Dietary Approach to Premenstrual Syndrome Symptoms Alleviation – A Systematic Review

Dietary Approach to Premenstrual Syndrome Symptoms Alleviation – A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Dietary Approach to Premenstrual Syndrome Symptoms Alleviation – A Systematic Review Ana Nobre, Carla Lagoa, Sandra Abreu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7101209/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Background/Objectives: Premenstrual Syndrome (PMS), experienced by women during their reproductive age, encompasses physical, emotional, and behavioural symptoms before menstruation. Common symptoms include fatigue, headaches, bloating, breast tenderness, mood swings, irritability, anxiety, and sadness. PMS severity varies among individuals and can affect daily life. Nutrition plays a significant role in PMS treatment, as dietary adjustments and supplementation have shown potential in alleviating symptoms and improving overall well-being. This systematic review aims to identify, assess, and analyse the efficacy of different dietary and nutritional interventions in alleviating PMS symptoms among women in their reproductive years. Subjects/Methods: In June 2023, three electronic databases (PubMed, Scopus, and Web of Science) were consulted to undertake a literature search. The screening process involved two phases: initial screening based on titles and abstracts and subsequent analysis of full-text articles. The study followed PRISMA guidelines, and the protocol was registered in PROSPERO; the RoB2 Tool was used to assess the quality of the included studies. Results: Seventeen studies were included in this systematic review: eleven evaluated the effect of supplementation with micronutrients, three assessed specific diets, and three examined the impact of Zataria multi-flora essence, wheat germ, and ginger on PMS. Most studies showed an apparent reduction in PMS-related symptoms post-intervention. Eight studies had a high risk of bias, and three were unclear. Conclusion: This systematic review confirms the potential of a nutritional approach involving supplements or dietary changes in improving PMS symptoms. Health sciences/Health care/Nutrition Health sciences/Health care/Therapeutics/Nutrition therapy Figures Figure 1 Figure 2 Introduction Most women experience some form of menstrual symptoms during their reproductive years. Premenstrual Syndrome (PMS) is a core premenstrual disorder ( 1 ) and consists of physical, psychological, and behavioural symptoms that cause significant impairment to the individual ( 2 ). The symptoms encompass various physical and psychological manifestations such as fatigue, headaches, bloating, mastalgia, irritability, anxiety, mood swings, sadness, depression, and decreased self-confidence ( 3 ). PMS usually occurs during all or part of the two-week premenstrual (luteal) phase of the menstrual cycle and stops with menses ( 4 , 5 ). It is estimated that 20–40% of reproductive women have recurrent moderate-to-severe PMS, and 3–8% have Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS ( 6 ). PMS can affect any fertile woman, as it has been proven that ovulation is required for the manifestation of PMS ( 7 ); thus, suppressing ovulation could result in a major reduction or elimination of symptoms ( 8 ). Although the aetiology of PMS remains unclear, some hypotheses suggest that it involves the interaction between hormonal fluctuations and neurotransmitter imbalances ( 9 ). Some of the underlying mechanisms described for PMS pathophysiology involve the hypothalamic-pituitary-adrenal (HPA) axis, gamma-aminobutyric acid (GABA) system and serotonergic system ( 10 – 12 ). Several studies have suggested that the severity of PMS may be improved by lifestyle behaviours, such as aerobic exercise ( 13 ) and dietary intake ( 14 ). Dietary supplementation with calcium has been shown to be effective in relieving PMS symptoms ( 15 ). The consumption of certain food groups has been associated with reducing PMS and its symptoms, such as vegetables, fruits, and legumes, as well as adopting low-fat and high-fibre diets ( 16 , 17 ). Intending to diminish the dependency on pharmacological treatments and explore more natural approaches, this review of Randomised Controlled Trials (RCTs) aims to shed light on the potential benefits of dietary adjustments as a viable strategy for women experiencing PMS. This systematic review aims to identify and appraise the effect of dietary and nutritional interventions on alleviating PMS symptoms among non-menopausal women. Methods The present review was meticulously planned to follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) ( 18 ). Additionally, the protocol was registered in the international Prospective Register of Systematic Reviews (PROSPERO; CRD42023443974). Literature search Three electronic databases – PubMed, Scopus, and Web of Science – were consulted in July 2024 to undertake a literature search. A timeline filter from 2013 to 2024 was applied to all databases. The search used a combination of Medical Subject Headings (MeSH) terms and keywords considering the intervention ("diet" OR "dietary intake" OR "dietary habits" OR "nutrient intake" OR "diet composition" OR "nutrition" OR "eating attitudes" OR "food consumption" OR "dietary pattern" OR "diet therapy" OR "food therapy" OR "food intervention" OR "nutritional intervention" OR "nutrition intervention" OR "dietetic treatment" OR "dietetic intervention" OR "clinical nutrition" OR "diet modification" OR "micronutrients" OR "macronutrients") and the condition of interest (“premenstrual syndrome" OR "premenstrual tension" OR "premenstrual dysphoric disorder"). Eligibility criteria and selection process Eligibility criteria were determined to begin the selection process as follows: published between 2013 and 2024; published in English, French, Spanish, or Portuguese; randomised controlled trials, randomised clinical trials or controlled clinical trials; a minimum of eight weeks or two menstrual cycles intervention; the main outcome of interest based on improving symptoms or the global score of PMS or PMDD in non-menopausal women (18 years or older) through dietary interventions; and secondary outcomes based on individual symptom cluster changes (psychological, behavioural, or physical symptoms). We excluded studies focusing on dietary interventions for PMS with cognitive-behavioural therapy and physical exercise. We conducted the screening process independently in two phases. Firstly, all articles were screened based on their titles and abstracts. Secondly, we analysed the full-text articles in their entirety. Disagreements on keeping or excluding studies were resolved through discussion. Data Extraction Studies were selected based on predetermined inclusion and exclusion criteria, and data regarding authors, sample size, participants, study design, intervention description, tools (used to evaluate primary and secondary outcomes), randomisation allocation, blinding, duration of intervention, outcomes, results, and adverse effects were documented. Risk of Bias (RoB) and Quality Assessment (QA) The Cochrane Risk-of-Bias Tool (ROB2) was used to assess the methodological quality of the RCTs ( 19 ). This tool evaluates various questions across five domains, including the randomisation process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of reported results. After answering these questions and evaluating the risk of bias for each domain, a final judgement of “Low”, “High”, or “Some concerns” risk of bias can be determined. Results Study selection Figure 1 summarises the screening process. We gathered 552 studies from all databases, automatically removed 52 duplicates using Mendeley® Software, and manually removed an additional 168. We screened 331 studies based on title and abstract, excluding 300. We reviewed 31 full-length studies and included 19 for data extraction and quality assessment based on eligibility criteria. We identified five more studies via other methods (citation searching) and rejected one because it did not comply with the eligibility criteria for age. Study characteristics This systematic review included a total of 22 RCTs. The characteristics of each study are presented in Table 1, sorted based on the type of intervention. Specifically, three studies investigated the effect of zinc on PMS ( 20 – 22 ). Additionally, two studies examined the impact of calcium on PMS ( 23 , 24 ), while two others explored mixed interventions, i.e., calcium plus vitamin B6 ( 25 ) and a micronutrient formula ( 26 ), both of which compared vitamin B6 as the control group. Furthermore, three studies investigated the effects of various vitamins on PMS symptoms, including the impact of vitamin B1 on ameliorating PMS symptoms ( 27 ) and the effects of vitamin D on women with PMS and vitamin D deficiency ( 28 – 30 ). One study focused on the effect of γ-tocopherol on PMS symptoms ( 31 ); the remaining studies did not fall into a specific intervention category. These studies evaluated interventions such as Zataria Multi-Flora essence ( 32 ), omega-3 supplements ( 33 ), whole grains consumption ( 34 ), wheat germ ( 35 ), PMS Diet ( 36 ), ginger ( 37 ), a supplement (PREMEDN-CALM) ( 38 ), and hydrogen-rich water ( 39 ) on PMS symptomatology. One study evaluated the effect of alternate-day modified fasting on premenstrual syndrome symptoms in obese or overweight women, compared to a daily calorie restriction ( 40 ), and one study evaluated the effect of curcumin on nitric oxide levels, and therefore on premenstrual symptoms in women with PMS ( 41 ). It is worth noting that all 22 studies administered the interventions orally. PMS symptoms and severity were measured through different tools, mostly using the Premenstrual Symptoms Screening Tool (PSST) and the Daily Record Symptoms Questionnaire (DRSP), as described in Table 1. Ten studies did not report side effects, nine reported no side effects, and three reported side effects - none or mild ( 26 ), non-specified in 1.7% of the intervention group ( 27 ), and nausea in one person from the intervention group ( 37 ). Quality assessment All twenty-two studies were evaluated for quality using the RoB2 tool, as described previously. Figure 2 summarises the classification for all domains. The overall risk of bias was rated as high for 36,4% (n = 8) of the studies ( 20 , 24 – 27 , 33 , 34 , 36 ), 31,8% (n = 7) were rated as low risk of bias ( 21 , 28 – 30 , 32 , 35 , 37 ), and 31,8% (n = 7) were rated with unclear risk of bias ( 22 , 23 , 31 , 38 – 41 ). The randomisation process was rated with a low risk of bias for 86,4% of the studies; the other 13,6% were rated as unclear since randomisation was only reported and not explained. Due to a lack of information concerning several questions, some domains are at high or unclear risk of bias. Zinc Three studies investigated the effect of zinc on quality of life ( 22 ), physical and psychological symptoms ( 21 ) and the improvement of symptoms ( 20 ) in women with PMS. Jafari et al. ( 22 ) studied the effect of zinc (30mg) on quality of life and found that the intervention group increased physical health domain (23.53 ± 2.92 to 28.81 ± 2.63 points, p < 0.001), and total score of quality of life (78.46 ± 6.98 to 86.88 ± 10.06 points, p < 0.001); however, the total score of quality of life was not significant when compared with the placebo group. Additionally, psychological health, social and personal relationships, and environmental aspects of life domains did not improve during the intervention. In another study, Jafari et al. ( 21 ) compared the effect of a 30mg zinc supplement over 12 weeks on physical and psychological symptoms; the intervention group showed decreased physical symptoms (0.66 ± 0.62 to 0.32 ± 0.29 points, p = 0.03), and psychological symptoms (0.62 ± 0.43 to 0.31 ± 0.36, p = 0.006), at the end of the intervention, compared to the placebo group (physical symptoms: 0.47 ± 0.31 to 0.45 ± 0.3 points, p = 0.20; psychological symptoms: 0.47 ± 0.29 to 0.48 ± 0.4 points, p = 0.77). Ahmadi et al. ( 20 ) studied the effect of zinc supplementation (50mg) on improving PMS symptoms. The results showed that the zinc supplement was effective in all dimensions of the PSST questionnaire. However, the mean scores for anger/irritability and anxiety/tension significantly differed between the intervention and control groups (Intervention group: 3.04 ± 0.41 points; Control group: 3.89 ± 1.02 points; p = 0.014 and Intervention group: 3.21 ± 0.48 points; Control group: 3.79 ± 0.86 points; p < 0.001), with an improvement seen in the intervention group. Calcium Shobeiri et al. ( 24 ) studied the effect of 500mg calcium supplementation on PMS symptoms during an 8-week intervention. This study showed significant differences in subgroups of depression (Intervention group: 2.16 ± 0.95 points; Control group: 1.75 ± 0.71 points, p = 0.052), emotional changes (Intervention group: 1.88 ± 1.02 points; Control group: 1.56 ± 0.66 points, p = 0.143), and somatic changes (Intervention group: 2.41 ± 1.07 points; Control group: 2.22 ± 0.55 points, p = 0.383) in the intervention group compared with placebo after treatment; depression (Intervention group: 1.09 ± 0.92 points; Control group: 2.00 ± 0.67 points, p = 0.001), emotional changes (Intervention group: 0.94 ± 0.87 points; Control group: 1.28 ± 0.77 points, p = 0.032), and somatic changes (Intervention group: 1.32 ± 0.39 points; Control group: 2.41 ± 0.56 points, p = 0.001). Another study from Yurt et al. ( 23 ) evaluated the effect of a dairy product intake − 50g of kasseri cheese and other recommendations, such as consuming 400 ml of milk and 150g of yoghurt daily - for two months in women with PMS. In this study, the Premenstrual Syndrome Scale (PMSS) score, except for the appetite change between the baseline and post-intervention, decreased in the intervention group. Physical functions and mental health scores on the SF-36 quality of life scale were increased in the intervention group, indicating a positive effect of dairy product intake on PMS symptomatology. Vitamins Both studies on Vitamin D were conducted in women with a vitamin D deficiency. The dose of vitamin D and duration of intervention differed between the two studies. In both studies, serum 25-hydroxyvitamin D (25(OH) D) increased from deficient to insufficient, ( 28 ) and from deficient to normal levels ( 29 ). Abdollahi et al. ( 28 ) reported no significant differences between the two groups regarding the 14 symptoms on the PSST after 12 weeks of supplementation with 2000 IU of vitamin D. However, the severity of nervousness, slump job activity, fatigue, and physical symptoms improved at the end of the intervention, and these changes were significantly different compared to the baseline in the vitamin D group. Heidari