EXECUTIVE SUMMARY
Results of a new study indicate that women with moderate-to-severe premenstrual syndrome had a 40% higher risk of developing high blood pressure over the following 20 years compared to women experiencing few menstrual symptoms.
- Premenstrual syndrome is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. The condition is estimated to affect 20-32% of premenopausal women.
- Psychological Symptoms Associated With Premenstrual Syndrome Might Include Irritability, Depression, Anxiety, Mood Swings, A Flat Mood (Anhedonia), And Lethargy. Physical Symptoms Might Include Breast Tenderness, Weight Gain, Bloating, Muscle Or Joint Pain, Headache, And Swelling Of The Extremities (Hands And Feet).
Results of a new study indicate that women with moderate-to-severe premenstrual syndrome (PMS) had a 40% higher risk of developing high blood pressure during the following 20 years compared to women experiencing few menstrual symptoms.1
Premenstrual syndrome is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. The condition is estimated to affect 20-32% of premenopausal women.2 Psychological symptoms associated with premenstrual syndrome might include irritability, depression, anxiety, mood swings, a flat mood (anhedonia), and lethargy. Physical symptoms might include breast tenderness, weight gain, bloating, muscle or joint pain, headache, and swelling of the extremities (hands and feet).3
To conduct the study, epidemiologist Elizabeth Bertone-Johnson, ScD, and colleagues in the School of Public Health and Health Sciences at the University of Massachusetts Amherst and the Harvard School of Public Health evaluated the relationship between PMS and blood pressure. The study included 1,257 women who developed clinically significant PMS between 1991 and 2005, and in 2,463 age-matched control participants with few menstrual symptoms. All participants were part of the Nurses’ Health Study II, one of the largest, longest running investigations of women’s health, overseen by researchers at Harvard School of Public Health and Brigham and Women’s Hospital in Boston.
Researchers with the current study assessed PMS with a modi-fied Calendar of Premenstrual Experiences, which includes such symptoms as palpitations, nausea, forgetfulness, dizziness, hot flashes, insomnia, depression, acne, and cramping. In their sub-study, scientists followed participants for new diagnoses of hypertension until 2011.
Data indicate that women with PMS had a hazard ratio for hypertension of 1.4 compared to women without PMS, a statistically significant increased risk of 40%. The risk associated with PMS was not impacted by oral contraceptive or antidepressant use; however, the higher risk was not present in women with high intakes of the B vitamins thiamine and riboflavin.
Bertone-Johnson and colleagues recently found that women with high dietary intake of the B vitamins thiamine and riboflavin had 25-35% lower risks of developing PMS.4 Results from the present study are “consistent with these findings, and suggest that improving B vitamin status in women with PMS may both reduce menstrual symptom severity and lower hypertension risk,” researchers note.
During the past 10 years, Bertone-Johnson’s research group has evaluated a variety of behavioral and dietary risk factors for incident PMS. Bertone-Johnson says she has been “struck” by how similar the risk factors her group has identified for PMS are to risk factors for cardiovascular disease (CVD) and hypertension.
“Some of these risk factors include smoking, high body mass index, low vitamin D and calcium intake, low B vitamin intake, and higher levels of inflammatory markers,” notes Bertone-Johnson in an email interview with Contraceptive Technology Update. “The similarities of these risk factors, and potential similarities in the underlying mechanisms contributing to PMS and to CVD, raised the question of whether women with PMS would have higher risk of developing hypertension and CVD in later life (and thus whether PMS might be a sentinel of future CVD risk).”
WHAT ARE OPTIONS?
How can you help women with PMS? If symptoms are mild to moderate, they often can be relieved by changes in lifestyle or diet. When PMS symptoms begin to interfere with daily life, women might decide to seek medical treatment. Treatment will depend on the severity of symptoms; in more severe cases, medication might be indicated.
Regular aerobic exercise, such as brisk walking, running, cycling, and swimming, might help lessen PMS symptoms, thus reducing fatigue and depression. Encourage women to exercise regularly, not just during the days that they have symptoms. A good goal is at least 30 minutes of exercise most days of the week.
Relaxation methods also can help relieve PMS symptoms. Suggest relaxation therapy options such as breathing exercises, meditation, and yoga. Massage therapy also might be helpful. Some women find therapies such as biofeedback and self-hypnosis to be effective. Also discuss sleeping habits. Regular sleeping habits might help lessen moodiness and fatigue.
Simple changes in daily diet habits might help relieve PMS symptoms. Talk about following a diet rich in complex carbohydrates to reduce mood symptoms and food cravings. Complex carbohydrates are found in foods made with whole grains, such as whole wheat bread, pasta, and cereals; other examples include barley, brown rice, beans, and lentils. Suggest adding calcium-rich foods, such as yogurt and leafy green vegetables; counsel on reducing intake of fat, salt, and sugar. Discuss avoiding caffeine and alcohol.
By eating six small meals a day rather than three large ones, or eating slightly less at normal meals and adding three light snacks, women can keep their blood sugar level stable, helping to alleviate symptoms.
Can dietary supplements help? Taking 1,200 mg of calcium a day might help reduce the physical and mood symptoms that are associated with PMS. Use of magnesium supplements might help reduce water retention, breast tenderness, and mood symptoms.5
Providers might suggest use of extended cycles of combined oral contraceptives or the contraceptive vaginal ring, levonorgestrel intrauterine contraception, or the contraceptive injection for lessening dysmenorrhea associated with PMS.6 However, not all might relieve the mood symptoms of PMS. It might be necessary to try more than one of these approaches before finding one that works.
REFERENCES
- Bertone-Johnson ER, Whitcomb BW, Rich-Edwards JW. Premenstrual syndrome and subsequent risk of hypertension in a prospective study. Am J Epidemiol 2015; 182(12):1000-1009.
- Yonkers KA, O’Brien PM, Eriksson E. Premenstrual syndrome. Lancet 2008; 371(9619):1200-1210.
- Marjoribanks J, Brown J, O’Brien PM, et al. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev 2013; 6:CD001396.
- Chocano-Bedoya PO, Manson JE, Hankinson SE, et al. Dietary B vitamin intake and incident premenstrual syndrome. Am J Clin Nutr 2011; 93(5):1080-1086.
- American College of Obstetricians and Gynecologists. Premenstrual syndrome. Accessed at http://bit.ly/1Mf5NLV.
- Nelson AL, Baldwin SB. Menstrual disorders. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
