Study finds heavy drinking linked to worse PMS

Women who are heavy drinkers are at increased risk of pre-menstrual syndrome (PMS), new research shows.

“Together with other researchers, we believe that alcohol increases PMS risk by altering the level of hormones, such as gonadotropin, during the menstrual cycle,” Dr. Bahi Takkouche, the study’s senior author, said.

Up to 40 per cent of women in the US have at least moderate PMS, while rates in global studies have ranged from 10 per cent to 98 per cent, Takkouche and colleagues noted in BMJ Open. Symptoms of PMS include mood swings, breast tenderness, fatigue, irritability and depression. PMS occurs during the luteal phase of the menstrual cycle, which begins after ovulation and lasts about 14 days, ending with menstruation if an egg has not been fertilized.

In 2014, the World Health Organization warned that women may be more vulnerable than men to alcohol’s ill effects. Some studies have found that women who drink alcohol have worse PMS than those who abstain, the authors note, while others have not found a link.

Takkouche. a professor of preventive medicine at the University of Santiago de Compostela in Spain, and colleagues analyzed 19 studies of alcohol and PMS. They found PMS risk was 45 per cent higher in women who reported drinking compared to non-drinkers, which they called a “moderate increase.” Women who were heavy drinkers - meaning those who drank more than the currently recommended one drink a day for women (men are allowed two) -were 79 per cent more likely to have PMS than abstainers.

Globally, the authors note, 29 per cent of women drink, while nearly 6 per cent are heavy drinkers. In Europe, 60 per cent of women drink and about 13 per cent are heavy drinkers. The authors say that if heavy drinking does turn out to contribute to PMS, wiping out excessive drinking could prevent one in every 12 cases of PMS in Europe.

In addition to causing burdensome symptoms, PMS may be associated with other health problems, Takkouche and colleagues write. “I know of at least one U.S. study, very well designed, that found an increase in the risk of hypertension among women who had suffered PMS, especially among those who had suffered from hypertension before 40 years of age,” Takkouche said.

 “Although we do not pretend to make recommendations on the basis of one study only, even if it is a ‘study of studies’ as ours (a meta-analysis), we think it would be better to avoid heavy drinking for women who are prone to PMS,” he added.

Takkouche’s team is now investigating the role of tobacco smoking and psychological factors, including stress, in PMS.

 “I think that this disorder should be taken as seriously as any other disease, both by women who suffer from it and by the community of health professionals, part of which disregards this syndrome and considers it as a social construct only,” he said.

Most of the studies the authors analyzed could not show which came first - drinking alcohol or PMS, said Dr. Elizabeth Bertone-Johnson, a professor of epidemiology at the University of Massachusetts at Amherst who studies PMS.

She said that women with severe PMS may drink to cope with anxiety and depression. The new study doesn’t provide “any greater understanding of whether alcohol increases the risk of PMS,” she believes.

Bertone-Johnson and her colleagues conducted a prospective study of alcohol use and PMS, meaning they started out with a group of women who were PMS-free, and investigated whether those who drank more were more likely to develop PMS over time. “In our study, we didn’t see any increase in women with the highest intake at all,” she said. “The risk was almost lower.”

While a woman can try to cut back on alcohol to see if it improves her symptoms, there are other lifestyle measures that have more evidence behind them, Bertone-Johnson added. Her own studies have found that women with higher intakes of calcium, vitamin D, B vitamins, and iron were at a lower risk of PMS. Both multivitamins and some fortified cereals can provide enough of these micronutrients, with no need for megadoses, Bertone-Johnson added.

Smoking and a higher body mass index have consistently been associated with an increased risk of PMS, the researcher added, so kicking the habit and maintaining a healthy weight are also likely to improve symptoms.