et al. ( 29 ) used 50.000 IU of vitamin D to evaluate its impact on PMS symptoms. The results showed an improvement in the mean score of total PMS symptoms in the vitamin D group (p < 0.001) and placebo group (p < 0.001), though the improvement was greater in the intervention group. The improvement of symptoms in the control group can be explained by increased serum 25(OH) D due to greater sun exposure. Heidari et al. ( 30 ) conducted a study in 2024, similar to a previous study, on the effect of vitamin D supplementation on symptom severity in vitamin D-insufficient women with premenstrual syndrome. This study, as expected, confirms a remarkable decrease in the mean score of psychological and physical symptoms of PMS in the intervention group, compared to the control group (p < 0.001). Abdollahifard et al. ( 27 ) studied the effect of 100mg of vitamin B1 on ameliorating PMS symptoms. The overall severity of symptoms decreased in both groups after the intervention, but more so in the vitamin B1 group. Physical and mental symptom severity decreased in the intervention group and was statistically different from the placebo group. Higuchi et al. ( 31 ) studied the effect of gamma-tocopherol (180mg), a natural vitamin E homolog, over two menstrual cycles. This study employed a crossover design, with both groups taking a placebo and gamma-tocopherol in reverse order. Results showed that during the placebo intake, participants reported higher levels of "breast tenderness/soreness", "abdominal bloating", and "irritability/anger" during the luteal phase compared to the follicular phase. Furthermore, Visual Analog Score (VAS) scores for "fatigue" and "irritability/anger" were lower with gamma-tocopherol intake than with placebo. Mixed micronutrients Retallick-Brown et al. ( 26 ) compared the effects of a broad-spectrum micronutrient formula containing diverse minerals, vitamins, amino acids, and antioxidants, to those of vitamin B6 (exclusively) on PMS symptoms. Both treatments had moderate effects on all five Daily Record of Severity of Problems (DRSP) variables, with an equal magnitude reduction in scores of PMS symptoms in the intervention and control groups. Moreover, the broad-spectrum decrease in mean scores of physical, psychological, and general symptoms compared to the control group. The authors concluded that there was a reduction in symptoms in both groups, but the decrease was more effective in the broad-spectrum micronutrient formula group. Masoumi et al. ( 25 ) studied the combined use of calcium and vitamin B6 on PMS symptoms. The intervention group received 500mg of calcium and 40mg of vitamin B6, and the control group received only vitamin B6 (in an unspecified amount) twice daily for two consecutive months. Results showed that calcium plus vitamin B6 significantly reduced the mean scores of physical symptoms (Intervention group: 0.57 ± 0.31 to 0.25 ± 0.15 points vs. Control group: 0.53 ± 0.33 to 0.42 ± 0.46points, p = 0.03), psychological symptoms (Intervention group: 0.74 ± 0.37 to 0.26 ± 0.21 points vs. Control group: 0.61 ± 0.36 to 0.47 ± 0.37 points, p = 0.003), as well as general symptoms (Intervention group: 0.72 ± 0.33 to 0.25 ± 0.17 points vs. Control group: 0.61 ± 0.35 to 0.44 ± 0.32 points, p = 0.002). Others Sodouri et al. ( 32 ) evaluated the effect of Zataria multi-flora essence (20mg) on the severity of PMS for two menstrual cycles. The severity of PMS reduced significantly in both the intervention and control groups. There were no significant differences between the groups in terms of severity and frequency of symptoms. Behboudi-Gandevani et al. ( 33 ) studied the effect of omega-3 (1g) supplementation for three menstrual cycles on PMS-related quality of life. Most PMS symptoms and PMS interference with daily activities were significantly reduced over the follow-up period. Esmaeilpour et al. ( 34 ) conducted a study to evaluate the effects of an enriched whole-grain diet on PMS reduction. Participants in the intervention group received 120g of whole bread daily and a list of whole grain foods to substitute refined grains for three months. After the intervention, the results showed significant differences in energy consumption; protein, carbohydrate, iron, magnesium, zinc, vitamin E, thiamine, pantothenic acid, tryptophan, biotin, dietary fibre, and cereals were higher in the intervention group. Over time, the intervention showed significant mean scores of general mood, physical and behavioural symptoms of PMS, compared to the control group. Ataollahi et al. ( 35 ) studied the effect of wheat germ extract (400mg) on PMS symptoms for two months. The severity of both general and psychological symptoms was reduced in both groups, but the reduction was higher in the intervention group (p < 0.001). Furthermore, the reduction in severity of physical symptoms was statistically significant only in the intervention group. Specifically, severity reduction occurred on fatigue (85.32%), irritability (84.80%), palpitation (80.24%), tension (80.24%), breast tenderness (79.71%), headache (76.52%), sleep problems (73.79%), increased appetite (73.12%), acne (70.40%), mood swings (69.64%), food cravings (68.71%), wish to be alone (68.10%), depression (61.64%), forgetfulness (59.15%), anxiety (58.94%), poor concentration (56.72%), crying (44.53%) and swelling (25.72%). Overall, there was a significant difference in all symptoms in the wheat germ group, and the number of painkillers was also reduced. Yilmaz-Akyuz et al. ( 36 ) studied the effect of diet and aerobic exercise separately on PMS over 12 weeks. The prescribed diet was rich in complex carbohydrates and low in refined sugar; participants were given fish 1–2 times a week, had to consume > 1000mg of calcium and 20 grams of dried nuts, and were limited to < 300mg of caffeine consumption. Additionally, the consumption of acidic, carbonated foods and extra salt was also limited. There were no differences between the groups before and after the intervention; however, the PMS score of the diet group decreased significantly (120.62 ± 33.03 to 112.20 ± 29,47 points, p = 0.0001). VAS, which was used to score pain severity, was significantly lower in the diet group compared to the control (Intervention group: 7.07 ± 1.32 to 4.91 ± 1.6 points, p < 0.0001 vs. Control group:6.91 ± 1.13 to 6.69 ± 1.21 points, p = 0.0001). Khayat et al. ( 37 ) evaluated the effect of treating PMS with 250mg of ginger for three menstrual cycles on the severity of PMS symptoms. Results showed a significant reduction in mood symptoms, as well as physical and behavioural symptoms: before intervention (Intervention group: 38.97 ± 14.16 points vs. Control group: 37.42 ± 17.37points, p = 0.69); (Intervention group: 45.76 ± 19.76 points vs. Control group: 42.64 ± 23.83 points, p = 0.56); (Intervention group: 25.42 ± 16.05 points vs. Control group: 26.64 ± 16.20 points, p = 0.78), after intervention (Intervention group: 13.45 ± 10.65 points vs. Control group: 38.37 ± 20.31 points, p < 0.0001); (Intervention group: 22.76 ± 19.62 points vs. Control group: 42.06 ± 22.76 points, p = 0.0005); (Intervention group: 10.85 ± 13.05 points vs. Control group: 25.61 ± 18.47 points, p = 0.0004). Hosseini et al. ( 40 ) studied the effect of an alternate-day modified fasting (ADMF) diet on PMS symptoms and health-related quality of life in obese or overweight women. The ADMF diet consisted of alternating periods of feasting and fasting. During the fasting days, the intervention group only consumed 25% of the daily calorie requirements from 12:00 pm to 2:00 pm, outside this window, they were allowed to drink water and other calorie-free drinks, with a daily limit of 400mg of caffeine; on feasting days, participants consumed their entire daily calorie requirement. The control group consisted of a deficit calorie restriction of 37%. On both diets, the macronutrient distribution was 15% protein, 30% fat and 55% carbohydrates. Participants were required to follow their prescribed diet for 8 weeks and cook all their meals at home. There was a statistically significant decrease in mood lability before and after the study (p = 0.002) in the intervention group. This group also showed a significant change in expressed anger (p < 0.001). There were no significant differences in other calendar of premenstrual experiences (COPE) subscales. Regarding the SF-12 survey, the intervention group showed significant improvements in the total score (p < 0,001) as well as physical function (p = 0,006) and mental health (p < 0,001) compared to the control group (p = 0,110; p = 0,296; p = 0,091), showing an improvement in health-related quality of life in the intervention group. As expected from a calorie deficit, the body weight and Body Mass Index of both intervention and control groups showed a significant decrease before and after the intervention (p < 0,001; p < 0,001, respectively). There were no significant changes in fat-free mass (p = 0,936) and skeletal muscle mass (p = 0,841) between the two groups, but there were significant differences in body fat mass (BFM) (p < 0,001), and waist circumference (WC) (p = 0,029) between the two groups, being the percentage change of BFM and WC higher in the intervention group. Aker et al. ( 39 ) evaluated the effect of hydrogen-rich water consumption on PMS symptoms and quality of life. This study showed, that in the first and second follow-ups, the intervention group had significantly lower mean scores on PMSS (1st follow-up – 113,76 ± 29,45 points; 2nd follow-up – 119,30 ± 33,36 points; p = 0,003) compared to the control group (1st follow up – 134,91 ± 24,96 points; 2nd follow up – 141,03 ± 23,84 points; p = 0,004). When assessed the WHOQOL-BREF, in the first follow-up, the intervention group had significantly higher mean scores in physical health (Intervention Group: 25,48 ± 3,15 points vs Control Group: 23,28 ± 4,30 points, p = 0,021) and psychological domain (Intervention Group: 19,73 ± 2,27 points vs Control Group: 17,88 ± 2,64 points, p = 0,003). No significant differences were found in the social domain and environment domain in the first follow-up between groups, nor in the second follow-up in all domains of the WHOQOL-BREF. Herrera et al. ( 38 ) studied the effect of a commercial phytotherapeutic dietary supplement (PREMEN-CALM) in the management of PMS. The supplement contained a combination of several active ingredients with antioxidant and anti-inflammatory properties (GABA, Rhodiola rosea L. and Vitex Agnus Castus ), which could affect the total antioxidant status (TAS), and therefore, reduce some symptoms of PMS, especially psychologically related symptoms. The results showed a significant increase in the TAS (p < 0,05) compared to the reference value in the intervention group. No significant differences in body composition between groups before and after intervention were found, and the subjective sleep quality did not show significant differences when comparing within and between groups; however, there was a slight decrease in the mean total scores of the women who received the intervention. Regarding the quality-of-life evaluation, there were no significant differences between groups in any of the domains (physical health, psychological health, social relationships, and environmental health). The evolution of menstrual characteristics was also evaluated, showing significant changes in the intervention group, increasing the percentage of participants who had no affective symptoms on the third cycle; no significant differences were observed for the somatic symptoms, pain intensity, need for analgesics, frequency and impact on daily life. On the contrary, results showed a significant decrease in the State-Trait Anxiety Inventory total score (p < 0,05), for the intervention group after three months of supplementation. Farrokhfall et al. ( 41 ) studied the effects of curcumin on nitric oxide levels in women with PMS and dysmenorrhea. This study showed, within-group analysis, a significant decrement in oxidised metabolites (NOx) levels post-intervention (p = 0.048); in the control group, NOx remained stable by the end of the trial (p = 0.32). Between-group comparisons revealed no significant differences in the net change of NOx level in the intervention group compared to the control group postintervention (p = 0.31). After the intervention, the between-group analysis showed no significant differences in the NOx index (p = 0.36). However, a significant reduction was found in PSST score after treatment in the intervention group (32.1 ± 9.6 to 20.4 ± 9.8, p < 0.001) and control group (30.9 ± 8.2 to 22.2 ± 9.9, p < 0.001). A significant Pearson´s correlation coefficient was observed between NOx level variation with PSST score variation only in the intervention group (r = 0.34, p = 0.042). Discussion This systematic review included diverse studies addressing nutritional interventions, such as supplementation or a specific diet, for managing PMS symptoms. Most of the studies (n = 13) included in this systematic review analysed the effect of micronutrients on PMS scores and symptoms ( 20 – 22 , 24 – 29 , 31 , 33 ). One study focused on PMS treatment with ginger ( 37 ), another on the effect of Zataria multi-flora essence ( 32 ), and another on the effect of curcumin in PMS and dysmenorrhea ( 41 ). Four studies' interventions focused on specific dietary changes( 23 , 34 , 36 , 40 ). One study focusing on the ingestion of hydrogen-rich water on PMS was also included ( 39 ), and one study focusing on a phytotherapeutic dietary supplement on PMS ( 38 ). The methodology of the studies was similar, with variations in intervention duration, participants, and tools used to evaluate PMS. Of all 22 studies, two were uncertain of the effects of the intervention on PMS ( 32 , 41 ). Studies with a confoundable variable (placebo) showed clearer results, though some aspects did not show significant differences between the placebo and intervention groups. In most studies, the placebo group showed improvements in scores or symptoms of PMS, however small they may have been. Receiving a placebo treatment may positively affect mental status, thus reducing some of the symptoms of PMS ( 42 , 43 ). Most studies included in this review focus on addressing premenstrual syndrome through the utilisation of supplements. Particular attention was given to examining micronutrients, namely zinc, calcium, and vitamins, specifically vitamins B6, B1 and D. Several micronutrients can impact reducing PMS, and their mechanisms of action are complex and multifaceted. Calcium and B vitamins may affect neurotransmitter regulation ( 44 , 45 ). For example, vitamin B6 is a cofactor in transforming the tryptophan amino acid to serotonin, and riboflavin is necessary for the activation of vitamin B6 ( 45 ); thus, both may have a positive influence