Treatment Overview

Most women normally have one or more troubling physical and emotional symptoms between the time they ovulate and the first days of their menstrual period. These are called premenstrual symptoms. When premenstrual symptoms interfere with your relationships or responsibilities, they are called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), a severe form of PMS.

Although PMS cannot be cured, you do have a number of lifestyle and medication choices that can reduce your symptoms and improve your quality of life.

Basic PMS treatment

If you have PMS, keep a menstrual diary(What is a PDF document?), make lifestyle changes, and use home treatment measures. After a few menstrual cycles, you should notice some improvement in symptoms. Whether or not you then decide to add medication treatment, the following home treatment may help you:

• Take daily calcium and vitamin B6 (50 mg to 100 mg). Both of these nutrients affect the hormone-producing endocrine system. Calcium may help relieve PMS symptoms. Daily vitamin B6 may improve PMS depression and physical symptoms.
• Reduce your caffeine, refined sugar, and sodium intake, at least during the premenstrual phase of your cycle. These substances are linked to emotional and physical PMS symptoms, such as insomnia, tension and anxiety, food cravings, pain, and bloating.
• Get regular exercise. Exercise helps reduce depression. Women often report that exercise helps relieve tension, pain, and mood-related PMS symptoms.
• Reduce stress. While stress is not a cause of PMS, it may make your symptoms worse. In turn, coping with stress can be more difficult during the premenstrual period.
• Use nonprescription medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), for headache, joint or muscle pain, or cramps. NSAIDs work best when taken before and continued at regular dosage intervals throughout the premenstrual pain period. For some women, this continues into the first days of menstrual bleeding, to relieve painful cramps.

Additional treatments for PMS

If you still have moderate to severe symptoms after two or three cycles of healthy lifestyle and home treatment measures, talk your health professional about further treatment options. Consider the following for specific symptoms.

All physical and mood-related symptoms

The selective serotonin reuptake inhibitor (SSRI) class of antidepressants is often the first-choice medicine for moderate to severe premenstrual symptoms, including aggression, depression, anxiety, and physical symptoms. Most women gain relief by taking an SSRI either continuously or only during their premenstrual days. If you try an SSRI but find it ineffective, it's a good idea to try another type of SSRI before moving on to another class of medicine.

PMS: Should I Try an SSRI Medicine for My Symptoms?

The birth control pill with estrogen and drospirenone may help relieve symptoms in women with severe PMS or PMDD. This pill is sold as YAZ (very low-estrogen) or Yasmin (low-estrogen).

Bloating or breast tenderness

• Spironolactone. Taken during the premenstrual phase, this diuretic can relieve bloating and breast tenderness.
• Drospirenone, in the birth control pill called YAZ or Yasmin, acts like spironolactone. It relieves bloating, breast tenderness.
• Daily vitamin E (400 IU), taken during the premenstrual phase, may help with breast tenderness.
• Evening primrose oil contains essential fatty acids that may offer mild relief of some PMS symptoms for some women.

Other hormonal, sedative, or surgical treatments for severe PMS

The goal of hormonal and surgical treatments is to stop a part of the hormonal (endocrine) system that is linked to premenstrual symptoms. These treatments are not commonly used to treat PMS symptoms, either because they are now known to be ineffective or because they have severe side effects.

• Birth control pills (estrogen-progestin) are widely prescribed for PMS, but they do not always relieve PMS. Although they may improve bloating, headache, abdominal pain, and breast tenderness for some women, other women report that they have worse symptoms or they develop mood problems. Birth control pills are known to be ineffective for treating mood symptoms. Estrogen alone may offer some benefit for some women, but when taken without progestin, it increases the risk of uterine (endometrial) cancer.
• Progestin has been used in the past for PMS, but for some women, it may make physical and emotional symptoms worse.
• Danazol is a synthetic male hormone that can relieve breast pain by decreasing estrogen production. It isn't often prescribed.
• Benzodiazepine treatment with alprazolam is occasionally used for PMS-related anxiety. It depresses the central nervous system, loses effectiveness over time, and can be addictive. Because long-term use can be complicated by withdrawal and life-threatening symptoms, this medicine is only recommended for a few days' use when other treatments have been ineffective.
• Gonadotropin-releasing hormone agonists (GnRH-a) are a last-resort treatment for severe PMDD symptoms. This medicine stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.
• Surgery to remove the ovaries (oophorectomy) is a rarely used, controversial treatment, because it irreversibly causes early menopause. Menopause symptoms caused by surgery, such as hot flashes, depression, and insomnia, are often more severe than those of natural menopause.

What to think about

No single therapy is effective for all women. You and your health professional may have to try more than one type of treatment before finding the right choice for you.