Vitamin E Studies performed in the 1940s suggested that vitamin E might be effective in the treatment of menstrual disorders such as PMS. Recent studies for PMS were mixed. Two randomized controlled trials investigating vitamin E (in d-alpha tocopherol form) showed promising results in the treatment of PMS over placebo (29). A randomized controlled trials studying the effect of vitamin E on dysmenorrhea showed decreases in both severity and duration of pain, as well as blood loss (30). The dosing regimen used was 200 IU twice a day beginning 2 days before the expected menses and continued for the first 3 days of menstruation. It is believed that the mechanism of action of vitamin E is an inhibition of arachidonic acid release with a consequential decrease in prostaglandin formation. Vitamin E with mixed tocopherols at 400 IU per day with meals is considered safe and may be of benefit.
Most controlled studies on vitamin B6 in the treatment of PMS have limited numbers of patients; therefore, the evidence of positive effects is fairly weak (31). This is a benign therapy in doses of 100 mg or less. A systematic review of nine trials indicated significant benefit over placebo for the symptoms of mastalgia, swollen breasts, pain, and depression (32).
Omega-3 Fatty Acids There are two major types of omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omega-3 fatty acids act as anti-inﬂammatory agents in that they shift arachidonic acid metabolism away from prostaglandin F2α (PgF2α) and increase levels of the less inﬂammatory PgE1. Omega-3 fatty acids are essential foods, and levels are extremely low in the average diet of individuals in the United States. They can be increased through dietary means as well as supplements (Table 13.7). One study looked at essential fatty
Table 13.7 Omega-3 Content of Foodsa a For general health, individuals should try to consume 7–10 g of omega-3 fatty acids weekly. Data from United States Department of Agriculture. USDA national nutrient database.
Beltsville, MD: USDA; 2004. Available online at http://www.nal.usda.gov/fnic/foodcomp/search acids (EFA) and PMS and showed no effect. There are some positive studies looking at the effectiveness of omega-3 fatty acids in treating mild depression with fish oils. This may be a reasonable approach to try if one of the patient’s primary symptoms is mood depression (3 g, divided with meals) (33). Side effects are rare, but occasionally patients will experience nausea, diarrhea, belching, or an unpleasant taste in the mouth. Omega-3 fatty acids have an anticoagulant effect and are relatively high in calories.