What is the most effective medication or herbal remedy for moodiness during PMS? I am about to start taking birth control pills again, and the last time they made me nuts! My mood swings were so extreme that my father wanted me to see a psychiatrist. I have seen a natural product advertised for PMS. Would something like this help, and can I use it with birth control pills?

Marisol

First of all, you might want to discuss with your doctor that the last pills you were on made you nuts; sometimes something as simple as changing to a different brand will eliminate the problem. Beyond that, your first line of defense against the mood changes of PMS (premenstrual syndrome) is to make sure you are exercising (a known mood elevator) and eating a well-balanced diet. Often eating frequent, small, high-carbohydrate meals around midcycle can help with mood swings. Vitamin and mineral supplements that are helpful are B-complex and calcium/magnesium/zinc.

St. John's wort is probably the most effective natural remedy for the mood changes of PMS. It has been extensively used in Europe, and studies done on women with PMS showed it to be effective. The usual dose of St. John's wort is 300 mg of a standardized preparation three times a day; I recommend taking it once a day to start and increasing it around the middle of your cycle. Never exceed the recommended dose for this or any other herb. Other herbs that may help are valerian root, evening primrose and chamomile. St. John's Wort may interact with certain medications; make sure to check with your doctor before starting any new drug and discuss other medications you might be taking.

As far as the "natural" PMS remedies, the ones I've seen typically contain a mix of St. John's wort, valerian root or chamomile, chaste tree and a few other herbs. I am a fan of using single-ingredient remedies wherever possible (why take things you may not need?) so I'd recommend trying the St. John's wort first. That herb alone has no interaction with birth control pills, whereas a mix of herbs is more likely to pose problems.