on mood-related symptoms such as irritability and depression. On the other hand, vitamin B1 stimulates the central nervous system and elevates mood. Vitamin B1 may increase endorphin secretion ( 45 ), thus causing relaxation and ameliorating symptoms, especially psychological ones ( 27 ). Furthermore, both included studies in this review regarding vitamin D reported an improvement of symptoms after supplementation with 2000 IU ( 28 ) and 50.000 IU ( 29 ). Vitamin D has known anti-inflammatory properties ( 46 ), and inflammation is thought to play a role in developing PMS ( 47 ); thus, by reducing inflammation, vitamin D may help alleviate pain, bloating and other symptoms associated with PMS. The study regarding gamma-tocopherol showed an improvement in somatic and mental symptoms as well as greater natriuresis, which may have led to a reduction of thigh circumference and a reduction in VAS score for “swelling of the legs” and “heavy legs” ( 31 ). Gamma-tocopherol is a form of vitamin E with antioxidant properties ( 48 ). By reducing oxidative stress, it may help alleviate some PMS symptoms. Additionally, it has a diuretic property ( 49 ), which can help reduce oedema or bloating. In the present review, a consistent trend emerged across all studies evaluating zinc supplementation, demonstrating improvements in numerous symptoms and overall quality of life. Zinc is concentrated in the hippocampus and, in PMS patients, is usually decreased ( 50 ); this can result in dysregulation of glucocorticoid secretion and cause neuropsychological dysfunctions such as isolation, irritability, and depression ( 51 ), symptoms associated with PMS. Some studies have shown decreased total antioxidant capacity (TAC) in women with PMS ( 50 , 52 ). Jafari et al.’s ( 21 ) study revealed a significant decrease in physical and psychological symptoms, as well as an increase in TAC and Brain-Derived Neurotrophic Factor (BDNF) for participants with zinc supplementation. Considering the antioxidant ( 53 ) and anti-depressive role of zinc ( 54 ), it may have a role in decreasing PMS symptomatology, especially psychological symptoms. Apart from nutrient supplementation, this review included studies which showed improvements in PMS parameters, focusing on wheat germ ( 35 ), dairy products ( 23 ), and whole grains ( 34 ). These have available essential vitamins and minerals, including calcium, zinc, vitamin B, and more, which have been previously elucidated to effectively reduce some PMS symptoms, making them potential candidates for managing the condition. Khayat et al. study ( 37 ) showed a substantial difference in scores between groups. It is believed that PMS may be related to changes in the prostaglandin system ( 55 ). During the luteal phase, there is an increase in prostaglandins in the endometrial tissue, leading to uterine contractions (to shed the uterine lining) and symptoms like bloating and cramping. Prostaglandin imbalances can also contribute to emotional and psychological symptoms ( 56 ). Ginger may prevent the production of prostaglandins by inhibiting the metabolism of cyclooxygenase and lipoxygenase ( 57 ); it also has anti-inflammatory properties ( 58 ), though it may help to reduce PMS symptoms. Farrokhfall et al. ( 41 ) and Herrera et al. ( 38 ) focused on the antioxidant and anti-inflammatory properties of curcumin and hormone regulation properties of phytotherapeutic dietary supplements (GABA, Rhodiola rosea L. and Vitex agnus castus ); they can help in the reduction of PMS symptoms, such as reduction of pain, and effective in reducing symptoms such as irritability and mood changes. This review shows that altering lifestyles or supplement intake can improve PMS symptomatology with no or mild side effects; however, studies on this matter are still scarce. These findings are promising, as the first line of treatment for PMS is selective serotonin reuptake inhibitors, which have associated side effects such as weight gain, sexual dysfunction, and sleep disturbances ( 59 ). It is crucial to continue research on this topic, as the aetiology of PMS is still unclear and lacks a concrete explanation of its cause. According to the quality assessment of the studies, seven were rated as high risk of bias, and seven were unclear, thus requiring careful interpretation. The domain “Deviations from the intended interventions” had the highest risk of bias, possibly because of the lack of measurements for intervention adherence in some studies. This review has both strengths and limitations. Its strength lies in the fact that it followed the PRISMA guidelines for searching, screening, and evaluating the literature, and three databases were used to reduce the chances of any relevant studies being missed. The primary limitation was the heterogeneity of the included studies, making it challenging to compare them due to their varying focuses. Furthermore, a large number of participants and a longer intervention duration would be beneficial for a more precise evaluation of the intervention's effects on PMS-related symptoms and a better understanding of its long-term impact. Conclusion This systematic review revealed that it is possible to improve the symptoms of PMS through a nutritional approach with supplements or dietary changes. A healthy, varied, and balanced diet, rich in vegetables, fruits, and legumes, may help manage PMS symptoms. However, there is little information available on specific diets or dietary habits related to this topic. Thus, investigating the relationship between a specific diet, based on previously revealed evidence, through experimental studies, would align with a broader approach, avoiding reliance on supplementation or pharmacological treatments for managing symptoms related to PMS. Declarations Conflict of Interest All authors declare no conflicts of interest. Funding No financial support or funding was provided for the conduct of this study. Author Contributions AN, CL and SA conceptualised the study and designed the review protocol. CL and SA supervised the project. AN and CL conducted the literature search, screened articles, extracted data, and assessed the quality of the studies. AN also performed the initial data synthesis and drafted the first version of the manuscript. All authors contributed to the interpretation of results and provided critical revisions to the manuscript. All authors read and approved the final version of the manuscript. 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(2020) (22) Zinc gluconate (Elemental zinc) Placebo (starch) 60 18-30 WHOQOL-BREF Zinc gluconate tablet (30mg/day) 12 weeks Increased score of the first domain of quality of life (improved physical aspects). Quality of life total score improved in intervention group, with no significant changes between groups Reported (no side effects) Jafari et al. (2020) (21) Zinc gluconate (Elemental zinc) Placebo 60 18-30 Daily Record Questionnaire based on DSM-VI Zinc gluconate (30mg/day) 12 weeks Decreased physical symptoms average score and psychological symptoms average score compared to placebo Reported (no side effects) Ahmadi et al. (2022) (20) Elemental zinc Placebo 72 18-35 PSST Zinc sulphate capsules 220mg (50mg zinc/day) 24 weeks The mean score of anger and irritability, anxiety, and tension 1 month after intervention was significatively different between intervention and control groups. (Intervention group shown more decrease on mean score) Not reported Calcium Shobeiri et al. (2016) (24) Calcium Placebo (starch) 66 >18 DRSP Calcium tablets (500mg/day) after lunch 8 weeks Significant differences in subgroups of depression, emotional changes, and somatic changes in intervention after the intervention. Reported (no side effects) Yurt et al. (2020) (23) Dairy Calcium consumption not altered 40 20-28 PMSS Quality of Life Scale (SF-36) Foods containing at least 1000mg of calcium (kasseri cheese 50g, 400ml milk, 150 yogurt) daily 2 months PMSS score and sub-scale scores except the appetite change between the baseline and post-intervention decreased in intervention group. Physical functions and mental health scores on the SF-36 quality of life scale were increased Not reported Vitamins Abdollahifard et al. (2014) (27) Vitamin B1 Placebo (Starch powder) 100 18-30 DSRF based on DSM-IV 1 pill in the morning (100mg) and 1 at night (100mg) during 1 week before menses 3 cycles The average of physical and mental symptoms severity of PMS reduced in vitamin B1 group after treatment, and the comparison with control group was significantly different. Reported (Yes, not specified in 1.7% in intervention group) Abdollahi et al. (2019) (28) Vitamin D Placebo (maltodextrin) 146 18-30 PSST (Iranian version) 1 tablet every day with lunch (2000IU) 12 weeks No significant differences in symptoms of PMS between the 2 groups. Vitamin D group the severity of nervousness, slump job activity, fatigue, and physical symptoms improved at the end of intervention, and were statistically significant compared to baseline. Not reported Heidari et al. (2019) (29) Vitamin D3 Placebo (paraffin) 44 18-25 PMS Daily Symptoms Rating Pearl of Vitamin D (50,000 IU/fortnightly) 4 months Mean score of the total PMS symptoms showed significant improvement in vitamin D group. Reported (no side effects) Heidari et al. (2023) (30) Vitamin D Placebo (paraffin) 44 18-25 PMS Daily Symptoms Rating Pearl of Vitamin D (50,000 IU/fortnightly) 4 months Mean score of psychological and physical symptoms of PMS decreased significantly in vitamin D group. Reported (no side effects) Higuchi et al. (2023) (31) γ-tocopherol dissolved in Vitamin E-stripped corn oil Placebo (Vitamin E-stripped corn oil) 51 >20 VAS MEDI-Q 2 capsules (92mg of γ-tocopherol) twice a day for 7 days in the luteal phase 2 cycles VAS scores for fatigue and irritability/angry were significantly lower with y-tocopherol intake than with placebo. Not reported Mixed micronutrients Masoumi et al. (2016) (25) Calcium + Vitamin B6 Vitamin B6 76 20-30 DRS Questionnaire Calcium tablet (500mg) + vitamin B6 (40mg), twice a day between the 16 th day of menstrual cycle and the 5 th day of the next menstrual cycle 2 months Both mean scores of physical and psychological symptoms decreased compared to the control group, as well as the mean score of general symptoms, with significant differences Not reported Retallick-Brown et al. (2020) (26) Micronutrient Formula Vitamin B6 78 >18 DRSP WQoLQ 4 capsules twice a day with food and water 3 cycles Reduction of scores of DRSP of equal magnitude for both groups. Quality-of-life ratings showed significantly greater improvement in micronutrient formula. Reported (None or mild) Others Sodouri et al. (2013) (32) Zataria multi-flora essence Placebo (Nonactive ingredients) 88 18-35 PRISM 2 pearls (20 mg of Zataria multi-flora essence) every 12 hours 7 days before menses for 2 menstrual cycles 2 cycles Mean of PMS severity reduced in both groups after intervention, but with no significant differences. Frequency of symptoms also decreased in both groups with no significant differences. Not reported Behboudi-Gandevani et al. (2017) (33) Omega-3 Placebo 95 20-35 PSST (Iranian version) Quality of Life Scale (SF-12) (Iranian version) 2 capsules daily (1g omega-3/capsule) for 10 consecutive days from 8d before and 2d after menstruation 3 cycles Most PMS symptoms and PMS interference with daily activities were significantly reduced over the follow up period, but with no significant differences between groups Reported (No side effects) Esmaeilpour et al. (2019) (34) At least 4 servings of whole grains No changes in diet 100 18-45 DRS Questionnaire 120g of whole bread and at least 4 serving of whole grain 3 months Consumption of whole grains was higher in intervention group. Scores of general, mood, physical and behavioural symptoms were significantly reduced in intervention group in comparison with control group. Not reported Ataollahi et al. (2015) (35) Wheat germ Placebo 100 20-25 DRS Questionnaire Wheat germ capsule (400mg), 3 times a day between the 16 th day of menstrual cycle to the 5 th day of the next cycle 2 months Severity of general and psychological symptoms reduced in both groups, but the reduction was significantly greater in the wheat germ extract group. Reduction in severity of physical symptoms was statistically significant only in wheat germ extract group. Reported (No side effects) Yilmaz-Akyuz et al. (2019) (36) PMS Diet No changes in diet nor exercise 111 18-35 PMSS VAS 50-55% CH, 25-30% F, 15-20% P (rich in complex carbohydrates, refined sugars limited, 1-2 times/week of fish, daily >1000mg calcium and 20g of dried nuts. <300mg caffeine 12 weeks No statistically significant difference between control group and intervention but decrease of PMS score of diet group. VAS score was significantly lower on diet group compared to control. Not reported Khayat et al (2014) (37) Ginger Placebo 70 18-35 Daily Record Scale Questionnaire based on DSM-IV 1 capsule (250mg of ginger) every 12 hours from 7 d before and 3 days after onset of menses 3 cycles Significant differences in total score of PMS, severity of mood, and physical and behavioural symptoms between the two groups after intervention, and ginger could reduce severity of PMS. Reported (nausea in ginger group n=1) Herrera et al. (2024) (38) PREMEN-CALM Placebo (potato starch) 44 18-40 Self-report characteristics of menstrual cycle PSQI STAI WHOQOL-BREF 1 daily capsule (400mg GABA, 250mg dry extract of Rhodiola rosea L. root, 125mg dry extract of Vitex agnus castus fruit; coating – potato starch, purified water, gellan gum, 1mg of melatonin and 0,7mg of vitamin B6) 30-60min before bedtime 3 cycles Slight decrease in the mean score total score of PSQI in intervention group. Significant decrease in the STAI total score for the intervention group. Non-significant changes were observed between groups in WHOQOL-BREF. Affective symptoms decreased in the intervention group. Reported (No side effects) Aker et al. (2024) (39) HRH Normal water 98 >18 PMSS WHOQOL-BREF 300-400ml of HRW (one hour before breakfast and lunch, two hours after lunch, one hour before dinner and half an hour before bedtime) from the 16 th of the menstrual cycle until the 2 nd day of the menstrual phase 3 cycles Significantly lower mean on PMSS in the first and second follow-ups in the intervention group. Higher mean scores in physical health and in the psychological domain of the WHOQOL-BREF in intervention group. Not reported Hooshiar et al. (2024) (40) ADMF DCR (63% of daily calorie requirements) 60 18-50 PSST COPE SF-12 Feasting (daily calorie requirement) and fasting (25% of daily calorie requirements from 12:00pm to 2:00pm), staring at midnight every day 8 weeks Significant change in expressed anger compared to the control group. Intervention group with an improvement in the SF-12 total score, as well as the physical function and mental health. Reported (No side effects) Farrokhfall et al. (2023) (41) Curcumin Placebo (500mg of lactose plus 5mg of peperine) 76 18-24 PSST 1 capsule (500mg curcuminoids + 5mg peperine) per day for 10 days (7 days pre and until 3 days post start of menstruation) 3 cycles Significant reduction in PSST score after treatment in the intervention group. Not reported CH, Carbohydrate; DRS, Daily Symptom Record; DRSP, Daily Record of Severity of Problems; DSM-VI, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DSRF; Daily Status Record Form; F, Fat; MEDI-Q, Menstrual Distress Questionnaire; P, Protein; PMS, Premenstrual Syndrome; PMSS, Premenstrual Syndrome Scale; PRISM, Prospective Record of the Impact and Severity of Menstrual Symptoms; PSST, Premenstrual Syndrome Screening Tool; SF-32, Short Form – 12 Questionnaire (Iranian version); SF-36, Short Form – 36 Questionnaire; VAS, Visual Analog Score; WHOQOL-BREF, World Health Organization Quality of Life Brief Version; WQoLQ, Women’s Quality-of- Life Questionnaire; PSQI, Pittsburgh Sleep Quality Index; STAI, State-Trait Anxiety Inventory; GABA, Gamma Aminobutyric Acid; HRW, Hydrogen-rich water ; ADMF, Alternate-Day Modified Fasting; DCR, Daily Calorie Restriction ; COPE, Calendar of premenstrual experiences Additional Declarations There is NO conflict of interest to disclose. