This protocol was developed for practitioners using Fullscript in the United States and the templates cannot be applied to accounts operating outside of the United States

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through D-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study
D
Non-RDBPC human or In-vivo animal trials
 

Introduction

Whole person care is a person-centered approach to medicine. It goes beyond treating symptoms or isolated conditions, focusing on the interconnectedness of bodily systems and addressing a wide range of factors. These include biological makeup, behavioral habits, environmental factors, and a patient’s personal beliefs, values, and goals. By tailoring care to align with these unique aspects, healthcare providers can create highly personalized patient plans that address not only physical health but also emotional and mental well-being.

This protocol aims to provide healthcare providers with practical suggestions for labs, supplements, and lifestyle strategies, helping them design personalized, whole person care plans for patients looking to support a healthy menstrual cycle and address the symptoms of premenstrual syndrome (PMS). 

Advanced lab testing may help identify the root causes of menstrual irregularities and PMS symptoms. By evaluating hormone levels, micronutrient status, and the gut microbiome, providers can uncover imbalances that contribute to cyclical symptoms and tailor interventions accordingly.

Estrogen dominance, progesterone deficiency, and stress-related cortisol patterns can impact the menstrual cycle and contribute to conditions like PMS, irregular cycles, and infertility. (Ford 2012)(Huang 2015)(Noviyanti 2021) Assessing these patterns across the menstrual cycle helps inform more targeted interventions.

The estrobolome consists of gut bacterial genes that regulate estrogen metabolism by producing enzymes that deconjugate estrogens, affecting their bioavailability and circulating levels. (Kumari 2024) This process influences hormonal balance and is linked to estrogen-related health conditions. (Baker 2017) Some women with premenstrual disorders have lower levels of beneficial bacteria, suggesting that changes in gut microbiota may exacerbate PMS symptoms by altering estrogen metabolism and inflammation. (Takeda 2022)(Nabeh 2023) 

Nutrient deficiencies can disrupt physiological and biochemical processes that influence mood, behavior, and physical symptoms. Some individuals with PMS may be deficient in certain nutrients—particularly calcium, magnesium, and vitamin D. (Saeedian Kia 2015) Research shows that replenishing these nutrients through nutritional therapy can lead to positive clinical outcomes. (Siminiuc 2023) 

The results of testing enable a personalized treatment approach that targets the underlying factors contributing to menstrual issues and PMS rather than simply managing symptoms with a one-size-fits-all strategy.

Evidence-based supplements support menstrual health by promoting balanced cyclical hormone patterns for a regular, symptom-free cycle. Botanical and dietary supplements help regulate hormone synthesis, metabolism, and elimination, fostering hormonal harmony. 

Lifestyle modifications should be considered first-line interventions for supporting women’s hormones and a healthy menstrual cycle. Diet, exercise, stress, and sleep directly impact the endocrine system and can contribute to PMS symptoms. (Cheng 2013) Optimizing these factors helps achieve and maintain hormonal balance, reducing the need for long-term reliance on supplements to manage symptoms.

This flexible approach ensures a personalized and comprehensive care plan for optimal results.

How to use this protocol

This protocol offers guidance to help healthcare providers integrate labs, supplements, and lifestyle recommendations into their patient care plans. Start by assessing the patient’s unique needs, goals, and health status. Use the labs section to identify potential areas of focus, such as biomarkers for estrogen dominance or nutrient deficiencies. Finally, incorporate evidence-based supplements and lifestyle strategies to address specific needs and preferences and enhance health outcomes.

Precision Analytical DUTCH Cycle Mapping Plus

Diagnostic Solutions Laboratory GI-MAP

Genova Diagnostics NutrEval FMV

Ingredients

Saffron (Crocus sativus)

Dosing: 15 mg twice daily for two menstrual cycles (Agha-Hosseini 2008)(Rajabi 2020) 

Supporting evidence:

  • In a double-blind, randomized, placebo-controlled trial, 50 women aged 20–45 who had experienced PMS symptoms for at least six months were given either saffron or a placebo for two menstrual cycles. Saffron effectively relieved PMS symptoms in 76% of women, as demonstrated by significant improvements in the Daily Symptom Report and Hamilton Depression Rating Scale scores. (Agha-Hosseini 2008) 
  • In a randomized clinical trial, 164 women were assigned to receive saffron or fluoxetine once daily on days 14–28 of the menstrual cycle for two months. Saffron was as effective as fluoxetine in reducing abdominal bloating, depression, and mood swings and more effective in relieving breast and abdominal pain. (Nemat-Shahi 2020)
  • A clinical study in patients with premenstrual dysphoric disorder (PMDD), a severe form of PMS, found that taking saffron twice daily for the 14 days before menstruation resulted in a reduction in patient-reported PMDD symptom severity compared to a placebo. While saffron was less effective than fluoxetine in relieving symptoms, it was associated with fewer adverse effects. (Rajabi 2020) 

Adverse effects:

Although rare and typically mild, saffron may cause side effects such as appetite changes, gastrointestinal symptoms, insomnia, headache, and increased menstrual bleeding. (Agha-Hosseini 2008)(Rajabi 2020)

Chaste Tree (Vitex agnus-castus)

Dosing: Minimum of 20 mg of dried fruit extract daily for three consecutive menstrual cycles (Berger 2000) 

Supporting evidence:

  • Vitex agnus-castus (VAC) acts on the hypothalamic-pituitary-gonadal axis to stimulate the release of luteinizing hormone (LH) from the pituitary gland, which in turn enhances progesterone production in the ovaries. (Webster 2010) Low luteal phase progesterone levels have been associated with increased severity of PMS symptoms. (Roomruangwong 2019)(Turner 2024)
  • A systematic review and meta-analysis of 14 studies concluded that VAC was more effective than magnesium, pyroxidine, St. John’s wort, and vitamin E at improving PMS-related symptoms. Additionally, VAC was as effective as conventional treatment options fluoxetine and oral contraceptive pills with a lower risk of side effects. (Verkaik 2017)
  • In a randomized, double-blind, placebo-controlled study, 170 women with PMS were assigned to take VAC extract or placebo daily for three menstrual cycles. At the end of the trial, 52% of women who took VAC reported significant improvement in symptoms, including irritability, headache, breast fullness, and bloating, compared to 24% in the placebo group. (Schellenberg 2001)
  • In a prospective, open-label study, 69 Japanese women took VAC extract daily for three consecutive menstrual cycles. Symptom improvement was observed as early as the first cycle, and by the end of the third menstrual cycle, 91% of participants experienced complete resolution or only mild PMS symptoms. (Momoeda 2014) 

Adverse effects

  • Adverse events associated with VAC treatment were generally mild and occurred at similar rates to those reported with placebo. Reported side effects included acne, abscesses, intermenstrual bleeding, urticaria, and hypersensitivity. (Momoeda 2014) (Schellenberg 2001)(Verkaik 2017)

Vitamin B6

Dosing: 50–100 mg 1–2 times daily for at least three menstrual cycles (Wyatt 1999) 

Supporting evidence:

  • Vitamin B6 (pyridoxine) acts as a cofactor in the conversion of tryptophan to serotonin, which may help increase serotonin concentrations that are often low in individuals with PMS. (Rapkin 1987)(Eriksson 1999)(Kemper 2007)
  • A meta-analysis of randomized, double-blind, placebo-controlled trials found that vitamin B6 may be effective in reducing both overall premenstrual symptoms and depressive symptoms associated with PMS. However, the included studies were generally of poor methodological quality. (Wyatt 2000) 
  • A systematic review of nine randomized, placebo-controlled trials involving 940 women with PMS found that patients taking vitamin B6 were more than twice as likely to see an overall improvement in premenstrual symptoms and about 1.7 times more likely to experience a reduction in depressive symptoms compared to placebo. (Wyatt 1999)
  • Despite the limited number of studies—particularly recent high-quality trials—the American Family Physician notes that, due to its low cost, accessibility, and minimal toxicity at doses below 200 mg, providers may consider recommending 100 mg of vitamin B6 daily as a conservative first-line option before turning to more established treatments like selective serotonin reuptake inhibitors (SSRIs). (AAFP 2000)

Magnesium

Dosing: Minimum of 200 mg every day during the luteal phase of the menstrual cycle for 2–3 months (Facchinetti 1991)(Walker 1998)(Quaranta 2012)

Supporting evidence:

  • PMS and magnesium deficiency share symptoms, including depression, muscle cramps, and fatigue. (Ayuk 2014)(Barbagallo 2021) 
  • Some women with PMS have significantly lower red blood cell magnesium levels, which are further depleted by luteal phase hormonal fluctuations, contributing to symptoms like headache, bloating, and swelling. (Li 2001)(Facchinetti 1991)
  • 41 women aged 18–45 with regular menstrual cycles and PMS were given a patented time-release magnesium from day 20 of their cycle to menstruation for three cycles. At the end of the trial, PMS severity improved by 35%, as assessed by the Moos’ Modified Menstrual Distress Questionnaire. (Quaranta 2012)
  • One study found that magnesium combined with vitamin B6 had a synergistic effect in reducing premenstrual symptoms. Women with PMS were divided into three groups: one receiving magnesium, another receiving magnesium with vitamin B6, and a third given a placebo. After two menstrual cycles, all groups showed reduced PMS symptoms, with the greatest improvement observed in the magnesium plus vitamin B6 group. (Fathizadeh 2010)
  • Two older, yet still notable, randomized, double-blind, placebo-controlled trials suggest magnesium may help alleviate PMS symptoms. In one study, women who took magnesium pyrrolidone carboxylic acid from mid-cycle to menstruation experienced significant improvements in mood-related symptoms. (Facchinetti 1991) In another crossover trial using magnesium oxide, participants reported reduced physical symptoms such as bloating, breast tenderness, swelling, and weight gain during the second month of supplementation. (Walker 1998)

Vitamin D

Dosing: Varies depending on age and vitamin D status

  • Adolescents who are vitamin D-deficient should take 2,000 IU of vitamin D3 daily for at least six weeks until levels are repleted, followed by maintenance therapy of 600–1,000 IU daily.
  • Adults with vitamin D deficiency should take 50,000 IU of vitamin D3 once weekly for at least eight weeks until serum levels normalize, followed by maintenance therapy of 1,500–2,000 IU daily. (Holick 2011) 

Supporting evidence:

  • A cross-sectional study of 998 women found that inadequate vitamin D status (<20 ng/mL, <50 nmol/l) was associated with an increased risk of experiencing PMS symptoms, including cramps, fatigue, and anxiety, ranging in severity. (Jarosz 2019)
  • In this study, 897 adolescent girls received 50,000 IU of vitamin D3 every week for nine weeks. At the end of the trial, the prevalence of PMS decreased from 14.9% to 4.8%, and dysmenorrhea decreased slightly from 35.9% to 32.4%. (Bahrami 2018)
  • In a randomized controlled trial, 158 adolescents with severe cognitive and emotional PMS symptoms and vitamin D deficiency were assigned to receive either vitamin D therapy or a placebo. The treatment group received an initial high dose of vitamin D, followed by repeat doses every two weeks for four months. By the end of the first month, vitamin D levels normalized and remained stable throughout the study. At the trial’s conclusion, significant improvements in PMS symptom scores, including anxiety (51 to 20), irritability (130 to 70), crying (41 to 30), and sadness (51 to 31), were reported in the treatment group, with no such improvements seen in the placebo group. (Tartagni 2016)

Lifestyle Recommendations

Nutrition

  • Diets high in animal fats, sugar, salt, processed foods, fried foods, and refined carbohydrates are associated with an increased risk of developing PMS symptoms. (Oboza 2024)
  • Conversely, the Mediterranean diet has been associated with a lower prevalence of PMS. This diet emphasizes the consumption of omega-3 fatty acids, which could help to reduce pain and depressive symptoms by indirectly releasing beta-endorphins in the brain. (Szmidt 2023) The Mediterranean diet is also rich in fiber, antioxidants, and polyphenols that nourish and foster a balanced microbiome, which is important for estrogen metabolism. (Nagpal 2019)
  • Increase intake of vegetables (especially crucifers), fruit, and fish. (Babakhani 2019)(Hashim 2019)(Takeda 2016)
  • Avoid excessive sugar, salt, caffeine, and alcohol intake. (Rossignol 1985)(Houghton 2018)(Siminiuc 2023)  
  • Recommend smaller, more frequent meals to stabilize blood sugar and prevent PMS symptoms like bloating and food cravings. (Oboza 2024)

Exercise

  • Regular physical activity is associated with reduced severity of PMS symptoms, lower perceived stress levels, and a better mental state. (Dózsa-Juhász 2023) 
  • Recommend aerobic activities, such as running, cycling, or swimming, for at least 30 minutes twice a week to reduce physical and psychological symptoms of PMS. (Maged 2018)(Chen 2023)(Dal Brun 2023)
  • Women reported significant reductions in Premenstrual Syndrome Scale scores after completing a three-month pilates program. (Çitil 2021) 

