Premenstrual Syndrome Treatment & Management

Updated: Sep 01, 2016
  • Author: Megan A Moreno, MD, MEd, MPH; Chief Editor: Andrea L Zuckerman, MD  more...
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Treatment

Medical Care

Medical care of premenstrual syndrome (PMS) is primarily pharmacologic and behavioral, with an emphasis on relief of symptoms. [21, 22]  No single pharmacologic treatment is universally effective, and studies with all therapies have not produced consistent results. Current recommendations in the literature regarding oral contraceptive pills are conflicting. [23, 18, 20, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46]  At present, selective serotonin reuptake inhibitors (SSRIs) are commonly considered suitable first-line therapy for premenstrual disorders. [47, 48]

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 [38] ; several studies have concluded that some alternative methods may be beneficial in symptom alleviation and that further research is warranted [49, 50, 51, 44, 40]
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Surgical Care

In women who are severely affected, bilateral oophorectomy has been effective in alleviating symptoms because it renders the patient postmenopausal. A hysterectomy is not needed to gain the symptomatic relief. For obvious reasons, this therapy is not recommended for adolescents and young women.

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Diet

Despite a lack of evidence to indicate that dietary changes can definitively change PMS symptoms, healthy lifestyle recommendations are worth making in that they benefit the patient overall, as well as give her a sense of control. [52]

Eating four to six smaller meals per day during the premenstrual period may help reduce symptoms or food cravings.

One study found that women with PMS typically consume more dairy products, refined sugar, and high-sodium foods than women without PMS. Accordingly, many clinicians recommend reducing or eliminating these foods from the diet. Avoidance of salt, caffeine, alcohol, chocolate, or simple carbohydrates may alleviate symptoms.

A written sheet with foods to avoid (eg, cola, coffee, hot dogs, potato chips, and canned goods) and foods to encourage (eg, fruits, vegetables, milk, complex carbohydrates, high-fiber foods, and low-fat meats) may assist patients in making helpful food choices. [53, 54, 43]

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Activity

The benefits of exercise include physical improvements as well as stress reduction. Regular aerobic exercise has been shown to decrease symptoms in some adolescents and young women. [55] Preliminary studies suggest that yoga may also alleviate symptoms in some women. [56, 57]

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Long-Term Monitoring

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.

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