PMS Is REAL! After years of suffering from debilitating menstrual cramps, there was nothing I hated more than trying to get myself home to suffer until my pain meds kicked in. It was just so disruptive to my life and what I had going on. It was hard to predict exactly when my cramps would hit, but I did my best to take my meds a few days before I knew it was due and it really helped to curb those symptoms. Do you have any PMS symptoms that are really disruptive to your life that you wish you could manage better? Maybe you hit the drugstore with tons of options and don’t quite know where to start?

I’ve put together a few recommendations to make sure PMS doesn’t get in the way of your daily hustle. By identifying your most troubling symptoms, you can create a self-care plan that should hopefully get you through to the end of your cycle with minimal disruption. As a practicing pharmacist, I thought it was also important to share some potential side effects you should consider and drug-drug interactions that should be avoided — even with the use of over-the-counter medications.

For Mood Swings and Cravings, try Calcium and Vitamin D

Emotional symptoms such as mood swings, depression, anger, and even food cravings as well as physical symptoms (fatigue, headache, bloating, etc.) can all be reduced with a high dietary intake of calcium and vitamin D (several studies have shown that they might even prevent PMS). An added bonus is that calcium can help prevent osteoporosis, something that we as women are more prone to develop as we age. Naturally, as a practicing pharmacist, it's really important that my patients are well-versed on any potential side effects and drug-drug interactions.

Patients often forget that over-the-counter therapies can interact with each other. Did you know that calcium is the fifth most abundant element in the human body? It's also known for its binding properties, which can lead to constipation, one of its most common side effects. It also can reduce the effectiveness of some prescription medications, most commonly thyroid medications and antibiotics. It's recommended that you wait at least 2 hours (before and after) to take any of those medications if you are taking any calcium supplementation.

For Irritability, try Magnesium

Do you find yourself feeling highly irritable around your period? Magnesium can help! Fifty percent of women consume less than the recommended dietary allowance for magnesium. Start taking magnesium during the luteal phase of your period (days 12-16 of your period^{^[1]}). Replacing magnesium during this phase will help keep you feeling super confident and sexy until you actually start your period. A word of warning, taking magnesium on its own can cause diarrhea, so try taking it with calcium to balance this side effect.

For Headaches and Muscle/Joint aches, try NSAIDS

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), otherwise known as Anti-Inflammatory Pain medications, are probably the most commonly-used medication for PMS symptoms [Ibuprofen (Advil) or Naproxen (Aleve) fall into this list]. NSAIDS reduce some of the physical symptoms of PMS such as headaches and muscle/joint pains. The best time to start taking these medications is prior to the start of your period and continuing through the first few days. Common side effects of NSAIDS include: stomach irritation, nausea, vomiting – so take them with food. Although a glass of wine at night might seem fun, avoid mixing alcohol with NSAIDS, which can take a toll on your stomach lining and intestines, leading to ulcers and an increased risk of bleeding. Also, be careful with mixing NSAIDS with blood thinners and some anti-depressants as they might also cause an increase risk of bleeding.

For Bloating try Water Pills (Diuretics)

Oh, the dreaded bloating — probably the most disturbing of all symptoms, especially when your favorite skirt or pants don’t quite fit like they should. Typically, bloating that is associated with your menstrual cycle is due to fluid shifting to the site of all the action (the stomach region) and is often not associated with additional weight gain. If that is the case, over-the-counter water pills (diuretics) will not be very effective. However, if you weigh yourself pretty regularly and notice you always gain a few pounds around that time of the month, you may get some relief with the use of an over-the-counter water pill.

Ammonium Chloride, Caffeine and Panabrom are common ingredients in over-the-counter water pills. Let’s focus on caffeine because it’s a popular drug that most of us take. Consistent use of caffeine can lead to developing a tolerance. The side effects of caffeine can potentially make you feel worse, since they are essentially the same as PMS symptoms – anxiety, restlessness, insomnia, irritability and increased heart rate. Not to mention if you're already a coffee lover or energy drink devotee, chasing down your water pills with these drinks will just make things worse.

A Few Last Helpful Tips!

Set the timer on your phone so you don't forget to take your medication or the supplement. Medications and supplements don't work if you don’t take them!

When evaluating combination PMS products, check on the active ingredients on the box and make sure they have what you need. Otherwise, stay away and create your own regimen that will work best for you.

If you already have an ongoing stomach condition such as acid reflux and you are taking an acid blocker like Pepcid AC (famotidine) or Prilosec (omeprazole), look for magnesium CITRATE rather than CARBONATE. Magnesium Citrate will work better when your stomach acid levels are lowered by the medication. It’s best to avoid magnesium OXIDE altogether.
My personal regimen – I would take Calcium and Vitamin D daily, Magnesium daily for 2 weeks, followed by Ibuprofen for 2-3 days starting a couple days before the start of my period.

I care about you, and although you should attempt self-care first, there are certain times when you should seek medical help. Naturally, we are all different, especially when it comes to our medical histories. My advice is for the general adult audience. You can find my disclaimer here or for personalized advice, feel free to message me directly on my Facebook page @bonvivantapothecary.

^{^[1]} If your period is on a 28 day cycle

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