Stress Management

  • Studies have found that women with PMS exhibit altered or blunted cortisol awakening responses (CARs), which are negatively correlated with the severity of PMS symptoms. These findings suggest that chronic stress and adrenal dysfunction may play a significant role in the development of PMS. (Huang 2015)(Beddig 2019)(Hou 2019)  
  • Some women with PMDD exhibit higher cortisol levels during the late luteal phase of their menstrual cycle compared to healthy controls. (Ko 2024)  
  • Stress management techniques support healthy cortisol secretion patterns, reduce levels of perceived stress, and effectively manage premenstrual symptoms.
    • Yoga and progressive muscle relaxation (PMR) significantly reduce PMS symptoms, depression, anxiety, and stress. The combination of yoga and PMR is particularly effective. (Abic 2024)
    • A mindfulness-based stress reduction (MBSR) program, consisting of eight weekly sessions and a six-hour silence retreat, significantly decreased PMS symptoms in a randomized controlled trial. (Şener Çetin 2023)
    • Cognitive behavioral therapy (CBT) significantly reduces the severity of PMS symptoms, including anxiety and depression, and is recommended as a first-line therapy for managing PMS in conventional medicine. (Kancheva Landolt 2021)

Sleep

  • Sleep disturbances can increase stress reactivity in the hypothalamic-pituitary-adrenal (HPA) axis, leading to irregular cortisol circadian rhythms. (Balbo 2010)(van Dalfsen 2018)
  • Women with poor sleep quality and insomnia are up to twice as likely to experience PMS. (Nicolau 2018)(Xing 2020)(Conzatti 2021)
  • Shorter sleep durations (<six hours) and lower sleep efficiency are linked to dysregulated diurnal cortisol patterns, including a blunted cortisol awakening response (CAR) and a less pronounced decline in cortisol throughout the day. In contrast, better sleep efficiency and longer sleep duration (>six hours) are associated with normal cortisol rhythms, characterized by a higher CAR and steeper diurnal cortisol decline. (Castro-Diehl 2015)(Guo 2024)  
  • Good sleep quality helps maintain a positive mood throughout the menstrual cycle. After poor sleep, individuals are more likely to experience low moods during menstruation, while a good night’s sleep promotes a more stable, positive mood across the cycle. (Shuster 2023)

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References

 

