Clinical Research Review: Omega 3 Fatty Acids for PMS
Author: Behboudi-Gandevani S, Hariri F, Moghaddam-Banaem L.
Reference: The effect of omega 3 fatty acid supplementation on premenstrual syndrome and health-related quality of life: a randomized clinical trial. J Psychosomatic Obstetrics and Gynecology 2017, July 14.
Design: A multi-center, placebo-controlled, parallel-group randomized clinical trial conducted in Iranian women who suffered from premenstrual syndrome (PMS). A total of 95 women with PMS were recruited and allocated omega-3 fish oils or placebo. The study was completed with 45 women in each group. The Iranian version of the PMS screening tool (PSST) was used. Women were asked to rate their symptoms as not at all, mild, moderate or severe. The Iranian version of the 12 item short form health survey (SF-12) questionnaire was used to measure the physical and mental components of health-related quality of life. Data was obtained at baseline of one control cycle and three treatment visits with one-month intervals at months 1, 2 and 3. Women were randomly allocated into two groups with one group receiving 2 gm/day of fish oil (two soft gels with each capsule containing 1 gm fish oil with 180 mg EPA and 120 mg DHA) per day for 10 consecutive days (8 days prior to menses and 2 days after onset of menses) for 3 consecutive cycles and the other group received a placebo oil.
Participants: Iranian women aged 20-35 with a normal body mass index and suffering from PMS were recruited to this study. Women had somatic, psychologic, or behavioral symptoms in the premenstrual phase of the menstrual cycle in at least 4 of the previous 6 menstrual cycles including the most recent cycle. Women were excluded if they had a history of coagulopathy, diabetes, cardiovascular or renal diseases, smoked cigarettes or consumed alcohol, were taking supplements or hormones, had an allergy to fish, menstruated irregularly, had a history of a psychological disorder, were pregnant or nursing, or had any stressful event 3 months prior.
The mean age of the women in the omega-3 and placebo groups was 24.22 and 23.64 years respectively. Prior to intervention, PMS was reported as severe by 8% in the omega-3 group and 11% in the placebo group.
Primary outcome: The primary clinical outcome was to assess the symptoms of PMS as the result of intervention, using the Iranian version of PMS screening tool (PSST) and quality of life.
Key findings: Most of the PMS symptoms and premenstrual interference with daily activities were significantly reduced in both groups. However, the mean score of overeating in the omega-3 group and insomnia in the placebo group did not differ at end of intervention compared to baseline. The prevalence of primary dysmenorrhea in the omega-3 group was 60% and 68.8% in the placebo group and only the omega-3 group reported a reduction of dysmenorrhea. The mean scores of physical and mental components of quality of life significantly improved in both groups.
Practice Implications: In this study, both the omega-3 supplement and the placebo decreased symptoms of PMS. However, it is not clear whether placebo has a greater effect than no treatment at all. If I were to experiment with fish oils for PMS, I would likely deliver a higher amount of EPA/DHA, and in particular the EPA, due to research on unipolar depression, and also have daily intake, rather than only 10 days per month. Previous research on omega-3 fatty acids is more compelling than this current study. A 2013 study, investigated the effect of 2 gm daily of omega-3 fatty acids for PMS. In that randomized double-blind controlled trial, omega-3 fatty acids significantly reduced the severity and duration of PMS symptoms. Another study demonstrated that 2 gm/day was more effective than 1 gm per day over 6 months. In contrast, a randomized, double-blind, crossover trial studied women with PMS over 10 menstrual cycles. Treatment with essential fatty acids was found to be ineffective for PMS.