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TREATMENT
Many premenstrual syndrome (PMS) symptoms improve with treatment. Treatment options range from medication therapy to a newly approved type of birth control pill to diet modification, including vitamin and mineral supplementation, herbal medicines and exercise.
Antidepressants called selective serotonin reuptake inhibitors (SSRI) are typically recommended to women with severe mood-related symptoms such as anxiety, depression or obsessive/compulsive disorders. However, these are the only antidepressants that are effective for PMS/PMDD.
Overall, common treatment options include:
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Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications are used to relieve premenstrual headache and other menstrual-cycle related pain. A variety of NSAIDs are available including over-the-counter ibuprofen products (Motrin) and others, or naproxen sodium (Aleve). They usually cost less and have fewer side effects than other treatments. Prescription NSAIDs also are available.
Note: NSAIDS have been linked to an increased risk of serious cardiovascular (CV) events, such as heart attack and stroke. As a result, the FDA has issued a "black box" warning highlighting this risk, as well as the risk of potentially life-threatening stomach bleeding. If you've recently had heart surgery, you shouldn't take NSAIDS. All other women considering NSAIDS to ease PMS or any other condition should discuss these potential risks with their health care professional.
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Contraceptive hormones. The combination birth control pill YAZ (containing 3 mg of drospirenone, a progestin and 20 mcg ethinyl estradiol, a form of estrogen) was recently approved by the FDA. This oral contraceptive (OC) was shown to be clinically effective for treating the emotional and physical symptoms of PMDD for women who choose OCs as their method of birth control.
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GnRH agonists (gonadotropin-releasing hormone). These medications include leuprolide (Lupron), among others. They belong to a class of hormones used to temporarily shrink fibroids and relieve endometriosis. They also may be recommended to treat PMS because they "turn off" the menstrual cycle by blocking estrogen production.
Side effects may include menopausal symptoms like hot flashes, vaginal dryness and bone loss, however. That's why low-dose hormone therapy, a combination of estrogen and progestin hormones, is typically prescribed along with GnRH agonists. Some women may experience a return of their PMS symptoms with the additional hormone therapy. GnRH agonists are usually considered only as a short-term treatment option because of the increased health risks such as osteoporosis associated with low estrogen levels.
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Selective serotonin reuptake inhibitors (SSRIs). These antidepressant medications are the preferred medication for treating severe PMS and PMDD symptoms, including depression. SSRIs include sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and fluoxetine (Prozac). Another type of antidepressant, venlafaxine (Effexor), may also be prescribed. The U.S. Food and Drug Administration warns that women taking antidepressants should monitor their symptoms closely, with the help of their health care professional, for signs that their condition is getting worse or that they are becoming suicidal, especially when they first start therapy, or when their dose is increased or decreased.
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Anti-anxiety medications such as alprazolam (Xanax)
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Calcium supplements (1,200 to 1,500 mg daily). Additional calcium in any form may help relieve some PMS symptoms. Low-fat dairy products (milk, yogurt and cheese) are a primary source of calcium, but you can also gain calcium from the following:
- Tofu and other soy products
- Rice milk
- Broccoli
- Dark greens, like turnip greens
- Green or red cabbage (raw)
- Salmon and sardines
Taking an over-the-counter calcium supplement can also help. But be patient; it may take two to three months to relieve PMS symptoms with calcium supplementation. If symptoms persist, have your vitamin D levels checked or change the type of calcium supplement you're using. Low levels of vitamin D can affect how the body absorbs calcium and some generic supplements may not have enough calcium available for absorption.
Exercise can also help relieve and possibly prevent PMS symptoms. Simple aerobic activity, such as taking a brisk walk for 30 minutes at least four times a week, or taking a jog or run for 20 minutes at least three times a week, can improve your mood
A word of caution: While a few small studies have shown that taking vitamin E and other nutrients, such as magnesium supplements, may relieve PMS symptoms the scientific evidence to support these claims is minimal. Likewise, the effectiveness of other nutrients reported to ease PMS symptoms, such as zinc and herbal remedies such as oil of primrose, are unproven. Always consult with your health care professional before taking any supplement or herbal product.
There is no single treatment that works well for every woman who experiences PMS. Typically, it's wise to try the most conservative treatment options first, which include lifestyle changes such as modifying your diet and exercising more. Discuss your symptoms with your health care professional if strategies you've tried don't work, so he or she can recommend other treatment options.