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7101209","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":485425662,"identity":"675f46ee-0531-498c-aa14-e98a7500a7b4","order_by":0,"name":"Ana Nobre","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYHACxgMMBkBKAog/ADEbOxF64FoYZ4C0MBOlhQGihZkHxCCkhX9284PDPAV1efzSvQ8f2/zaJs/HzMD44WMObi0Sd44ZHOYxOFwsOee4sXFu323DNmYGZsmZ2/BYcyMBpOVA4oYbaWzSuT23GYFa2Jh58WiRv5H+AailDqSF/bdlz217gloMbuSAbGEG28LM8ON2IkEthjdyCg7OMTicOHPOMWbJ3obbyW3MjM14/SJ3I33jgzd/6hL7pdsYP/z4c9t2fnvzwQ8f8XkfBTC2gckGYtWDwB9SFI+CUTAKRsFIAQC7VlKgAgwAQQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Trás-Os-Montes e Alto Douro","correspondingAuthor":true,"prefix":"","firstName":"Ana","middleName":"","lastName":"Nobre","suffix":""},{"id":485425663,"identity":"64ef1609-6e32-41f7-92f2-daf6aecd5ac0","order_by":1,"name":"Carla Lagoa","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Carla","middleName":"","lastName":"Lagoa","suffix":""},{"id":485425664,"identity":"ffc1e418-19ba-4ed3-8ea4-c7720aa3201f","order_by":2,"name":"Sandra Abreu","email":"","orcid":"","institution":"University of Trás-Os-Montes e Alto Douro","correspondingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"","lastName":"Abreu","suffix":""}],"badges":[],"createdAt":"2025-07-11 11:35:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7101209/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7101209/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87020120,"identity":"cef259a5-3cee-4959-bc81-53a98a5d5fe1","added_by":"auto","created_at":"2025-07-18 10:58:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55709,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram summarising the results of the search and selection process.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7101209/v1/3fbe143e5a283a0d6069cf52.png"},{"id":87020135,"identity":"42e33859-58d2-4e19-b210-cae2f72c4c02","added_by":"auto","created_at":"2025-07-18 10:58:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":262787,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias assessment of included randomised controlled trials.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7101209/v1/350d522f6fbb02c08ce923df.png"},{"id":87021752,"identity":"1f036593-1328-443d-93fc-ed43a330a9cd","added_by":"auto","created_at":"2025-07-18 11:22:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1070674,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7101209/v1/b7b6afdf-c85c-4d1c-8abe-803d514532d3.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Dietary Approach to Premenstrual Syndrome Symptoms Alleviation – A Systematic Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMost women experience some form of menstrual symptoms during their reproductive years. Premenstrual Syndrome (PMS) is a core premenstrual disorder (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and consists of physical, psychological, and behavioural symptoms that cause significant impairment to the individual (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The symptoms encompass various physical and psychological manifestations such as fatigue, headaches, bloating, mastalgia, irritability, anxiety, mood swings, sadness, depression, and decreased self-confidence (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). PMS usually occurs during all or part of the two-week premenstrual (luteal) phase of the menstrual cycle and stops with menses (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). It is estimated that 20–40% of reproductive women have recurrent moderate-to-severe PMS, and 3–8% have Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePMS can affect any fertile woman, as it has been proven that ovulation is required for the manifestation of PMS (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e); thus, suppressing ovulation could result in a major reduction or elimination of symptoms (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Although the aetiology of PMS remains unclear, some hypotheses suggest that it involves the interaction between hormonal fluctuations and neurotransmitter imbalances (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Some of the underlying mechanisms described for PMS pathophysiology involve the hypothalamic-pituitary-adrenal (HPA) axis, gamma-aminobutyric acid (GABA) system and serotonergic system (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral studies have suggested that the severity of PMS may be improved by lifestyle behaviours, such as aerobic exercise (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and dietary intake (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Dietary supplementation with calcium has been shown to be effective in relieving PMS symptoms (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The consumption of certain food groups has been associated with reducing PMS and its symptoms, such as vegetables, fruits, and legumes, as well as adopting low-fat and high-fibre diets (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIntending to diminish the dependency on pharmacological treatments and explore more natural approaches, this review of Randomised Controlled Trials (RCTs) aims to shed light on the potential benefits of dietary adjustments as a viable strategy for women experiencing PMS.\u003c/p\u003e\u003cp\u003eThis systematic review aims to identify and appraise the effect of dietary and nutritional interventions on alleviating PMS symptoms among non-menopausal women.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe present review was meticulously planned to follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Additionally, the protocol was registered in the international Prospective Register of Systematic Reviews (PROSPERO; CRD42023443974).\u003c/p\u003e\u003cp\u003e\u003cb\u003eLiterature search\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThree electronic databases – PubMed, Scopus, and Web of Science – were consulted in July 2024 to undertake a literature search. A timeline filter from 2013 to 2024 was applied to all databases. The search used a combination of Medical Subject Headings (MeSH) terms and keywords considering the intervention (\"diet\" OR \"dietary intake\" OR \"dietary habits\" OR \"nutrient intake\" OR \"diet composition\" OR \"nutrition\" OR \"eating attitudes\" OR \"food consumption\" OR \"dietary pattern\" OR \"diet therapy\" OR \"food therapy\" OR \"food intervention\" OR \"nutritional intervention\" OR \"nutrition intervention\" OR \"dietetic treatment\" OR \"dietetic intervention\" OR \"clinical nutrition\" OR \"diet modification\" OR \"micronutrients\" OR \"macronutrients\") and the condition of interest (“premenstrual syndrome\" OR \"premenstrual tension\" OR \"premenstrual dysphoric disorder\").\u003c/p\u003e\u003cp\u003e\u003cb\u003eEligibility criteria and selection process\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEligibility criteria were determined to begin the selection process as follows: published between 2013 and 2024; published in English, French, Spanish, or Portuguese; randomised controlled trials, randomised clinical trials or controlled clinical trials; a minimum of eight weeks or two menstrual cycles intervention; the main outcome of interest based on improving symptoms or the global score of PMS or PMDD in non-menopausal women (18 years or older) through dietary interventions; and secondary outcomes based on individual symptom cluster changes (psychological, behavioural, or physical symptoms). We excluded studies focusing on dietary interventions for PMS with cognitive-behavioural therapy and physical exercise. We conducted the screening process independently in two phases. Firstly, all articles were screened based on their titles and abstracts. Secondly, we analysed the full-text articles in their entirety. Disagreements on keeping or excluding studies were resolved through discussion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Extraction\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStudies were selected based on predetermined inclusion and exclusion criteria, and data regarding authors, sample size, participants, study design, intervention description, tools (used to evaluate primary and secondary outcomes), randomisation allocation, blinding, duration of intervention, outcomes, results, and adverse effects were documented.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRisk of Bias (RoB) and Quality Assessment (QA)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Cochrane Risk-of-Bias Tool (ROB2) was used to assess the methodological quality of the RCTs (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This tool evaluates various questions across five domains, including the randomisation process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of reported results. After answering these questions and evaluating the risk of bias for each domain, a final judgement of “Low”, “High”, or “Some concerns” risk of bias can be determined.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eStudy selection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarises the screening process. We gathered 552 studies from all databases, automatically removed 52 duplicates using Mendeley\u0026reg; Software, and manually removed an additional 168.\u003c/p\u003e\u003cp\u003eWe screened 331 studies based on title and abstract, excluding 300. We reviewed 31 full-length studies and included 19 for data extraction and quality assessment based on eligibility criteria. We identified five more studies via other methods (citation searching) and rejected one because it did not comply with the eligibility criteria for age.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis systematic review included a total of 22 RCTs. The characteristics of each study are presented in Table\u0026nbsp;1, sorted based on the type of intervention. Specifically, three studies investigated the effect of zinc on PMS (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Additionally, two studies examined the impact of calcium on PMS (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), while two others explored mixed interventions, i.e., calcium plus vitamin B6 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and a micronutrient formula (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), both of which compared vitamin B6 as the control group. Furthermore, three studies investigated the effects of various vitamins on PMS symptoms, including the impact of vitamin B1 on ameliorating PMS symptoms (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and the effects of vitamin D on women with PMS and vitamin D deficiency (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). One study focused on the effect of γ-tocopherol on PMS symptoms (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e); the remaining studies did not fall into a specific intervention category. These studies evaluated interventions such as \u003cem\u003eZataria\u003c/em\u003e Multi-Flora essence (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), omega-3 supplements (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), whole grains consumption (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), wheat germ (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), PMS Diet (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), ginger (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), a supplement (PREMEDN-CALM) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), and hydrogen-rich water (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) on PMS symptomatology. One study evaluated the effect of alternate-day modified fasting on premenstrual syndrome symptoms in obese or overweight women, compared to a daily calorie restriction (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), and one study evaluated the effect of curcumin on nitric oxide levels, and therefore on premenstrual symptoms in women with PMS (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). It is worth noting that all 22 studies administered the interventions orally. PMS symptoms and severity were measured through different tools, mostly using the Premenstrual Symptoms Screening Tool (PSST) and the Daily Record Symptoms Questionnaire (DRSP), as described in Table\u0026nbsp;1. Ten studies did not report side effects, nine reported no side effects, and three reported side effects - none or mild (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), non-specified in 1.7% of the intervention group (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), and nausea in one person from the intervention group (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuality assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll twenty-two studies were evaluated for quality using the RoB2 tool, as described previously. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises the classification for all domains. The overall risk of bias was rated as high for 36,4% (n\u0026thinsp;=\u0026thinsp;8) of the studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), 31,8% (n\u0026thinsp;=\u0026thinsp;7) were rated as low risk of bias (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), and 31,8% (n\u0026thinsp;=\u0026thinsp;7) were rated with unclear risk of bias (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The randomisation process was rated with a low risk of bias for 86,4% of the studies; the other 13,6% were rated as unclear since randomisation was only reported and not explained. Due to a lack of information concerning several questions, some domains are at high or unclear risk of bias.