  1. AAFP. (2000). Is vitamin B6 beneficial in treating PMS. American Family Physician, 62(8), 1912. https://www.aafp.org/afp/2000/1015/p1912.html
  2. Abic, A., Dag-Canatan, S., Er-Korucu, A., & Aksoy-Can, A. (2024). The effects of yoga and progressive muscle relaxation exercises on premenstrual syndrome: a randomized controlled trial. Women & Health, 64(3), 261–273. https://doi.org/10.1080/03630242.2024.2314524
  3. Agha‐Hosseini, M., Kashani, L., Aleyaseen, A., Ghoreishi, A., Rahmanpour, H., Zarrinara, A., & Akhondzadeh, S. (2008). Crocus sativus L. (saffron) in the treatment of premenstrual syndrome: a double‐blind, randomised and placebo‐controlled trial. BJOG an International Journal of Obstetrics & Gynaecology, 115(4), 515–519. https://doi.org/10.1111/j.1471-0528.2007.01652.x
  4. Ayuk, J., & Gittoes, N. J. (2014). Contemporary view of the clinical relevance of magnesium homeostasis. Annals of Clinical Biochemistry International Journal of Laboratory Medicine, 51(2), 179–188. https://doi.org/10.1177/0004563213517628
  5. Babakhani, K., Sotoudeh, G., Siassi, F., & Qorbani, M. (2019). Comparison of Vegetable Intake in Nurses with and without Premenstrual Syndrome: A Case-Control Study. Shiraz E-Medical Journal, 21(2). https://doi.org/10.5812/semj.91319
  6. Bahrami, A., Avan, A., Sadeghnia, H. R., Esmaeili, H., Tayefi, M., Ghasemi, F., Salehkhani, F. N., Arabpour-Dahoue, M., Rastgar-Moghadam, A., Ferns, G. A., Bahrami-Taghanaki, H., & Ghayour-Mobarhan, M. (2018). High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecological Endocrinology, 34(8), 659–663. https://doi.org/10.1080/09513590.2017.1423466
  7. Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45–53. https://doi.org/10.1016/j.maturitas.2017.06.025
  8. Balbo, M., Leproult, R., & Van Cauter, E. (2010). Impact of sleep and its disturbances on Hypothalamo-Pituitary-Adrenal axis activity. International Journal of Endocrinology, 2010, 1–16. https://doi.org/10.1155/2010/759234
  9. Barbagallo, M., Veronese, N., & Dominguez, L. J. (2021). Magnesium in aging, health and Diseases. Nutrients, 13(2), 463. https://doi.org/10.3390/nu13020463
  10. Beddig, T., Reinhard, I., & Kuehner, C. (2019). Stress, mood, and cortisol during daily life in women with Premenstrual Dysphoric Disorder (PMDD). Psychoneuroendocrinology, 109, 104372. https://doi.org/10.1016/j.psyneuen.2019.104372
  11. Berger, D., Schaffner, W., Schrader, E., Meier, B., & Brattström, A. (2000). Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Archives of Gynecology and Obstetrics, 264(3), 150–153. https://doi.org/10.1007/s004040000123
  12. Brun, D. D., Spagnolo, G., Cuni, B., Favaro, A., Tenconi, E., & Meneguzzo, P. (2023). Moving online: Implementation of virtual sessions of physical activity and movement training as a therapeutic approach to premenstrual symptoms. Heliyon, 9(5), e15809. https://doi.org/10.1016/j.heliyon.2023.e15809
  13. Castro-Diehl, C., Roux, A. V. D., Redline, S., Seeman, T., Shrager, S. E., & Shea, S. (2015). Association of sleep duration and quality with alterations in the Hypothalamic-Pituitary adrenocortical Axis: the Multi-Ethnic Study of Atherosclerosis (MESA). The Journal of Clinical Endocrinology & Metabolism, 100(8), 3149–3158. https://doi.org/10.1210/jc.2015-1198
  14. Çetin, N. Ş., & Kırca, A. Ş. (2023). The Effect of a Mindfulness‐Based Stress Reduction Program on premenstrual Symptoms: a randomized controlled trial. Journal of Midwifery & Women S Health, 68(5), 604–610. https://doi.org/10.1111/jmwh.13530
  15. Chen, Z., Imai, K., & Zhou, X. (2023). The relationship between physical activity and premenstrual syndrome in senior high school students: a prospective study. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-32357-2
  16. Cheng, S., Shih, C., Yang, Y., Chen, K., Chang, Y., & Yang, Y. (2013). Factors associated with premenstrual syndrome — A survey of new female university students. The Kaohsiung Journal of Medical Sciences, 29(2), 100–105. https://doi.org/10.1016/j.kjms.2012.08.017
