You are not imagining things if you think that your IBS is worse when you are also dealing with PMS: for some women, the hormonal changes associated with the menstrual cycle do affect the severity of IBS symptoms. With such an overlap, you may have been afraid to try some remedies or treatments for PMS for fear that they will cause you further IBS trouble. Unfortunately, there doesn't seem to be any research that has looked specifically at treating both conditions simultaneously, though there are a number of treatments/remedies for PMS. The following examines some of these more common treatments, as well as their effects on IBS, to help you see if there's an option that might be right for you.
Please keep in mind that the research on PMS treatments is still considered to be in a preliminary phase, so no hard conclusions can be drawn regarding the effectiveness of most of the options. In addition, remember to always consult with your physician before trying any over-the-counter remedy or supplement, as some supplements—particularly at high doses—can have medical ramifications. Your physician is in the best position to advise you as to how the remedy might impact your own individual health status or interact with any other medication that you might be on.
Birth Control Pills
Although birth control pills (oral contraceptives) are frequently prescribed by physicians as a way to alleviate PMS symptoms, research on the subject is surprisingly limited and has yielded mixed results. Birth control pills may be more effective in treating the mood symptoms of premenstrual dysphoric disorder (PMDD) rather than the physical symptoms associated with PMS.
Given that, some researchers posit the theory that both PMS and IBS might benefit more from a monophasic pill over other types. The thinking is that it is the change in hormone levels that triggers symptoms, as opposed to the actual hormones themselves. There is also preliminary support for the use of extended cycle pills for PMS, although it is unknown what effect these pills would have on IBS symptoms.
As for IBS, research has not shown any significant positive effect of birth control pills on IBS symptoms. On the flip side, there does not seem to be a negative effect either. Thus, the decision as to whether or not to use oral contraceptives should be one made with your doctor, taking into account your medical history and your contraceptive needs.
For further information, see:
Of the many suggested over-the-counter products for PMS, calcium appears to have the most research support for its effectiveness. Calcium has been shown to be helpful in reducing mood symptoms, pain, physical discomfort, and in lessening appetite changes. Calcium from food sources appears to be optimal, but taking supplements in the range of 1000 to 1200 mg/day also appears to be quite helpful. Just be careful not to exceed the recommended upper limit of 2500 mg/day.
Although evidence is anecdotal, many people who suffer from diarrhea predominant IBS (IBS-D) report that they have been helped by calcium. It may therefore be a nice option if you find that your IBS-D is worsened when you're premenstrual. For more information, see:
Chasteberry is a supplement made from dried berries of the chaste tree. Of the few studies that have been done on chasteberry for PMS, most have shown indications that the supplement is helpful in reducing mood symptoms, irritability, breast tenderness, and headaches. But people who have taken chasteberry have reported a wide variety of mild side effects, including gastrointestinal symptoms. Chasteberry may therefore not be a good option if you have IBS.
While research has been published on the effects of dietary changes on PMS, the findings have been inconsistent, failing to show a clear link between any specific dietary factors and PMS. But many of the common-sense recommendations for diet and PMS are similar to those changes recommended to prevent exacerbation of IBS symptoms. Some things you should think about doing if you suffer from both IBS and PMS include:
- Increase your intake of high fiber complex carbohydrates.
- Avoid alcohol, caffeine and fatty foods.
- Eat small meals throughout your day.
Evening Primrose Oil
Evening primrose oil, a supplement in the form of an oil that's derived from the seeds of the evening primrose plant, is frequently touted as a remedy for PMS. Unfortunately, the research to date on evening primrose oil has not shown any benefit of the supplement on PMS symptoms. Although side effects of the supplement are usually mild, there have been reports of gastrointestinal symptoms. With this in mind, as well as the lack of evidence for usefulness, evening primrose oil is probably not a good option for those with IBS.
There is some research supporting exercise's positive effects in reducing PMS symptoms. Although current research on IBS and exercise doesn't show any conclusive evidence, the overall health benefits of exercise make it a good option for all, with a little bit of added hope that it may help to ease symptoms of both conditions. If you're concerned that intense exercise will aggravate your IBS symptoms, see:
Research specifically on the use of hot water bottles or heating pads for PMS has not been conducted, but many women can attest to the fact that heat can ease the intensity of menstrual cramps. Similarly, there's no specific research on the use of heat for IBS, although many people with IBS have reported that heat does help to ease intestinal cramps. Research shows that intermittent, continuous heat does help pain, so a heating pad or hot water bottle is probably a nice option for easing the symptoms of both disorders. Place the heat source on your abdomen for thirty minutes at a time, several times throughout the day. Be sure to place some cloth between the heat sources and your skin in order to prevent a burn.
The vitamin magnesium has received some research attention in terms of effectiveness for reducing PMS symptoms, but research has been limited, and results have been mixed. Although no research has been conducted on magnesium for IBS, many individuals with constipation-predominant IBS (IBS-C) have reported that it's helpful in easing constipation. So if your predominant IBS symptom is constipation, magnesium may be a good option. For safety and dosing information, see:
One thing that PMS and IBS have in common is that the symptoms of each are exacerbated by stress, so mind/body approaches to reducing stress may help to ease the symptoms of both disorders. For both IBS and PMS, research supports the use of cognitive behavioral therapy and relaxation training. The lack of unwanted side effects or negative drug interactions give these treatments a nice advantage over many of the other options in this list.
Selective serotonin reuptake inhibitors (SSRIs) are medications traditionally designed to treat depression. But since evidence shows that PMS may be linked to levels of the neurotransmitter serotonin, SSRIs have also been used as a treatment for PMS—typically at a lower dosage than what's used to treat depression. SSRIs have also been evaluated in terms of their helpfulness for IBS, with some positive results depending on the specific medication. The downside of SSRIs can be their side effects, but if you are experiencing significant mood swings, irritability and/or anxiety alongside your IBS and PMS, this may be something worth speaking to your doctor about.
Many studies have been conducted to evaluate the effectiveness of vitamin B6 for reducing PMS symptoms. The theory behind B6 supplementation is that the vitamin contributes to the development of serotonin and dopamine, another neurotransmitter. Study results have been mixed, and at least one meta-analysis concluded that the evidence for recommending vitamin B6 for PMS is simply not strong enough. Side effects of B6 include gastrointestinal symptoms -- most notably nausea -- therefore ruling it out as a good option for a person with IBS.
Essential Reading from Dr. Bolen, Your IBS Guide:
"Chasteberry" Natural Center for Complementary and Alternative Medicine Fact Sheet Accessed September 17, 2012.
"Evening Primrose Oil" Natural Center for Complementary and Alternative Medicine Fact Sheet Accessed September 17, 2012.
Douglas, S. "Premenstrual syndrome. Evidence-based treatment in family practice." Canadian Family Physician 2002 48:1789-1797.
Friedrich, M., Grady, S. & Wall, G. "Effects of antidepressants in patients with irritable bowel syndrome and comorbid depression" Clinical Therapeutics 2012 32:1221-1233.
O’Connor, A. & McCarberg, B. “ A New Look at Heat Treatment for Pain Disorders, Part 2” American Pain Society Bulletin 2005 15.
Whelan, A., Jurgens, T. & Naylor, H. "Herbs, Vitamins and Minerals in the Treatment of Premenstrual Syndrome: A Systematic Review" The Canadian Journal of Clinical Pharmacology 2009 16:e407-e429.
Yonkers, K., O'Brien, S., & Eriksson, E. "Premenstrual syndrome" The Lancet 2008 371:1200-1210.
DISCLAIMER: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.