\u003c/p\u003e\u003cp\u003e\u003cb\u003eZinc\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThree studies investigated the effect of zinc on quality of life (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), physical and psychological symptoms (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and the improvement of symptoms (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) in women with PMS.\u003c/p\u003e\u003cp\u003eJafari et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) studied the effect of zinc (30mg) on quality of life and found that the intervention group increased physical health domain (23.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92 to 28.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63 points, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and total score of quality of life (78.46\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98 to 86.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06 points, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); however, the total score of quality of life was not significant when compared with the placebo group. Additionally, psychological health, social and personal relationships, and environmental aspects of life domains did not improve during the intervention.\u003c/p\u003e\u003cp\u003eIn another study, Jafari et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) compared the effect of a 30mg zinc supplement over 12 weeks on physical and psychological symptoms; the intervention group showed decreased physical symptoms (0.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 to 0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 points, p\u0026thinsp;=\u0026thinsp;0.03), and psychological symptoms (0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43 to 0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36, p\u0026thinsp;=\u0026thinsp;0.006), at the end of the intervention, compared to the placebo group (physical symptoms: 0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31 to 0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 points, p\u0026thinsp;=\u0026thinsp;0.20; psychological symptoms: 0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 to 0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 points, p\u0026thinsp;=\u0026thinsp;0.77).\u003c/p\u003e\u003cp\u003eAhmadi et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) studied the effect of zinc supplementation (50mg) on improving PMS symptoms. The results showed that the zinc supplement was effective in all dimensions of the PSST questionnaire. However, the mean scores for anger/irritability and anxiety/tension significantly differed between the intervention and control groups (Intervention group: 3.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41 points; Control group: 3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 points; p\u0026thinsp;=\u0026thinsp;0.014 and Intervention group: 3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 points; Control group: 3.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86 points; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with an improvement seen in the intervention group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCalcium\u003c/b\u003e\u003c/p\u003e\u003cp\u003eShobeiri et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) studied the effect of 500mg calcium supplementation on PMS symptoms during an 8-week intervention. This study showed significant differences in subgroups of depression (Intervention group: 2.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 points; Control group: 1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71 points, p\u0026thinsp;=\u0026thinsp;0.052), emotional changes (Intervention group: 1.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 points; Control group: 1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66 points, p\u0026thinsp;=\u0026thinsp;0.143), and somatic changes (Intervention group: 2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07 points; Control group: 2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55 points, p\u0026thinsp;=\u0026thinsp;0.383) in the intervention group compared with placebo after treatment; depression (Intervention group: 1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92 points; Control group: 2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67 points, p\u0026thinsp;=\u0026thinsp;0.001), emotional changes (Intervention group: 0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87 points; Control group: 1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77 points, p\u0026thinsp;=\u0026thinsp;0.032), and somatic changes (Intervention group: 1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39 points; Control group: 2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56 points, p\u0026thinsp;=\u0026thinsp;0.001). Another study from Yurt et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) evaluated the effect of a dairy product intake \u0026minus;\u0026thinsp;50g of \u003cem\u003ekasseri\u003c/em\u003e cheese and other recommendations, such as consuming 400 ml of milk and 150g of yoghurt daily - for two months in women with PMS. In this study, the Premenstrual Syndrome Scale (PMSS) score, except for the appetite change between the baseline and post-intervention, decreased in the intervention group. Physical functions and mental health scores on the SF-36 quality of life scale were increased in the intervention group, indicating a positive effect of dairy product intake on PMS symptomatology.\u003c/p\u003e\u003cp\u003e\u003cb\u003eVitamins\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBoth studies on Vitamin D were conducted in women with a vitamin D deficiency. The dose of vitamin D and duration of intervention differed between the two studies. In both studies, serum 25-hydroxyvitamin D (25(OH) D) increased from deficient to insufficient, (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and from deficient to normal levels (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Abdollahi et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) reported no significant differences between the two groups regarding the 14 symptoms on the PSST after 12 weeks of supplementation with 2000 IU of vitamin D. However, the severity of nervousness, slump job activity, fatigue, and physical symptoms improved at the end of the intervention, and these changes were significantly different compared to the baseline in the vitamin D group. Heidari et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) used 50.000 IU of vitamin D to evaluate its impact on PMS symptoms. The results showed an improvement in the mean score of total PMS symptoms in the vitamin D group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and placebo group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), though the improvement was greater in the intervention group. The improvement of symptoms in the control group can be explained by increased serum 25(OH) D due to greater sun exposure. Heidari et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) conducted a study in 2024, similar to a previous study, on the effect of vitamin D supplementation on symptom severity in vitamin D-insufficient women with premenstrual syndrome. This study, as expected, confirms a remarkable decrease in the mean score of psychological and physical symptoms of PMS in the intervention group, compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eAbdollahifard et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) studied the effect of 100mg of vitamin B1 on ameliorating PMS symptoms. The overall severity of symptoms decreased in both groups after the intervention, but more so in the vitamin B1 group. Physical and mental symptom severity decreased in the intervention group and was statistically different from the placebo group.\u003c/p\u003e\u003cp\u003eHiguchi et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) studied the effect of gamma-tocopherol (180mg), a natural vitamin E homolog, over two menstrual cycles. This study employed a crossover design, with both groups taking a placebo and gamma-tocopherol in reverse order. Results showed that during the placebo intake, participants reported higher levels of \"breast tenderness/soreness\", \"abdominal bloating\", and \"irritability/anger\" during the luteal phase compared to the follicular phase. Furthermore, Visual Analog Score (VAS) scores for \"fatigue\" and \"irritability/anger\" were lower with gamma-tocopherol intake than with placebo.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMixed micronutrients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRetallick-Brown et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) compared the effects of a broad-spectrum micronutrient formula containing diverse minerals, vitamins, amino acids, and antioxidants, to those of vitamin B6 (exclusively) on PMS symptoms. Both treatments had moderate effects on all five Daily Record of Severity of Problems (DRSP) variables, with an equal magnitude reduction in scores of PMS symptoms in the intervention and control groups. Moreover, the broad-spectrum decrease in mean scores of physical, psychological, and general symptoms compared to the control group. The authors concluded that there was a reduction in symptoms in both groups, but the decrease was more effective in the broad-spectrum micronutrient formula group.\u003c/p\u003e\u003cp\u003eMasoumi et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) studied the combined use of calcium and vitamin B6 on PMS symptoms. The intervention group received 500mg of calcium and 40mg of vitamin B6, and the control group received only vitamin B6 (in an unspecified amount) twice daily for two consecutive months. Results showed that calcium plus vitamin B6 significantly reduced the mean scores of physical symptoms (Intervention group: 0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31 to 0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15 points vs. Control group: 0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 to 0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46points, p\u0026thinsp;=\u0026thinsp;0.03), psychological symptoms (Intervention group: 0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37 to 0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21 points vs. Control group: 0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36 to 0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37 points, p\u0026thinsp;=\u0026thinsp;0.003), as well as general symptoms (Intervention group: 0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 to 0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17 points vs. Control group: 0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35 to 0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 points, p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003cp\u003e\u003cb\u003eOthers\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSodouri et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) evaluated the effect of \u003cem\u003eZataria\u003c/em\u003e multi-flora essence (20mg) on the severity of PMS for two menstrual cycles. The severity of PMS reduced significantly in both the intervention and control groups. There were no significant differences between the groups in terms of severity and frequency of symptoms.\u003c/p\u003e\u003cp\u003eBehboudi-Gandevani et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) studied the effect of omega-3 (1g) supplementation for three menstrual cycles on PMS-related quality of life. Most PMS symptoms and PMS interference with daily activities were significantly reduced over the follow-up period.\u003c/p\u003e\u003cp\u003eEsmaeilpour et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) conducted a study to evaluate the effects of an enriched whole-grain diet on PMS reduction. Participants in the intervention group received 120g of whole bread daily and a list of whole grain foods to substitute refined grains for three months. After the intervention, the results showed significant differences in energy consumption; protein, carbohydrate, iron, magnesium, zinc, vitamin E, thiamine, pantothenic acid, tryptophan, biotin, dietary fibre, and cereals were higher in the intervention group. Over time, the intervention showed significant mean scores of general mood, physical and behavioural symptoms of PMS, compared to the control group.\u003c/p\u003e\u003cp\u003eAtaollahi et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) studied the effect of wheat germ extract (400mg) on PMS symptoms for two months. The severity of both general and psychological symptoms was reduced in both groups, but the reduction was higher in the intervention group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the reduction in severity of physical symptoms was statistically significant only in the intervention group. Specifically, severity reduction occurred on fatigue (85.32%), irritability (84.80%), palpitation (80.24%), tension (80.24%), breast tenderness (79.71%), headache (76.52%), sleep problems (73.79%), increased appetite (73.12%), acne (70.40%), mood swings (69.64%), food cravings (68.71%), wish to be alone (68.10%), depression (61.64%), forgetfulness (59.15%), anxiety (58.94%), poor concentration (56.72%), crying (44.53%) and swelling (25.72%). Overall, there was a significant difference in all symptoms in the wheat germ group, and the number of painkillers was also reduced.\u003c/p\u003e\u003cp\u003eYilmaz-Akyuz et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) studied the effect of diet and aerobic exercise separately on PMS over 12 weeks. The prescribed diet was rich in complex carbohydrates and low in refined sugar; participants were given fish 1\u0026ndash;2 times a week, had to consume\u0026thinsp;\u0026gt;\u0026thinsp;1000mg of calcium and 20 grams of dried nuts, and were limited to \u0026lt;\u0026thinsp;300mg of caffeine consumption. Additionally, the consumption of acidic, carbonated foods and extra salt was also limited. There were no differences between the groups before and after the intervention; however, the PMS score of the diet group decreased significantly (120.62\u0026thinsp;\u0026plusmn;\u0026thinsp;33.03 to 112.20\u0026thinsp;\u0026plusmn;\u0026thinsp;29,47 points, p\u0026thinsp;=\u0026thinsp;0.0001). VAS, which was used to score pain severity, was significantly lower in the diet group compared to the control (Intervention group: 7.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32 to 4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 points, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001 vs. Control group:6.