  17. Çitil, E. T., & Kaya, N. (2020). Effect of pilates exercises on premenstrual syndrome symptoms: a quasi-experimental study. Complementary Therapies in Medicine, 57, 102623. https://doi.org/10.1016/j.ctim.2020.102623
  18. Conzatti, M., Perez, A. V., Maciel, R. F., De Castro, D. H., Sbaraini, M., & Wender, M. C. O. (2021). Sleep quality and excessive daytime sleepiness in women with Premenstrual Syndrome. Gynecological Endocrinology, 37(10), 945–949. https://doi.org/10.1080/09513590.2021.1968820
  19. Dózsa-Juhász, O., Makai, A., Prémusz, V., Ács, P., & Hock, M. (2023). Investigation of premenstrual syndrome in connection with physical activity, perceived stress level, and mental status—a cross-sectional study. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1223787
  20. Eriksson, E. (1999). Serotonin reuptake inhibitors for the treatment of premenstrual dysphoria. PubMed, 14 Suppl 2, S27-33. https://pubmed.ncbi.nlm.nih.gov/10471170
  21. Facchinetti, F., Borella, P., Sances, G., Fioroni, L., Nappi, R. E., & Genazzani, A. R. (1991). Oral magnesium successfully relieves premenstrual mood changes. PubMed, 78(2), 177–181. https://pubmed.ncbi.nlm.nih.gov/2067759
  22. Fathizadeh, N., Ebrahimi, E., Valiani, M., Tavakoli, N., & Yar, M. H. (2010). Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. PubMed. https://pubmed.ncbi.nlm.nih.gov/22069417
  23. Ford, O., Lethaby, A., Roberts, H., & Mol, B. W. J. (2012). Progesterone for premenstrual syndrome. Cochrane Library. https://doi.org/10.1002/14651858.cd003415.pub4
  24. Guo, K., Zhao, X., Luo, J., Ren, Y., Liu, Y., & Yang, J. (2024). Relationship of sleep with diurnal cortisol rhythm considering sleep measurement and cortisol sampling schemes. Psychoneuroendocrinology, 162, 106952. https://doi.org/10.1016/j.psyneuen.2023.106952
  25. Hashim, M. S., Obaideen, A. A., Jahrami, H. A., Radwan, H., Hamad, H. J., Owais, A. A., Alardah, L. G., Qiblawi, S., Al-Yateem, N., & Faris, M. a. E. (2019). Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE. Nutrients, 11(8), 1939. https://doi.org/10.3390/nu11081939
  26. Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., Murad, M. H., & Weaver, C. M. (2011). Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96(7), 1911–1930. https://doi.org/10.1210/jc.2011-0385
  27. Hou, L., Huang, Y., & Zhou, R. (2019). Premenstrual syndrome is associated with altered cortisol awakening response. Stress, 22(6), 640–646. https://doi.org/10.1080/10253890.2019.1608943
  28. Houghton, S. C., Manson, J. E., Whitcomb, B. W., Hankinson, S. E., Troy, L. M., Bigelow, C., & Bertone-Johnson, E. R. (2018). Carbohydrate and fiber intake and the risk of premenstrual syndrome. European Journal of Clinical Nutrition, 72(6), 861–870. https://doi.org/10.1038/s41430-017-0076-8
  29. Huang, Y., Zhou, R., Wu, M., Wang, Q., & Zhao, Y. (2014). Premenstrual syndrome is associated with blunted cortisol reactivity to the TSST. Stress, 18(2), 160–168. https://doi.org/10.3109/10253890.2014.999234
  30. Jarosz, A. C., & El-Sohemy, A. (2018). Association between Vitamin D Status and Premenstrual Symptoms. Journal of the Academy of Nutrition and Dietetics, 119(1), 115–123. https://doi.org/10.1016/j.jand.2018.06.014
  31. Kemper, K. J., & Shannon, S. (2007). Complementary and alternative medicine therapies to promote healthy moods. Pediatric Clinics of North America, 54(6), 901–926. https://doi.org/10.1016/j.pcl.2007.09.002
  32. Kia, A. S., Amani, R., & Cheraghian, B. (2015). The Association between the Risk of Premenstrual Syndrome and Vitamin D, Calcium, and Magnesium Status among University Students: A Case Control Study. Health Promotion Perspectives, 5(3), 225–230. https://doi.org/10.15171/hpp.2015.027
  33. Ko, C., Wong, T., Suen, J., Lin, P., Long, C., & Yen, J. (2023). Estrogen, progesterone, cortisol, brain-derived neurotrophic factor, and vascular endothelial growth factor during the luteal phase of the menstrual cycle in women with premenstrual dysphoric disorder. Journal of Psychiatric Research, 169, 307–317. https://doi.org/10.1016/j.jpsychires.2023.11.019
