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Treatment of Premenstrual Syndrome (PMS)

By Dr Ananya Mandal, MD

Premenstrual syndrome (PMS) is characterized by physical, emotional and behavioural symptoms and usually occurs 5 to 10 days before a menstrual period and usually resolves once the periods begin. There are over 150 symptoms of the condition.

Diagnosis of Premenstrual Syndrome

At present there are no specific laboratory tests or findings that can be used to diagnose the disease.

For diagnosis, usually physicians ask the patient to maintain a symptom diary. This diary records the intensity of symptoms, day of onset and duration for at least 3 months before the physician reaches a diagnosis of PMS.

A complete medical history and history of depressive illnesses of mood disorders is taken.

Physical examination includes a complete check up with pelvic examination as well. Some patients may also need a psychiatric evaluation.

Diagnosis is made solely on the basis of the symptoms in the symptom calendar or diary. Since symptoms vary from person to person this could be a challenge.

Treatments for Premenstrual Syndrome

There is no cure for PMS but there are treatments that can help decrease the severity of symptoms so they do not interfere with the daily life.

If PMS is mild or moderate only diet and lifestyle changes are enough.

Treatment of PMS includes a maintaining a healthy lifestyle, eating small and frequent meals to prevent bloating and so forth. (1-7)

A Healthy Life Style for Premenstrual Syndrome

This includes drinking plenty of fluids like water and juice and avoidance of caffeinated or alcoholic beverages. Clear fluids help in reduction of bloating and fluid retention.

Salt should be restricted in diet as excessive salt in diet leads to bloating and fluid retention.

Preventing Bloating in Premenstrual Syndrome

Patients are advised to eat small and frequent meals to prevent bloating and fullness. There should be no more than 3 hours between snacks and overeating needs to be avoided.

Diet should be low salt and lack fats, alcohol, caffeine and simple sugars. Patients with PMS are advised to take plenty of fruit and vegetables (at least five portions a day), which are rich in vitamins and minerals.

Supplements for Nutritional Deficiencies

Some women suffer from PMS due to nutritional, vitamin and mineral deficiencies. These women are advised to take supplements such as:

  • Vitamin B6, E
  • gamma-linolenic acid (GLA)
  • calcium
  • magnesium

Sometimes women are also advised to take Tryptophan, which is found in dairy products is also helpful.

Exercise and Premenstrual Syndrome

Regular aerobic exercise or stretching and breathing exercises, such as yoga and pilates should be undertaken throughout the month to reduce the severity of PMS symptoms.

Pain Relievers for Premenstrual Syndrome

Women benefit from pain relievers like Aspirin, Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs). These help in reducing pain of headaches, back and muscle pain, breast tenderness and pelvic pain.

Antidepressants for Premenstrual Syndrome Symptoms

Some patients with a more severe disease may be prescribed antidepressants. These include selective serotonin-reuptake inhibitors (SSRIs) like:

  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Escitalopram etc.

Other Treatments for Premenstrual Syndrome

Other treatments for PMS include:

  • Night time sleep habits may need to be changed to improve insomnia.
  • Birth control pills work differently in different women and may decrease or increase PMS symptoms
  • Some women may have psychological issues and may benefit from counselling and cognitive behavioral therapy.
  • Light therapy is another option for women with PMS and decreases the need for antidepressant medications
  • Those with severe anxiety may benefit from anti-anxiety drugs
  • Women with fluid retention may benefit from water pills of diuretics. This reduces bloating, breast tenderness, and weight gain.
  • Drugs acting on hormones like Bromocriptine, Danazol and Tamoxifen are used to relive severe breast pain.
  • There is no concrete evidence that removal of the uterus (womb) or ovaries helps in reduction of PMS symptoms and this should not be attempted.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Jul 31, 2012

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