reduced stores of magnesium in the body.
Although magnesium content is high in unrefined whole grains and dark, leafy green vegetables like spinach, nuts, legumes, magnesium is also high in white vegetables such as white potatoes. However, the intestinal absorption from these sources varies greatly between individuals.
How is Magnesium effective in PMS
Magnesium has a sedative effect on neuromuscular excitability. Nerves and muscles interact or communicate by generating electric currents. The electric currents are generated by their respective membranes. Magnesium reduces the strength and the speed of generation of these electric impulses, thereby reducing the 'excitability' of nerves and muscles. Thus the ensuing symptoms of irritability, tension headaches, hypertension and neuromuscular effects are alleviated.
Decreased magnesium levels may promote an increase in the hormone aldosterone, which causes a further increase in excretion of important minerals like magnesium and an increase in sodium levels. This leads to water retention as found in some cases of PMS.
Also, deficient magnesium levels decrease blood glucose control, by decreasing liver metabolism of glucose and increasing insulin release in response to blood glucose. Hence, changes in appetite and craving, both common PMS symptoms may be closely linked to magnesium deficiency.
Even the decreased brain dopamine (The "happy neurotransmitter") levels, postulated to be responsible for anxiety and irritability of PMS, may be exacerbated by magnesium deficiency.
Moreover, it acts as an enzyme cofactor in many reactions in the body, either alone or with other cofactors like vitamin B6, zinc, niacin and vitamin C. Cofactors act with enzymes to accelerate the chemical reactions in the body. Magnesium also helps maintain electrolyte balance and the action of calcium at the cellular level, thus directly or indirectly contributing to the prevention of PMS symptoms.
Effects of supplementation in PMS
Though further studies are indicated, studies thus far have found that magnesium therapy for PMS, given alone or in combination with vitamin B6, is beneficial particularly for fluid retention and mood changes. The supplementation has to be given for at least three months for an effect to be seen. Oral magnesium therapy is generally considered safe at doses up to 483 mg/d in healthy adults but should be avoided among those with serious heart and kidney disease.
An alternative and effective method of perhaps attaining recommended magnesium intakes might be through topical application. This would potentially avoid the adverse effects associated with systemic administration, via the oral route. Current formulations include magnesium oils, transdermal creams, and sprays, from which the magnesium may be absorbed across the skin and into the systemic circulation. Metals in their ionic form are known to be able to cross the skin more effectively than the organic molecules and are the preferred form in topical preparations.
Magnesium and the Premenstrual syndrome
~ Written by Nandan Roongta, Medical Expert and Gynecologist