  34. Kumari, N., Kumari, R., Dua, A., Singh, M., Kumar, R., Singh, P., Duyar‐Ayerdi, S., Pradeep, S., Ojesina, A. I., & Kumar, R. (2024). From Gut to hormones: Unraveling the role of gut microbiota in (Phyto)Estrogen modulation in health and disease. Molecular Nutrition & Food Research, 68(6). https://doi.org/10.1002/mnfr.202300688
  35. Landolt, N. K., & Ivanov, K. (2020). Short report: cognitive behavioral therapy – a primary mode for premenstrual syndrome management: systematic literature review. Psychology Health & Medicine, 26(10), 1282–1293. https://doi.org/10.1080/13548506.2020.1810718
  36. Li, W., Zheng, T., Altura, B. M., & Altura, B. T. (2001). Sex steroid hormones exert biphasic effects on cytosolic magnesium ions in cerebral vascular smooth muscle cells: possible relationships to migraine frequency in premenstrual syndromes and stroke incidence. Brain Research Bulletin, 54(1), 83–89. https://doi.org/10.1016/s0361-9230(00)00428-7
  37. Maged, A. M., Abbassy, A. H., Sakr, H. R. S., Elsawah, H., Wagih, H., Ogila, A. I., & Kotb, A. (2018). Effect of swimming exercise on premenstrual syndrome. Archives of Gynecology and Obstetrics, 297(4), 951–959. https://doi.org/10.1007/s00404-018-4664-1
  38. Momoeda, M., Sasaki, H., Tagashira, E., Ogishima, M., Takano, Y., & Ochiai, K. (2014). Efficacy and Safety of Vitex agnus-castus Extract for Treatment of Premenstrual Syndrome in Japanese Patients: A Prospective, Open-label Study. Advances in Therapy, 31(3), 362–373. https://doi.org/10.1007/s12325-014-0106-z
  39. Nabeh, O. A. (2023). New insights on the impact of gut microbiota on premenstrual disorders. Will probiotics solve this mystery? Life Sciences, 321, 121606. https://doi.org/10.1016/j.lfs.2023.121606
  40. Nagpal, R., Shively, C. A., Register, T. C., Craft, S., & Yadav, H. (2019). Gut microbiome-Mediterranean diet interactions in improving host health. F1000Research, 8, 699. https://doi.org/10.12688/f1000research.18992.1
  41. Nemat-Shahi, M., Asadi, A., Nemat-Shahi, M., Soroosh, D., Mozari, S., Bahrami-Taghanaki, H., & Mehrpour, M. (2020). Comparison of Saffron versus Fluoxetine in Treatment of Women with Premenstrual Syndrome: A Randomized Clinical Trial Study. Indian Journal of Forensic Medicine & Toxicology. https://doi.org/10.37506/ijfmt.v14i2.3191
  42. Nicolau, Z. F., Bezerra, A. G., Polesel, D. N., Andersen, M. L., Bittencourt, L., Tufik, S., & Hachul, H. (2018). Premenstrual syndrome and sleep disturbances: Results from the Sao Paulo Epidemiologic Sleep Study. Psychiatry Research, 264, 427–431. https://doi.org/10.1016/j.psychres.2018.04.008
  43. Noviyanti, N. I., Gusriani, N., Ruqaiyah, N., Mappaware, N. A., & Ahmad, M. (2021). The effect of estrogen hormone on premenstrual syndrome (PMS) occurrences in teenage girls at Pesantren Darul Arqam Makassar. Gaceta Sanitaria, 35, S571–S575. https://doi.org/10.1016/j.gaceta.2021.10.103
  44. Oboza, P., Ogarek, N., Wójtowicz, M., Rhaiem, T. B., Olszanecka-Glinianowicz, M., & Kocełak, P. (2024). Relationships between Premenstrual Syndrome (PMS) and Diet Composition, Dietary Patterns and Eating Behaviors. Nutrients, 16(12), 1911. https://doi.org/10.3390/nu16121911
  45. Quaranta, S., Buscaglia, M. A., Meroni, M. G., Colombo, E., & Cella, S. (2007). Pilot study of the efficacy and Safety of a Modified-Release Magnesium 250mg Tablet (SincroMag??) for the treatment of premenstrual syndrome. Clinical Drug Investigation, 27(1), 51–58. https://doi.org/10.2165/00044011-200727010-00004
  46. Rajabi, F., Rahimi, M., Sharbafchizadeh, M., & Tarrahi, M. (2020). Saffron for the management of premenstrual dysphoric disorder: A randomized controlled trial. Advanced Biomedical Research, 9(1), 60. https://doi.org/10.4103/abr.abr_49_20
  47. Rapkin, A. J., Edelmuth, E., Chang, L. C., Reading, A. E., McGuire, M. T., & Su, T. P. (1987). Whole-blood serotonin in premenstrual syndrome. PubMed, 70(4), 533–537. https://pubmed.ncbi.nlm.nih.gov/3627623
