Reference
Khayat S, Fanaei H, Kheirkhah A, et al. Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial. Complement Ther Med. 2015;23:318-324.
Design
Randomized, double-blind, placebo-controlled clinical trial
Participants
The trial included 70 healthy premenopausal women with regular menses suffering from premenstrual syndrome (PMS) symptoms, randomized to receive curcumin (n=35) or placebo (n=35).
Intervention
Each participant received 100 mg capsules every 12 hours (totaling 200 mg/daily of curcumin or identical placebo) for 7 days prior to menstruation and 3 days into menstruation for 3 successive cycles and recorded the severity of their symptoms by daily record questionnaire.
Outcome Measures
The questionnaire evaluated the severity of PMS using 3 categories: mood symptoms, physical symptoms, and behavior characteristics. Mood symptoms included restlessness, irritability, anxiety, depression, sadness, crying, and feelings of isolation. Physical symptoms included backache, headache, breast tenderness, weight gain, abdominal pain, swelling of extremities, muscle stiffness, gastrointestinal symptoms, and nausea. Behavior characteristics evaluated included fatigue, lack of energy, insomnia, trouble with concentration, and appetite changes. Severity of symptoms was scored with (0) absence of symptom, (1) mild symptom that doesn’t interfere with daily activity, (2) moderate symptom that interferes with daily activity, and (3) severe symptoms that impede daily activity. Women with at least 5 symptoms were diagnosed with PMS.
Key Findings
Out of 70 participants, 4 women in the placebo group and 3 in the curcumin group were unable to complete the study.
The curcumin group experienced significant reduction in behavioral (22.8 ± 17.4 to 9.1 ± 5.49, P<0.0001), physical (41.4 ± 21.6 to 18.13±10.92, P<0.0001), and mood (37.8 ± 18.3 to 15.13 ± 7.48, P<0.0001) scores after the intervention. The placebo group experienced significant reduction in physical symptoms (46.7 ± 26.8 to 38.50 ± 20.27, P<0.0425), but no significant difference in behavior and mood scores. Overall, the total PMS score in the intervention group had decreased significantly from 102.06 ± 39.64 to 42.47 ± 16.37 (P<0.0001) whereas this score in placebo group did not change significantly.
Practice Implications
This article is the first known to this author to evaluate curcumin for PMS, which is surprising, given curcumin’s known effects on neurotransmitter levels and inflammation, both of which are involved in the pathophysiology of PMS.1 In their discussion, the authors do a nice job summarizing the pathophysiology of PMS related to neurotransmitter release and inflammation, and also the studies measuring curcumin’s effect on each.
Physical symptoms of PMS are very strongly connected to pain and inflammation pathways.
PMS has a multitude of symptoms and several underlying mechanisms by which those arise. Many of the mood and behavioral symptoms have been shown to be related to neurotransmitter changes, including decreased norepinephrine, dopamine, and serotonin. Some of these changes are thought to be stimulated by the decline in estrogen and progesterone premenstrually, such as with dopamine, while others are not yet explained.2 Curcumin has been shown in vivo an in vitro to increase norepinephrine, dopamine, and serotonin, which may be one of the mechanisms of its positive effect on PMS behavioral and mood symptoms.3
Physical symptoms of PMS are very strongly connected to pain and inflammation pathways. For example, cyclooxygenase-2 enzyme (COX-2) is responsible for the production of prostaglandin E2, which is known to play a role in the pathophysiology of PMS. Curcumin has been shown in animal studies to downregulate COX-2 gene expression, thereby inhibiting prostaglandin production.4
Naturopathic physicians frequently turn to the use of phytotherapies, vitamin B6, and magnesium to treat PMS, depending on the symptoms present. The addition of curcumin to the treatment protocol at a dose of 100 mg twice daily appears to offer some benefit with no reported side effects regardless of the symptom picture and should be considered.
Limitations
This study’s design as a randomized, double blinded controlled trial is a strength, although it had a relatively small sample size and the study participants were limited to students. Larger trials should be conducted to confirm results. It also may be worthwhile to consider trials that utilize consistent dosing, versus acute dosing around premenstrual time.
