Vitamin E may alleviate certain PMS symptoms: RCT

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Supplementation with gamma-tocopherol could alleviate premenstrual symptoms (PMS), according to a new study from Japanese researchers.

The research, published in BMC Complementary Medicine and Therapies, suggests that gamma-tocopherol (the gamma form of the naturally-occurring fat-soluble vitamin E) significantly reduced several symptoms associated with PMS, including fatigue, irritability and water retention.

Premenstrual syndrome

PMS is a cyclic phenomenon occurring during the late luteal phase of the menstrual cycle. The diagnostic criteria for PMS include somatic symptoms, such as abdominal bloating, breast tenderness or swelling, headache, joint or muscle pain, swelling of the extremities, and weight gain, as well as mental symptoms, including angry outbursts, anxiety, confusion, depression, irritability, and social withdrawal. According to an epidemiological survey, 75% of women suffer from symptoms of PMS.

The etiology of PMS involves many factors such as genetics, genomics, psychological, socio-demographic, dietary and environmental, although, pathogenesis is still poorly understood (Jahanfar, 2011).

Current PMS treatment approaches include lifestyle modification and cognitive behavioral therapy. Pharmacologic options, such as antidepressants, oral estrogen-progestin contraceptives, nonsteroidal anti-inflammatory drugs (NSAIDs), and diuretics, focus on mitigating symptoms, but carry worrisome side effects (Nevatte, 2013). Because of this, women are seeking alternative treatment options.

In a recent cross-sectional study, Elkoca et al. concluded that 73% of women diagnosed with PMS used complementary and alternative medicine practices. Because of this, Elkoca et al., believes “It’s necessary to investigate their effectiveness.”

Numerous randomized controlled clinical studies have demonstrated the efficacy and safety of calcium, vitamin D, B6, and E supplementation for the treatment of PMS (Dadkhah, 2016). “These studies have mainly examined the antioxidant and anti-inflammatory effects of γ-Toc; its sodium-diuretic effects in humans remain unclear,” stated Higuchi et al. “This study was the first to examine γ-Toc’s effects on alleviating PMS symptoms related to water retention during the luteal phase.

Study details

The randomized, double-blind, placebo-controlled crossover study enrolled 51 Japanese women who were randomly assigned to receive 180mg of vitamin E followed by a placebo (group A) or placebo followed by vitamin E (group B) twice a day for seven days in the luteal phase. The washout period was approximately 3 weeks from the completion of the first cycle of luteal phase test supplement intake to the start of the second cycle of luteal phase test supplement intake.

Scores from the visual analog scale (VAS) were used as the primary outcome measure to evaluate the efficacy of vitamin E in alleviating PMS symptoms during the evaluation period.

Secondary outcome measures used to evaluate the severity of menstrual symptoms were the menstrual distress questionnaire (MDQ), body weight and water content measured through multi-frequency bioelectrical impedance analysis, waist, thigh, maximum leg, and minimum leg circumferences and plasma γToc and γCEHC levels measured using high-performance liquid chromatography (HPLC).

Results

The VAS scores for “fatigue” and “irritability/angry” were significantly lower with vitamin E intake than placebo. Significantly lower scores for “swelling of the legs,” “heavy legs,” and “fatigue” were also shown with vitamin E intake vs placebo. Non-significant results between vitamin E intake and placebo were seen on MDQ scores for “concentration.”

Vitamin E intake demonstrated significantly higher 24-hour urinary sodium excretion, along with increased plasma atrial natriuretic peptide (ANP) levels and decreased plasma aldosterone levels vs. placebo. Thigh circumference was significantly lower with vitamin E intake and plasma levels of both vitamin E and gamma-CEHC significantly increased with vitamin E intake vs. placebo.

Researchers concluded that vitamin E intake could safely and effectively alleviate certain PMS symptoms, particularly those related to water retention during the luteal phase. The underlying mechanism may involve the diuretic effect of gamma-CEHC, which is a beta-oxidized metabolite of vitamin E.

The authors noted this study has limitations, including insufficient sample size, short duration, and complex protocol, the data can be used as baseline information for other clinical studies needed to improve our understanding of the etiology and pathogenesis of PMS, which will assist in the diagnosis and development of safe and effective treatment.

Source: BMC Complementary Medicine and Therapies

2023 April 28 doi.org/10.1186/s12906-023-03962-5

“Effect of γ-tocopherol supplementation on premenstrual symptoms and natriuresis: a randomized, double-blind, placebo-controlled study"

Authors: Higuchi et al.