April 7, 2025

Phospholipids Reduce PMS Symptoms: A Summary of Research

By: Sakina Burhani

Editor’s Note: Throughout the world, countless women experience symptoms of premenstrual syndrome (PMS) and seek ways to prevent and manage this common condition. Sakina Burhani summarized this week’s research article while on the FACTS elective that teaches physicians in training about fertility, including benefits of charting the female cycle. She summarized a clinical trial published by Schmidt et al in 2018 [1] that assessed the use of PAS complex—a combination of phospholipids—to reduce symptoms of PMS. Read her summary below to learn about the promising results about this safe potential intervention for PMS.

Introduction

Premenstrual syndrome (PMS) refers to a variety of physical and psychological symptoms women may experience at specific points during the ovarian-menstrual cycle. These symptoms typically start in the luteal phase until menstruation. For some patients, PMS includes but is not limited to irritability, mood fluctuations, breast tenderness, and fatigue. Affecting approximately half of reproductive-age women, the exact cause of PMS is unclear, as it seems to be multifactorial. PMS is also related to a more severe form, premenstrual dysphoric disorder (PMDD), which has a prevalence of 3 to 8 percent.

“Premenstrual syndrome (PMS) refers to a variety of physical and psychological symptoms women may experience … in the luteal phase until menstruation… PMS is also related to a more severe form, premenstrual dysphoric disorder (PMDD).”

Observational data collected from December 2011 through March 2012 showed improvement of PMS symptoms after 2 months of using Lipogen’s phosphatidylserine (PS) and phosphatidic acid complex (PAS). The study by Schmidt et al summarized below aimed to confirm the benefit of PAS complex for women with PMS. [1]

Methodology

For this study, 99 women were screened for eligibility, with 40 women ages 18 to 45 completing the study. The other women were excluded for a variety of reasons including cycle length, past medical history, diet, and lifestyle habits. In this prospective, randomized, double-blinded study, the 40 participants were randomized into the PAS group or the placebo group. The PAS group was given a complex with 400 mg of phosphatidylserine and 400 mg of phosphatidic acid per day. Patients in both groups were monitored for 5 visits, which included a baseline menstrual cycle and 3 treatment cycles. PMS symptoms were monitored via the Daily Record of Severity of Problems (DRSP). Serum cortisol, estradiol, progesterone, and corticosteroid binding globulin levels were measured along with salivary cortisol levels.

Results

The total score on the Daily Record of Severity of Problems was significantly improved (P=0.001) for the PAS treatment group compared to the placebo group with improvements seen for both subscale of physical symptoms and depressive symptoms. The average symptom reduction was 19.4% for the PAS group compared to 8.9% for the placebo group. Participants in the PAS group also had a lower reduction of productivity compared to the placebo group (P=0.052). In addition, they had less interference with relationships compared to the placebo group (P=0.099). There was no difference in the reduction of the number of participants who met PMS or PMDD criteria based on the Screening Instrument for Premenstrual Symptoms (SIPS). Lastly, the PAS group had a decrease in serum cortisol level from the first to the fifth visit, while the placebo group had an increase in cortisol.

“The total score on the Daily Record of Severity of Problems was significantly improved (P=0.001) for the PAS treatment group (combination of phospholipids) compared to the placebo group with improvements seen for both subscale of physical symptoms and depressive symptoms.”

Discussion

This article supports the conclusion that PAS complex (400 mg of phosphatidylserine and 400 mg of phosphatidic acid per day) is a safe and effective treatment option for patients experiencing symptoms of premenstrual syndrome. The improvement in DRSP scores for women in the PAS group supports improvement in a variety of symptoms that make up PMS. Helping patients manage these symptoms is important when considering their impact on quality of life.

The symptoms of PMS not only affect the patient but also her relationships and interactions with her partner. PMS symptoms may begin at the start of the luteal phase, which is the end of the fertile window, so these symptoms could impact a patient’s ability to conceive. Patients who have a stronger understanding of their cycle through the use of fertility awareness-based methods (FABMs) may be able to recognize some of their symptoms as PMS because they are more aware of when they are in the luteal phase, leading to earlier, more effective treatment.

“Patients who have a stronger understanding of their cycle through the use of fertility awareness-based methods (FABMs) may be able to recognize some of their symptoms as PMS … leading to earlier, more effective treatment.”

This article provides a basis to encourage future research that explores more treatment options for PMS. This study was limited in its sample, as it only included one site with only forty adult patients. As most women begin menstruating before the age of 18, it would be ideal to include the adolescent population in a similar study. This research also excluded patients with abnormal cycle lengths and various medical conditions, so a more thorough and inclusive study would be required to justifiably generalize the results to all women of reproductive age. It would also be interesting to see how the use of PAS complex compares to other treatments offered for PMS, including selective serotonin inhibitors, hormonal birth control, and cognitive behavioral therapy (CBT).

Editor’s Note: Are you interested in learning more about PMS and PMDD, and ways in which FABMs and charting the female cycle may help? Follow the links below to read more research reviews written by future physicians who participated in the FACTS elective:

References

[1] Schmidt K, Weber N, Steiner M, et al. A lecithin phosphatidylserine and phosphatidic acid complex (PAS) reduces symptoms of the premenstrual syndrome (PMS): Results of a randomized, placebo-controlled, double-blind clinical trial. Clinical Nutrition ESPEN. 2018;24:22-30. doi:10.1016/j.clnesp.2018.01.067

ABOUT THE AUTHOR

Sakina Burhani
Sakina Burhani is a fourth-year medical student at Chicago Medical School/ Rosalind Franklin University. She completed her undergraduate education at the University of Illinois in Urbana-Champaign, IL. She plans to complete residency in pediatrics and is passionate about patient education and advocacy. She enrolled in the FACTS elective to gain a better understanding of reproductive health and the possible medical uses of FABMs.

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