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 to 6.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21 points, p\u0026thinsp;=\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003eKhayat et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) evaluated the effect of treating PMS with 250mg of ginger for three menstrual cycles on the severity of PMS symptoms. Results showed a significant reduction in mood symptoms, as well as physical and behavioural symptoms: before intervention (Intervention group: 38.97\u0026thinsp;\u0026plusmn;\u0026thinsp;14.16 points vs. Control group: 37.42\u0026thinsp;\u0026plusmn;\u0026thinsp;17.37points, p\u0026thinsp;=\u0026thinsp;0.69); (Intervention group: 45.76\u0026thinsp;\u0026plusmn;\u0026thinsp;19.76 points vs. Control group: 42.64\u0026thinsp;\u0026plusmn;\u0026thinsp;23.83 points, p\u0026thinsp;=\u0026thinsp;0.56); (Intervention group: 25.42\u0026thinsp;\u0026plusmn;\u0026thinsp;16.05 points vs. Control group: 26.64\u0026thinsp;\u0026plusmn;\u0026thinsp;16.20 points, p\u0026thinsp;=\u0026thinsp;0.78), after intervention (Intervention group: 13.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.65 points vs. Control group: 38.37\u0026thinsp;\u0026plusmn;\u0026thinsp;20.31 points, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001); (Intervention group: 22.76\u0026thinsp;\u0026plusmn;\u0026thinsp;19.62 points vs. Control group: 42.06\u0026thinsp;\u0026plusmn;\u0026thinsp;22.76 points, p\u0026thinsp;=\u0026thinsp;0.0005); (Intervention group: 10.85\u0026thinsp;\u0026plusmn;\u0026thinsp;13.05 points vs. Control group: 25.61\u0026thinsp;\u0026plusmn;\u0026thinsp;18.47 points, p\u0026thinsp;=\u0026thinsp;0.0004).\u003c/p\u003e\u003cp\u003eHosseini et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) studied the effect of an alternate-day modified fasting (ADMF) diet on PMS symptoms and health-related quality of life in obese or overweight women. The ADMF diet consisted of alternating periods of feasting and fasting. During the fasting days, the intervention group only consumed 25% of the daily calorie requirements from 12:00 pm to 2:00 pm, outside this window, they were allowed to drink water and other calorie-free drinks, with a daily limit of 400mg of caffeine; on feasting days, participants consumed their entire daily calorie requirement. The control group consisted of a deficit calorie restriction of 37%. On both diets, the macronutrient distribution was 15% protein, 30% fat and 55% carbohydrates. Participants were required to follow their prescribed diet for 8 weeks and cook all their meals at home. There was a statistically significant decrease in mood lability before and after the study (p\u0026thinsp;=\u0026thinsp;0.002) in the intervention group. This group also showed a significant change in expressed anger (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant differences in other calendar of premenstrual experiences (COPE) subscales. Regarding the SF-12 survey, the intervention group showed significant improvements in the total score (p\u0026thinsp;\u0026lt;\u0026thinsp;0,001) as well as physical function (p\u0026thinsp;=\u0026thinsp;0,006) and mental health (p\u0026thinsp;\u0026lt;\u0026thinsp;0,001) compared to the control group (p\u0026thinsp;=\u0026thinsp;0,110; p\u0026thinsp;=\u0026thinsp;0,296; p\u0026thinsp;=\u0026thinsp;0,091), showing an improvement in health-related quality of life in the intervention group. As expected from a calorie deficit, the body weight and Body Mass Index of both intervention and control groups showed a significant decrease before and after the intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0,001; p\u0026thinsp;\u0026lt;\u0026thinsp;0,001, respectively). There were no significant changes in fat-free mass (p\u0026thinsp;=\u0026thinsp;0,936) and skeletal muscle mass (p\u0026thinsp;=\u0026thinsp;0,841) between the two groups, but there were significant differences in body fat mass (BFM) (p\u0026thinsp;\u0026lt;\u0026thinsp;0,001), and waist circumference (WC) (p\u0026thinsp;=\u0026thinsp;0,029) between the two groups, being the percentage change of BFM and WC higher in the intervention group.\u003c/p\u003e\u003cp\u003eAker et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) evaluated the effect of hydrogen-rich water consumption on PMS symptoms and quality of life. This study showed, that in the first and second follow-ups, the intervention group had significantly lower mean scores on PMSS (1st follow-up \u0026ndash; 113,76\u0026thinsp;\u0026plusmn;\u0026thinsp;29,45 points; 2nd follow-up \u0026ndash; 119,30\u0026thinsp;\u0026plusmn;\u0026thinsp;33,36 points; p\u0026thinsp;=\u0026thinsp;0,003) compared to the control group (1st follow up \u0026ndash; 134,91\u0026thinsp;\u0026plusmn;\u0026thinsp;24,96 points; 2nd follow up \u0026ndash; 141,03\u0026thinsp;\u0026plusmn;\u0026thinsp;23,84 points; p\u0026thinsp;=\u0026thinsp;0,004). When assessed the WHOQOL-BREF, in the first follow-up, the intervention group had significantly higher mean scores in physical health (Intervention Group: 25,48\u0026thinsp;\u0026plusmn;\u0026thinsp;3,15 points vs Control Group: 23,28\u0026thinsp;\u0026plusmn;\u0026thinsp;4,30 points, p\u0026thinsp;=\u0026thinsp;0,021) and psychological domain (Intervention Group: 19,73\u0026thinsp;\u0026plusmn;\u0026thinsp;2,27 points vs Control Group: 17,88\u0026thinsp;\u0026plusmn;\u0026thinsp;2,64 points, p\u0026thinsp;=\u0026thinsp;0,003). No significant differences were found in the social domain and environment domain in the first follow-up between groups, nor in the second follow-up in all domains of the WHOQOL-BREF.\u003c/p\u003e\u003cp\u003eHerrera et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) studied the effect of a commercial phytotherapeutic dietary supplement (PREMEN-CALM) in the management of PMS. The supplement contained a combination of several active ingredients with antioxidant and anti-inflammatory properties (GABA, \u003cem\u003eRhodiola rosea L.\u003c/em\u003e and \u003cem\u003eVitex Agnus Castus\u003c/em\u003e), which could affect the total antioxidant status (TAS), and therefore, reduce some symptoms of PMS, especially psychologically related symptoms. The results showed a significant increase in the TAS (p\u0026thinsp;\u0026lt;\u0026thinsp;0,05) compared to the reference value in the intervention group. No significant differences in body composition between groups before and after intervention were found, and the subjective sleep quality did not show significant differences when comparing within and between groups; however, there was a slight decrease in the mean total scores of the women who received the intervention.\u003c/p\u003e\u003cp\u003eRegarding the quality-of-life evaluation, there were no significant differences between groups in any of the domains (physical health, psychological health, social relationships, and environmental health). The evolution of menstrual characteristics was also evaluated, showing significant changes in the intervention group, increasing the percentage of participants who had no affective symptoms on the third cycle; no significant differences were observed for the somatic symptoms, pain intensity, need for analgesics, frequency and impact on daily life. On the contrary, results showed a significant decrease in the State-Trait Anxiety Inventory total score (p\u0026thinsp;\u0026lt;\u0026thinsp;0,05), for the intervention group after three months of supplementation.\u003c/p\u003e\u003cp\u003eFarrokhfall et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) studied the effects of curcumin on nitric oxide levels in women with PMS and dysmenorrhea. This study showed, within-group analysis, a significant decrement in oxidised metabolites (NOx) levels post-intervention (p\u0026thinsp;=\u0026thinsp;0.048); in the control group, NOx remained stable by the end of the trial (p\u0026thinsp;=\u0026thinsp;0.32). Between-group comparisons revealed no significant differences in the net change of NOx level in the intervention group compared to the control group postintervention (p\u0026thinsp;=\u0026thinsp;0.31). After the intervention, the between-group analysis showed no significant differences in the NOx index (p\u0026thinsp;=\u0026thinsp;0.36). However, a significant reduction was found in PSST score after treatment in the intervention group (32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6 to 20.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and control group (30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2 to 22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A significant Pearson\u0026acute;s correlation coefficient was observed between NOx level variation with PSST score variation only in the intervention group (r\u0026thinsp;=\u0026thinsp;0.34, p\u0026thinsp;=\u0026thinsp;0.042).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review included diverse studies addressing nutritional interventions, such as supplementation or a specific diet, for managing PMS symptoms. Most of the studies (n\u0026thinsp;=\u0026thinsp;13) included in this systematic review analysed the effect of micronutrients on PMS scores and symptoms (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). One study focused on PMS treatment with ginger (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), another on the effect of \u003cem\u003eZataria multi-flora\u003c/em\u003e essence (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), and another on the effect of curcumin in PMS and dysmenorrhea (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Four studies' interventions focused on specific dietary changes(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). One study focusing on the ingestion of hydrogen-rich water on PMS was also included (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), and one study focusing on a phytotherapeutic dietary supplement on PMS (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The methodology of the studies was similar, with variations in intervention duration, participants, and tools used to evaluate PMS.\u003c/p\u003e\u003cp\u003eOf all 22 studies, two were uncertain of the effects of the intervention on PMS (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Studies with a confoundable variable (placebo) showed clearer results, though some aspects did not show significant differences between the placebo and intervention groups. In most studies, the placebo group showed improvements in scores or symptoms of PMS, however small they may have been. Receiving a placebo treatment may positively affect mental status, thus reducing some of the symptoms of PMS (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost studies included in this review focus on addressing premenstrual syndrome through the utilisation of supplements. Particular attention was given to examining micronutrients, namely zinc, calcium, and vitamins, specifically vitamins B6, B1 and D. Several micronutrients can impact reducing PMS, and their mechanisms of action are complex and multifaceted. Calcium and B vitamins may affect neurotransmitter regulation (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). For example, vitamin B6 is a cofactor in transforming the tryptophan amino acid to serotonin, and riboflavin is necessary for the activation of vitamin B6 (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e); thus, both may have a positive influence on mood-related symptoms such as irritability and depression. On the other hand, vitamin B1 stimulates the central nervous system and elevates mood. Vitamin B1 may increase endorphin secretion (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), thus causing relaxation and ameliorating symptoms, especially psychological ones (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Furthermore, both included studies in this review regarding vitamin D reported an improvement of symptoms after supplementation with 2000 IU (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and 50.000 IU (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Vitamin D has known anti-inflammatory properties (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), and inflammation is thought to play a role in developing PMS (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e); thus, by reducing inflammation, vitamin D may help alleviate pain, bloating and other symptoms associated with PMS.\u003c/p\u003e\u003cp\u003eThe study regarding gamma-tocopherol showed an improvement in somatic and mental symptoms as well as greater natriuresis, which may have led to a reduction of thigh circumference and a reduction in VAS score for \u0026ldquo;swelling of the legs\u0026rdquo; and \u0026ldquo;heavy legs\u0026rdquo; (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Gamma-tocopherol is a form of vitamin E with antioxidant properties (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). By reducing oxidative stress, it may help alleviate some PMS symptoms. Additionally, it has a diuretic property (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), which can help reduce oedema or bloating.\u003c/p\u003e\u003cp\u003eIn the present review, a consistent trend emerged across all studies evaluating zinc supplementation, demonstrating improvements in numerous symptoms and overall quality of life. Zinc is concentrated in the hippocampus and, in PMS patients, is usually decreased (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e); this can result in dysregulation of glucocorticoid secretion and cause neuropsychological dysfunctions such as isolation, irritability, and depression (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), symptoms associated with PMS. Some studies have shown decreased total antioxidant capacity (TAC) in women with PMS (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Jafari et al.\u0026rsquo;s (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) study revealed a significant decrease in physical and psychological symptoms, as well as an increase in TAC and Brain-Derived Neurotrophic Factor (BDNF) for participants with zinc supplementation. Considering the antioxidant (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e) and anti-depressive role of zinc (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), it may have a role in decreasing PMS symptomatology, especially psychological symptoms.\u003c/p\u003e\u003cp\u003eApart from nutrient supplementation, this review included studies which showed improvements in PMS parameters, focusing on wheat germ (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), dairy products (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), and whole grains (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These have available essential vitamins and minerals, including calcium, zinc, vitamin B, and more, which have been previously elucidated to effectively reduce some PMS symptoms, making them potential candidates for managing the condition.