Evaluation of the Effects of Krill Oil on the Management
of Premenstrual Syndrome
Fotini Sampalis M.D., Ph.D.
, Roxandra Bunea M.D.
, Marie France
Odile Kowalski, M.D.,
Natalie Duguet, M.D.,
Sébastien Dupuis, BSc.
1 Technologies & Bioressources, Inc.
2 Assistant Professor, Department of Internal Medicine, McGill University; Riverview Medical Center,
Montreal, Quebec, Canada.
3 Marie Family Medicine & Obstetrics, CLSC Bordeau Cartierville, Department of Gynecology, Montreal,
Quebec, Canada; Family Medicine & Obstetrics, Sacré-Coeur Hospital.
4 Family Medicine & Obstetrics, Clinique l’Envolée, Montreal, Quebec, Canada.
Altern Med Rev 2003;8(2):171-179
Multiple causes have been attributed to
the complex interplay of neuroendocrine,
chronobiological, and psychosocial interactions
that comprise the symptomatology of PMS.
review reveals more than 200 symptoms that have
been reported to occur premenstrually.
ing on the symptom, the causative factors include
hormonal imbalance, psychological abnormalities,
nutritional deficiency or excess, increased inflam-
matory prostaglandin synthesis, and neurotrans-
Nevertheless, laboratory find-
ings vary from being completely normal in some
women to an excess or deficiency of certain hor-
mones, neurotransmitters, or nutrients in others.
The most probable cause of the physical symp-
toms of PMS seems to be the combined interac-
tion of hormones and essential nutrients leading to
an increased inflammatory response. On the other
hand, the emotional symptoms of PMS seem to be
propagated by an exaggerated response of
neurotransmitters to psychosocial stresses. These
imbalances have been shown to differ extensively
from person to person, as well as from cycle to
cycle within the same person.
Evidence suggests that alpha-tocopherol
can significantly reduce symptoms of PMS.
Tocopherol reduces release of arachidonic acid
from phospholipids, resulting in a decrease in for-
mation of prostaglandin E2
crosses the blood-brain barrier, also has modulat-
ing effects on neurotransmitters.
suggest a beneficial effect of vitamin A for the
treatment of PMS, particularly for premenstrual
The balance of polyunsaturated
(essential) fatty acids in the body is critical for the
maintenance of healthy cell membranes and
hormone regulation. During the last several
decades, the average Western diet has shifted to
much higher levels of omega-6 and less omega-3
fatty acid intake. Long-chain omega-6 fatty acids,
such as arachidonic acid, predominating in the
phospholipids of cell membranes can encourage
the production of pro-inflammatory type-2
), while omega-3 fatty acids
promote the production of anti-inflammatory
Omega-6 fatty acids, mainly arachidonic acid, are
released following the reduction of progesterone
prior to menstruation,
inflammatory process by triggering a flux of
inflammatory prostaglandins and leukotrienes in
At the same time, cyclooxygenase
metabolites of arachidonic acid, prostaglandins E2
, cause vasoconstriction and myometrial
contractions that lead to ischemia and eventually
the pain of menstrual cramps.
Research has uncovered abnormal fatty acid
metabolism in women with PMS. Brush and
colleagues examined plasma fatty acid levels in
42 women with premenstrual syndrome. They
found that although levels of linoleic acid, the
body’s main dietary source of omega-6 fatty ac-
ids, were significantly above normal in all the
women, levels of its anti-inflammatory metabo-
lites, including gamma-linolenic acid, were all
reinforcing the theory that one of the
main causes of PMS is inflammation.
The role of long-chain fatty acids for the
management of PMS has been evaluated in sev-
Omega-3 fatty acids, mainly
eicosapentanoic acid (EPA) and docosahexanoic
acid (DHA), compete with the omega-6 species
for the enzyme prostaglandin synthetase. The
omega-3 fatty acids trigger secretion of less po-
tent leukotrienes and anti-inflammatory prostag-
landins of the 3 series (PE3
The result is a decrease of myometrial
contractions and uterine vasoconstriction, reliev-
ing ischemia and reducing pain. This effect may
be due to an increase in sensitivity of the uterus to
the relaxing effects of beta-adrenergic catechola
While prostaglandin E1
) inhibits glu-
cose-induced insulin secretion, a deficiency –
occurring either as a result of an inadequate
intake of essential fatty acids in the form of
cis-linoleic acid or problems with conversion to
gamma-linolenic acid (GLA) – could result in
symptoms of hypoglycemia, cravings for sweets,
and increase in appetite reported by many PMS
Long-chain omega-3 fatty acids in
fish oil have been shown to be effective for the
control of cravings occurring prior to
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Volume 8, Number 2 ◆ 2003 Page 173
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