What to Do When IBS and PMS Hit at the Same Time

Birth Control Pills

Some research has shown that hormonal contraceptives can be helpful for cyclical changes in IBS symptoms. A small study of 129 women showed that 20% had an improvement in their cycle-related IBS symptoms while taking oral contraceptives.

Although birth control pills (oral contraceptives) are frequently prescribed by physicians as a way to alleviate PMS symptoms, research on the subject is surprisingly limited and has yielded mixed results. Birth control pills may be more effective in treating the mood symptoms of premenstrual dysphoric disorder (PMDD) than the physical symptoms associated with PMS.

Some researchers think a monophasic pill might be more beneficial for both PMS and IBS than other types of birth control pills. The theory is that it is the change in hormone levels that triggers PMS symptoms, as opposed to the actual hormones themselves. There is also preliminary support for the use of extended-cycle pills for PMS, although it is unknown what effect these pills would have on IBS symptoms.

Calcium

Of the many suggested over-the-counter products for PMS, the combination of calcium and vitamin D appears to have the most research support for its effectiveness. Calcium has been shown to be helpful in reducing mood symptoms, pain, physical discomfort, and appetite changes.

Calcium from food sources appears to be best, but taking supplements may also work. Researchers are still undecided on the optimal dose, however.

Although evidence is anecdotal, many people who have diarrhea predominant IBS (IBS-D) report that they have been helped by calcium. Vitamin D and calcium may therefore be a nice option if you find that your IBS-D is worse when you're premenstrual.

Chasteberry

Chasteberry is a supplement made from dried berries of the chaste tree (Vitex agnus-castus).

In a review of 43 studies on chasteberry for PMS, most of the studies showed chasteberry to be helpful in reducing mood symptoms, irritability, breast tenderness, and headaches.

But people who have taken chasteberry have reported a wide variety of mild side effects, including headaches, nausea, and other gastrointestinal symptoms. Because of the gastrointestinal side-effects, chasteberry may cause you more discomfort if you have IBS.

Chasteberry may also interfere with certain medications, including oral contraceptives. It is not recommended for women who are pregnant, breastfeeding, or who have hormone-sensitive conditions like breast, uterine, or ovarian cancer.

Diet Changes

While research has been published on the effects of dietary changes on PMS, the findings have been inconsistent, failing to show a clear link between any specific dietary factors and PMS.

But many of the dietary changes studied for PMS are similar to those recommended to relieve IBS symptoms. For example, eating fruit and cruciferous vegetables (eg. broccoli) may help the emotional symptoms of PMS. (However, some people may find their IBS is aggravated by cruciferous vegetables.)

Some things you should think about doing if you suffer from both IBS and PMS include:

• Increase your intake of high-fiber complex carbohydrates.
• Avoid alcohol, caffeine, and foods high in fat or sugar.
• Eat small meals throughout your day.

Evening Primrose Oil

Evening primrose oil, a supplement in the form of an oil that's derived from the seeds of the evening primrose plant, is frequently touted as a remedy for PMS.

Although side effects of the supplement are usually mild, there have been reports of gastrointestinal symptoms. With this in mind, as well as the lack of evidence for usefulness, evening primrose oil is probably not a good option for those with IBS.

Exercise/Yoga

There is some research supporting exercise's positive effects in reducing PMS symptoms. Both aerobic exercise and yoga have shown themselves helpful for PMS, but especially yoga in some studies.

Although some current research on IBS and exercise doesn't show any conclusive evidence, the American College of Gastroenterology makes a "weak recommendation" for exercise in their 2021 guidelines for IBS, citing improvements in GI symptoms, quality of life and anxiety.

Because yoga has also been shown to help with IBS, yoga may be a good choice to help with both IBS and PMS symptoms.

Heat

Research specifically on the use of hot water bottles or heating pads for PMS has not been conducted, but many women can attest to the fact that heat can ease the intensity of menstrual cramps.

Similarly, there's no specific research on the use of heat for IBS, although many people with IBS have reported that heat does help to ease intestinal cramps. So a heating pad or hot water bottle is probably a nice option to try for easing the symptoms of both disorders.

Place the heat source on your abdomen for 30 minutes at a time, several times throughout the day. Be sure to place some cloth between the heat source and your skin in order to prevent a burn.

Magnesium

Supplemental magnesium has received some research attention in terms of effectiveness for reducing PMS symptoms, but research has been limited, and results have been mixed.

Even though research is not available on magnesium for IBS, some individuals with constipation-predominant IBS (IBS-C) have reported that it's helpful in easing constipation. So if your predominant IBS symptom is constipation, magnesium may be a good option. In people with IBS-D, however, magnesium may cause loose stool.

Mind/Body Treatments

One thing that PMS and IBS have in common is that the symptoms of each are exacerbated by stress, so mind/body approaches to reducing stress may help to ease the symptoms of both disorders.

For both IBS and PMS, research supports the use of cognitive behavioral therapy and relaxation training. The lack of unwanted side effects or negative drug interactions give these treatments a nice advantage over many of the other options in this list.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are medications most often used to treat depression.

But since evidence shows that PMS may be linked to levels of the neurotransmitter serotonin, SSRIs have also been used as a treatment for PMS—typically at a lower dosage than what's used for depression.

Research has shown that 60% to 75% of women with PMS and PMDD may be helped by taking an SSRI. Some women find SSRIs helpful for PMS symptoms when taken only during the second half of their menstrual cycle, instead of throughout the month.

SSRIs have also been evaluated in terms of their helpfulness for IBS, with some positive results depending on the specific medication.

The American College of Gastroenterology (ACG) recommends a different class of antidepressants for IBS, especially for IBS-D: tricyclic antidepressants (TCAs). They advise starting with a low dose and working up to symptom relief.

SSRIs can also cause diarrhea, so there may be more appropriate treatment options if you also have IBS.

Acupuncture and acupressure

Acupuncture is a common practice in Traditional Chinese Medicine (TCM). The premise of acupuncture is to restore energy balance and organ function by manipulating specialized needles at one or more of 361 designated points along 14 energy meridians. With acupressure, the idea is similar, but without using needles.

Some studies have shown that acupuncture may be helpful for IBS-D symptoms, and it has a low risk of causing harm.

In addition, a Cochrane Review of five clinical trials looking at whether acupuncture or acupressure was helpful for PMS showed that women appeared to get some PMS symptom relief and improvements in quality of life from acupressure and acupuncture.