\u003c/p\u003e\u003cp\u003eKhayat et al. study (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) showed a substantial difference in scores between groups. It is believed that PMS may be related to changes in the prostaglandin system (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). During the luteal phase, there is an increase in prostaglandins in the endometrial tissue, leading to uterine contractions (to shed the uterine lining) and symptoms like bloating and cramping. Prostaglandin imbalances can also contribute to emotional and psychological symptoms (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). Ginger may prevent the production of prostaglandins by inhibiting the metabolism of cyclooxygenase and lipoxygenase (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e); it also has anti-inflammatory properties (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e), though it may help to reduce PMS symptoms. Farrokhfall et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) and Herrera et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) focused on the antioxidant and anti-inflammatory properties of curcumin and hormone regulation properties of phytotherapeutic dietary supplements (GABA, \u003cem\u003eRhodiola rosea L.\u003c/em\u003e and \u003cem\u003eVitex agnus castus\u003c/em\u003e); they can help in the reduction of PMS symptoms, such as reduction of pain, and effective in reducing symptoms such as irritability and mood changes.\u003c/p\u003e\u003cp\u003eThis review shows that altering lifestyles or supplement intake can improve PMS symptomatology with no or mild side effects; however, studies on this matter are still scarce. These findings are promising, as the first line of treatment for PMS is selective serotonin reuptake inhibitors, which have associated side effects such as weight gain, sexual dysfunction, and sleep disturbances (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). It is crucial to continue research on this topic, as the aetiology of PMS is still unclear and lacks a concrete explanation of its cause.\u003c/p\u003e\u003cp\u003eAccording to the quality assessment of the studies, seven were rated as high risk of bias, and seven were unclear, thus requiring careful interpretation. The domain \u0026ldquo;Deviations from the intended interventions\u0026rdquo; had the highest risk of bias, possibly because of the lack of measurements for intervention adherence in some studies.\u003c/p\u003e\u003cp\u003eThis review has both strengths and limitations. Its strength lies in the fact that it followed the PRISMA guidelines for searching, screening, and evaluating the literature, and three databases were used to reduce the chances of any relevant studies being missed. The primary limitation was the heterogeneity of the included studies, making it challenging to compare them due to their varying focuses. Furthermore, a large number of participants and a longer intervention duration would be beneficial for a more precise evaluation of the intervention's effects on PMS-related symptoms and a better understanding of its long-term impact.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis systematic review revealed that it is possible to improve the symptoms of PMS through a nutritional approach with supplements or dietary changes. A healthy, varied, and balanced diet, rich in vegetables, fruits, and legumes, may help manage PMS symptoms. However, there is little information available on specific diets or dietary habits related to this topic. Thus, investigating the relationship between a specific diet, based on previously revealed evidence, through experimental studies, would align with a broader approach, avoiding reliance on supplementation or pharmacological treatments for managing symptoms related to PMS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of Interest\u003c/h2\u003e\u003cp\u003eAll authors declare no conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo financial support or funding was provided for the conduct of this study.\u003c/p\u003e\u003ch2\u003eAuthor Contributions\u003c/h2\u003e\u003cp\u003eAN, CL and SA conceptualised the study and designed the review protocol. CL and SA supervised the project. AN and CL conducted the literature search, screened articles, extracted data, and assessed the quality of the studies. AN also performed the initial data synthesis and drafted the first version of the manuscript. All authors contributed to the interpretation of results and provided critical revisions to the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eO\u0026rsquo;Brien PMS, B\u0026auml;ckstr\u0026ouml;m T, Brown C, Dennerstein L, Endicott J, Epperson CN, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14(1):13\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKadian S, O\u0026rsquo;Brien S. Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders. Menopause Int. 2012;18(2):43\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRyu A, Kim TH. Premenstrual syndrome: A mini review. 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J Psychiatr Pract. 2015;21(5):334\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e - Characteristics of included studies.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"992\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTools for PMS assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRoute of administration and dosage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdv. Event\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 992px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZinc\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eJafari et al. (2020)\u003c/p\u003e\n \u003cp\u003e(22)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eZinc gluconate\u003c/p\u003e\n \u003cp\u003e(Elemental zinc)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo (starch)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eWHOQOL-BREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eZinc gluconate tablet (30mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eIncreased score of the first domain of quality of life (improved physical aspects).\u003c/p\u003e\n \u003cp\u003eQuality of life total score improved in intervention group, with no significant changes between groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported (no side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eJafari et al. (2020)\u003c/p\u003e\n \u003cp\u003e(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eZinc gluconate\u003c/p\u003e\n \u003cp\u003e(Elemental zinc)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDaily Record Questionnaire based\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eon DSM-VI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eZinc gluconate (30mg/day)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eDecreased physical symptoms average score and psychological symptoms average score compared to placebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported (no side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eAhmadi et al. (2022)\u003c/p\u003e\n \u003cp\u003e(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eElemental zinc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePSST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eZinc sulphate capsules 220mg (50mg zinc/day)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e24 weeks\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eThe mean score of anger and irritability, anxiety, and tension 1 month after intervention was significatively different between intervention and control groups. (Intervention group shown more decrease on mean score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 992px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalcium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eShobeiri et al. (2016)\u003c/p\u003e\n \u003cp\u003e(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eCalcium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo (starch)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026gt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDRSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eCalcium tablets (500mg/day) after lunch\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e8 weeks\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eSignificant differences in subgroups of depression, emotional changes, and somatic changes in intervention after the intervention.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported (no side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eYurt et al. (2020)\u003c/p\u003e\n \u003cp\u003e(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eDairy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eCalcium consumption not altered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e20-28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePMSS\u003c/p\u003e\n \u003cp\u003eQuality of Life Scale\u003c/p\u003e\n \u003cp\u003e(SF-36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eFoods containing at least 1000mg of calcium (kasseri cheese 50g, 400ml milk, 150 yogurt) daily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003ePMSS score and sub-scale scores except the appetite change between the baseline and post-intervention decreased in intervention group.\u003c/p\u003e\n \u003cp\u003ePhysical functions and mental health scores on the SF-36 quality of life scale were increased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 992px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamins\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eAbdollahifard et al. (2014)\u003c/p\u003e\n \u003cp\u003e(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eVitamin B1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003cp\u003e(Starch powder)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDSRF based on DSM-IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 pill in the morning (100mg) and 1 at night (100mg) during 1 week before menses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eThe average of physical and mental symptoms severity of PMS reduced in vitamin B1 group after treatment, and the comparison with control group was significantly different.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported\u003c/p\u003e\n \u003cp\u003e(Yes, not specified in 1.7% in intervention group)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eAbdollahi et al. (2019)\u003c/p\u003e\n \u003cp\u003e(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eVitamin D\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003cp\u003e(maltodextrin)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePSST (Iranian version)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 tablet every day with lunch (2000IU)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eNo significant differences in symptoms of PMS between the 2 groups. Vitamin D group the severity of nervousness, slump job activity, fatigue, and physical symptoms improved at the end of intervention, and were statistically significant compared to baseline.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHeidari et al. (2019)\u003c/p\u003e\n \u003cp\u003e(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eVitamin D3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003cp\u003e(paraffin)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePMS Daily Symptoms Rating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003ePearl of Vitamin D (50,000 IU/fortnightly)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eMean score of the total PMS symptoms showed significant improvement in vitamin D group.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported (no side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHeidari et al.\u003c/p\u003e\n \u003cp\u003e(2023)\u003c/p\u003e\n \u003cp\u003e(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eVitamin D\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(paraffin)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePMS Daily Symptoms Rating\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003ePearl of Vitamin D (50,000 IU/fortnightly)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eMean score of psychological and physical symptoms of PMS decreased significantly in vitamin D group.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported (no side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHiguchi et al. (2023)\u003c/p\u003e\n \u003cp\u003e(31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026gamma;-tocopherol dissolved in Vitamin E-stripped corn oil\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003cp\u003e(Vitamin E-stripped corn oil)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003cp\u003eMEDI-Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2 capsules (92mg of \u0026gamma;-tocopherol) twice a day for 7 days in the luteal phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eVAS scores for fatigue and irritability/angry were significantly lower with y-tocopherol intake than with placebo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 992px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMixed micronutrients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eMasoumi et al. (2016)\u003c/p\u003e\n \u003cp\u003e(25)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eCalcium + Vitamin B6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eVitamin B6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDRS\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eQuestionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eCalcium tablet (500mg) + vitamin B6 (40mg), twice a day between the 16\u003csup\u003eth\u003c/sup\u003e day of menstrual cycle and the 5\u003csup\u003eth\u003c/sup\u003e day of the next menstrual cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eBoth mean scores of physical and psychological symptoms decreased compared to the control group, as well as the mean score of general symptoms, with significant differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eRetallick-Brown et al. (2020)\u003c/p\u003e\n \u003cp\u003e(26)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMicronutrient Formula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eVitamin B6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026gt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDRSP\u003c/p\u003e\n \u003cp\u003eWQoLQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4 capsules twice a day with food and water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eReduction of scores of DRSP of equal magnitude for both groups.