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Premenstrual Syndrome Follow-up

  • Author: Megan A Moreno, MD, MEd, MPH; Chief Editor: Andrea L Zuckerman, MD  more...
Updated: Feb 11, 2015

Further Outpatient Care

Outpatient management primarily involves monitoring, keeping a 2-month symptom diary, and instituting further therapy as the symptoms warrant. PMS is a very difficult condition to treat and cannot be completely eradicated by any single therapy. It is to be hoped that continued research in this area will lead to better treatment.

Because of the difficulty of treating PMS and the variations in response to treatments experienced by patients, complementary and alternative strategies have been explored for patients with PMS. These include the following:

  • Relaxation response - This technique consists of quiet sitting, progressive muscle relaxation, and the repetition of a constant stimulus, such as the word "one" during each inhale and exhale; practicing for 10-20 minutes daily is recommended
  • Biofeedback and guided imagery
  • Cognitive behavioral therapy and group therapy
  • Light therapy - Bright-light therapy uses 10,000 lx cool-white fluorescent light daily for 30 minutes
  • Massage
  • Chiropractic therapy
  • Homeopathy and herbal medicines - Studies have examined the efficacy of various homeopathic and herbal medicines, including Crocus sativus L (saffron) and Chinese herbal medications; one pilot study found that 90% of patients receiving a homeopathic treatment regimen experienced improvement in symptoms, compared with 37.5% of those receiving placebo[33] ; several studies have concluded that some alternative methods may be beneficial in symptom alleviation and that further research is warranted[48, 49, 50, 39, 35]


Complications of PMS may include school absence and behavioral problems.



Inability to maintain normal activities is part of the definition of this disease; hence, morbidity is related to loss of function. Most PMS symptoms worsen with the patient's age until menopause; thus, little good news can be given to severely affected adolescents.


Patient Education

Because PMS may cause major morbidity for the adolescent, providing patient education regarding alternative therapies that may alleviate some symptoms is important.

Behavioral counseling and stress management may help the patients regain control during times of high emotionalism. Relaxation techniques may also help. Areas of stress should be identified. Relaxation techniques such as yoga, biofeedback, and self-hypnosis may be beneficial. Regular exercise often decreases the symptoms of PMS. Patients should be counseled to avoid salt, caffeine, alcohol, and simple carbohydrates.

For patient education resources, see the Women's Health Center, as well as Premenstrual Syndrome (PMS).

Contributor Information and Disclosures

Megan A Moreno, MD, MEd, MPH Associate Professor, Division of Adolescent Medicine, Center for Child Health Behavior and Development, Seattle Childrens Hospital

Megan A Moreno, MD, MEd, MPH is a member of the following medical societies: Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.


Liana Roxanne Clark, MD, MS Assistant Professor, Department of Pediatrics, Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia; Medical Director, Global Medical Affairs and Policy, Merck Vaccines

Liana Roxanne Clark, MD, MS is a member of the following medical societies: American Academy of Pediatrics, Society for Adolescent Health and Medicine

Disclosure: Received salary from Merck & Co. Inc for employment. for: Merck & Co., Inc.

Ann E Giesel, MD Clinical Professor of Pediatrics, Division of Adolescent Medicine, University of Washington; Director of Pediatric and Adolescent Gynecology, Seattle Children's Hospital; Medical Director of the King County Juvenile Detention Center Health Clinic; Medical Director of the Evevning Clinics at the Country Free Doctor FreeTeen Clinic for Homeless Youth

Ann E Giesel, MD is a member of the following medical societies: North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine, Washington State Medical Association

Disclosure: Nothing to disclose.

Cara Beth Rogers University of Rochester

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD Associate Professor of Obstetrics/Gynecology, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Additional Contributors

Elizabeth Alderman, MD Director, Pediatric Residency Program, Director of Fellowship Training Program, Adolescent Medicine, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.

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