Medical Care

Medical care of premenstrual syndrome (PMS) is primarily pharmacologic and behavioral, with an emphasis on relief of symptoms.^{[22, 23]}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.^{[24, 19, 21, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47]}At present, selective serotonin reuptake inhibitors (SSRIs) are commonly considered suitable first-line therapy for premenstrual disorders.^{[48, 49]}

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 ^[39]; several studies have concluded that some alternative methods may be beneficial in symptom alleviation and that further research is warranted ^{[50, 51, 52, 45, 41]}

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.

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.^[53]

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.^{[54, 55, 44]}

Activity

The benefits of exercise include physical improvements as well as stress reduction. Regular aerobic exercise has been found to decrease symptoms in some adolescents and young women.^[56]A systematic review showed that exercise reduced physical symptoms such as pain, constipation, and breast sensitivity, as well as psychological symptoms such as anger and anxiety.^[57] Preliminary studies suggest that yoga may also alleviate symptoms in some women.^{[58, 59]}

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.

Medication

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Author

Megan A Moreno, MD, MSEd, MPH Professor, Interim Chair, Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health

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

Disclosure: Nothing to disclose.

Coauthor(s)

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.

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.

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.

Premenstrual Syndrome Treatment & Management

Medical Care

Surgical Care

Diet

Activity

Long-Term Monitoring

References

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