  48. Roomruangwong, C., Carvalho, A. F., Comhaire, F., & Maes, M. (2019). Lowered plasma Steady-State levels of progesterone combined with declining progesterone levels during the luteal phase predict Peri-Menstrual syndrome and its major subdomains. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.02446
  49. Rossignol, A. M. (1985). Caffeine-containing beverages and premenstrual syndrome in young women. American Journal of Public Health, 75(11), 1335–1337. https://doi.org/10.2105/ajph.75.11.1335
  50. Schellenberg, R. (2001). Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ, 322(7279), 134–137. https://doi.org/10.1136/bmj.322.7279.134
  51. Shuster, A. E., Simon, K. C., Zhang, J., Sattari, N., Pena, A., Alzueta, E., De Zambotti, M., Baker, F. C., & Mednick, S. C. (2023). Good sleep is a mood buffer for young women during menses. SLEEP, 46(10). https://doi.org/10.1093/sleep/zsad072
  52. Siminiuc, R., & Ţurcanu, D. (2023). Impact of nutritional diet therapy on premenstrual syndrome. Frontiers in Nutrition, 10. https://doi.org/10.3389/fnut.2023.1079417
  53. Szmidt, M., Granda, D., Madej, D., Sicinska, E., & Kaluza, J. (2023). Adherence to the Mediterranean Diet in Women and Reproductive Health across the Lifespan: A Narrative Review. Nutrients, 15(9), 2131. https://doi.org/10.3390/nu15092131
  54. Takeda, T., Imoto, Y., Nagasawa, H., Takeshita, A., & Shiina, M. (2016). Fish consumption and premenstrual syndrome and dysphoric disorder in Japanese collegiate athletes. Journal of Pediatric and Adolescent Gynecology, 29(4), 386–389. https://doi.org/10.1016/j.jpag.2016.01.122
  55. Takeda, T., Yoshimi, K., Kai, S., Ozawa, G., Yamada, K., & Hiramatsu, K. (2022). Characteristics of the gut microbiota in women with premenstrual symptoms: A cross-sectional study. PLoS ONE, 17(5), e0268466. https://doi.org/10.1371/journal.pone.0268466
  56. Tartagni, M., Cicinelli, M. V., Tartagni, M. V., Alrasheed, H., Matteo, M., Baldini, D., De Salvia, M., Loverro, G., & Montagnani, M. (2015). Vitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders in Adolescents with Severe Hypovitaminosis D. Journal of Pediatric and Adolescent Gynecology, 29(4), 357–361. https://doi.org/10.1016/j.jpag.2015.12.006
  57. Turner, J., Mclindon, L., Turner, D., Alefsen, Y., & Ecochard, R. (2023). Relationship between steroid hormone profile and premenstrual syndrome in women consulting for infertility or recurrent miscarriage. Reproductive Sciences, 31(3), 736–745. https://doi.org/10.1007/s43032-023-01375-w
  58. Van Dalfsen, J. H., & Markus, C. R. (2017). The influence of sleep on human hypothalamic–pituitary–adrenal (HPA) axis reactivity: A systematic review. Sleep Medicine Reviews, 39, 187–194. https://doi.org/10.1016/j.smrv.2017.10.002
  59. Verkaik, S., Kamperman, A. M., Van Westrhenen, R., & Schulte, P. F. (2017). The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 217(2), 150–166. https://doi.org/10.1016/j.ajog.2017.02.028
  60. Walker, A. F., De Souza, M. C., Vickers, M. F., Abeyasekera, S., Collins, M. L., & Trinca, L. A. (1998). Magnesium supplementation alleviates premenstrual symptoms of fluid retention. Journal of Women’s Health, 7(9), 1157–1165. https://doi.org/10.1089/jwh.1998.7.1157
  61. Webster, D. E., He, Y., Chen, S., Pauli, G. F., Farnsworth, N. R., & Wang, Z. J. (2010). Opioidergic mechanisms underlying the actions of Vitex agnus-castus L. Biochemical Pharmacology, 81(1), 170–177. https://doi.org/10.1016/j.bcp.2010.09.013
  62. Wyatt, K. (2000). Poor-quality studies suggest that vitamin B6 use is beneficial in premenstrual syndrome. Western Journal of Medicine, 172(4), 245. https://doi.org/10.1136/ewjm.172.4.245
  63. Wyatt, K. M., Dimmock, P. W., Jones, P. W., & O’Brien, P. M. S. (1999). Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ, 318(7195), 1375–1381. https://doi.org/10.1136/bmj.318.7195.1375
  64. Xing, X., Xue, P., Li, S. X., Zhou, J., & Tang, X. (2020). Sleep disturbance is associated with an increased risk of menstrual problems in female Chinese university students. Sleep and Breathing, 24(4), 1719–1727. https://doi.org/10.1007/s11325-020-02105-1