\u003c/p\u003e\n \u003cp\u003eQuality-of-life ratings showed significantly greater improvement in micronutrient formula.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported\u003c/p\u003e\n \u003cp\u003e(None or mild)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 992px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOthers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eSodouri et al. (2013)\u003c/p\u003e\n \u003cp\u003e(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cem\u003eZataria multi-flora\u003c/em\u003e essence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003cp\u003e(Nonactive ingredients)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;PRISM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2 pearls (20 mg of \u003cem\u003eZataria multi-flora\u003c/em\u003e essence) every 12 hours 7 days before menses for 2 menstrual cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eMean of PMS severity reduced in both groups after intervention, but with no significant differences. Frequency of symptoms also decreased in both groups with no significant differences.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eBehboudi-Gandevani et al. (2017)\u003c/p\u003e\n \u003cp\u003e(33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eOmega-3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e20-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePSST (Iranian version)\u003c/p\u003e\n \u003cp\u003eQuality of Life Scale\u003c/p\u003e\n \u003cp\u003e(SF-12) (Iranian version)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2 capsules daily (1g omega-3/capsule) for 10 consecutive days from 8d before and 2d after menstruation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eMost PMS symptoms and PMS interference with daily activities were significantly reduced over the follow up period, but with no significant differences between groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported\u003c/p\u003e\n \u003cp\u003e(No side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eEsmaeilpour et al. (2019)\u003c/p\u003e\n \u003cp\u003e(34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eAt least 4 servings of whole grains\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eNo changes in diet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDRS\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eQuestionnaire\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e120g of whole bread and at least 4 serving of whole grain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eConsumption of whole grains was higher in intervention group.\u003c/p\u003e\n \u003cp\u003eScores of general, mood, physical and behavioural symptoms were significantly reduced in intervention group in comparison with control group.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eAtaollahi et al. (2015)\u003c/p\u003e\n \u003cp\u003e(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eWheat germ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDRS\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eQuestionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eWheat germ capsule (400mg), 3 times a day between the 16\u003csup\u003eth\u003c/sup\u003e day of menstrual cycle to the 5\u003csup\u003eth\u003c/sup\u003e day of the next cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eSeverity of general and psychological symptoms reduced in both groups, but the reduction was significantly greater in the wheat germ extract group. Reduction in severity of physical symptoms was statistically significant only in wheat germ extract group.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported\u003c/p\u003e\n \u003cp\u003e(No side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eYilmaz-Akyuz et al. (2019)\u003c/p\u003e\n \u003cp\u003e(36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003ePMS Diet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eNo changes in diet nor exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePMSS\u003c/p\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e50-55% CH, 25-30% F, 15-20% P (rich in complex carbohydrates, refined sugars limited, 1-2 times/week of fish, daily \u0026gt;1000mg calcium and 20g of dried nuts. \u0026lt;300mg caffeine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eNo statistically significant difference between control group and intervention but decrease of PMS score of diet group.\u003c/p\u003e\n \u003cp\u003eVAS score was significantly lower on diet group compared to control.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eKhayat et al (2014)\u003c/p\u003e\n \u003cp\u003e(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eGinger\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eDaily Record Scale Questionnaire based on DSM-IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 capsule (250mg of ginger) every 12 hours from 7 d before and 3 days after onset of menses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eSignificant differences in total score of PMS, severity of mood, and physical and behavioural symptoms between the two groups after intervention, and ginger could reduce severity of PMS.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported (nausea in ginger group n=1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHerrera et al.\u003c/p\u003e\n \u003cp\u003e(2024)\u003c/p\u003e\n \u003cp\u003e(38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003ePREMEN-CALM\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePlacebo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(potato starch)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eSelf-report characteristics of menstrual cycle\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePSQI\u003c/p\u003e\n \u003cp\u003eSTAI\u003c/p\u003e\n \u003cp\u003eWHOQOL-BREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 daily capsule (400mg GABA, 250mg dry extract of Rhodiola rosea L. root, 125mg dry extract of Vitex agnus castus fruit; coating \u0026ndash; potato starch, purified water, gellan gum, 1mg of melatonin and 0,7mg of vitamin B6) 30-60min before bedtime\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 cycles\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eSlight decrease in the mean score total score of PSQI in intervention group. Significant decrease in the STAI total score for the intervention group. Non-significant changes were observed between groups in WHOQOL-BREF. Affective symptoms decreased in the intervention group.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported\u003c/p\u003e\n \u003cp\u003e(No side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eAker et al.\u003c/p\u003e\n \u003cp\u003e(2024)\u003c/p\u003e\n \u003cp\u003e(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eHRH\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eNormal water\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026gt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePMSS\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWHOQOL-BREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e300-400ml of HRW (one hour before breakfast and lunch, two hours after lunch, one hour before dinner and half an hour before bedtime) from the 16\u003csup\u003eth\u003c/sup\u003e of the menstrual cycle until the 2\u003csup\u003end\u003c/sup\u003e day of the menstrual phase\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 cycles\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eSignificantly lower mean on PMSS in the first and second follow-ups in the intervention group. Higher mean scores in physical health and in the psychological domain of the WHOQOL-BREF in intervention group.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHooshiar et al.\u003c/p\u003e\n \u003cp\u003e(2024)\u003c/p\u003e\n \u003cp\u003e(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eADMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eDCR\u003c/p\u003e\n \u003cp\u003e(63% of daily calorie requirements)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePSST\u003c/p\u003e\n \u003cp\u003eCOPE\u003c/p\u003e\n \u003cp\u003eSF-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eFeasting (daily calorie requirement) and fasting (25% of daily calorie requirements from 12:00pm to 2:00pm), staring at midnight every day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e8 weeks\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eSignificant change in expressed anger compared to the control group. Intervention group with an improvement in the SF-12 total score, as well as the physical function and mental health.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eReported\u003c/p\u003e\n \u003cp\u003e(No side effects)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eFarrokhfall et al.\u003c/p\u003e\n \u003cp\u003e(2023)\u003c/p\u003e\n \u003cp\u003e(41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eCurcumin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePlacebo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(500mg of lactose plus 5mg of peperine)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003ePSST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1 capsule (500mg curcuminoids + 5mg peperine) per day for 10 days (7 days pre and until 3 days post start of menstruation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 cycles\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003eSignificant reduction in PSST score after treatment in the intervention group.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCH, Carbohydrate; DRS, Daily Symptom Record; DRSP, Daily Record of Severity of Problems; DSM-VI, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DSRF; Daily Status Record Form; F, Fat; MEDI-Q, Menstrual Distress Questionnaire; P, Protein; PMS, Premenstrual Syndrome; PMSS, Premenstrual Syndrome Scale; PRISM, Prospective Record of the Impact and Severity of Menstrual Symptoms; PSST, Premenstrual Syndrome Screening Tool; SF-32, Short Form \u0026ndash; 12 Questionnaire (Iranian version); SF-36, Short Form \u0026ndash; 36 Questionnaire; VAS, Visual Analog Score; WHOQOL-BREF, World Health Organization Quality of Life Brief Version; WQoLQ, Women\u0026rsquo;s Quality-of- Life Questionnaire; PSQI, Pittsburgh Sleep Quality Index; STAI, State-Trait Anxiety Inventory; GABA, \u0026nbsp;Gamma Aminobutyric Acid; HRW, \u0026nbsp;Hydrogen-rich water ; ADMF, Alternate-Day Modified Fasting; DCR, Daily Calorie Restriction ; COPE, Calendar of premenstrual experiences\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-clinical-nutrition","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ejcn","sideBox":"Learn more about [European Journal of Clinical Nutrition](http://www.nature.com/ejcn/)","snPcode":"41430","submissionUrl":"https://mts-ejcn.nature.com/cgi-bin/main.plex","title":"European Journal of Clinical Nutrition","twitterHandle":"@ejcneditor","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7101209/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7101209/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objectives: \u003c/strong\u003ePremenstrual Syndrome (PMS), experienced by women during their reproductive age, encompasses physical, emotional, and behavioural symptoms before menstruation. Common symptoms include fatigue, headaches, bloating, breast tenderness, mood swings, irritability, anxiety, and sadness. PMS severity varies among individuals and can affect daily life. Nutrition plays a significant role in PMS treatment, as dietary adjustments and supplementation have shown potential in alleviating symptoms and improving overall well-being. This systematic review aims to identify, assess, and analyse the efficacy of different dietary and nutritional interventions in alleviating PMS symptoms among women in their reproductive years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjects/Methods: \u003c/strong\u003eIn June 2023, three electronic databases (PubMed, Scopus, and Web of Science) were consulted to undertake a literature search. The screening process involved two phases: initial screening based on titles and abstracts and subsequent analysis of full-text articles. The study followed PRISMA guidelines, and the protocol was registered in PROSPERO; the RoB2 Tool was used to assess the quality of the included studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSeventeen studies were included in this systematic review: eleven evaluated the effect of supplementation with micronutrients, three assessed specific diets, and three examined the impact of \u003cem\u003eZataria multi-flora\u003c/em\u003e essence, wheat germ, and ginger on PMS. Most studies showed an apparent reduction in PMS-related symptoms post-intervention. Eight studies had a high risk of bias, and three were unclear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis systematic review confirms the potential of a nutritional approach involving supplements or dietary changes in improving PMS symptoms.\u003c/p\u003e","manuscriptTitle":"Dietary Approach to Premenstrual Syndrome Symptoms Alleviation – A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 10:58:26","doi":"10.21203/rs.3.rs-7101209/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-09-03T15:19:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-09-01T13:45:09+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-08-25T06:59:46+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-07-27T20:55:42+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-07-15T13:19:42+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-07-15T00:37:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-14T11:08:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-14T11:07:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Clinical Nutrition","date":"2025-07-11T11:33:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-clinical-nutrition","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ejcn","sideBox":"Learn more about [European Journal of Clinical Nutrition](http://www.nature.com/ejcn/)","snPcode":"41430","submissionUrl":"https://mts-ejcn.nature.com/cgi-bin/main.plex","title":"European Journal of Clinical Nutrition","twitterHandle":"@ejcneditor","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d6d17de4-962f-4166-9fa8-890e08d032a2","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":51530549,"name":"Health sciences/Health care/Nutrition"},{"id":51530550,"name":"Health sciences/Health care/Therapeutics/Nutrition therapy"}],"tags":[],"updatedAt":"2025-09-03T15:22:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 10:58:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7101209","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7101209","identity":"rs-7101209","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}