Treatment & Considerations for PMS

Once doctors diagnose a patient with PMS, it’s now time to initiate a comprehensive treatment plan that will address the symptoms. The treatment options include:

Education/Awareness – The first line of defense against PMS begins with an effective patient educational and awareness program. Research published in the Journal of Pharmaceutical Sciences & Research studied women who were administered an education program regarding PMS. Three months following the program, the women, who were given instruction regarding PMS, showed an increased awareness and decreased symptoms compared to the control group that didn’t receive training.6

Lifestyle and Dietary Changes – These productive changes are often the first line of defense in a detailed patient educational program. These simple, but often-overlooked, modifications can sometimes be all that is needed to reduce or alleviate the symptoms of PMS. These changes include frequent exercise. Studies have indicated that aerobic exercise, such as thirty minutes of daily moderate-intensity activity, help to lessen the severity of symptoms associated with PMS, such as depression, anxiety, tension and other mood-related symptoms.3  

Diet is also an important factor to help control PMS symptoms. Randomized controlled trials have shown that complex carbohydrates, like fruits, whole grains and certain vegetables, can reduce the severity of PMS symptoms.3  Experts also recommend to limit salty foods, caffeine and alcohol. These substances may increase symptoms, such as bloating, tension, insomnia and anxiety.

Home Treatment – A home treatment plan often includes vitamins, supplements and herbal medicine. This form of PMS management has become increasingly popular among women. A 2009 systematic review of 62 studies concerning vitamins, supplements and herbs revealed that certain vitamins and herbs, such as vitamin B-6 and chasteberry (a small tree shrub grown in Europe) may reduce symptoms of PMS. During one of the randomized controlled studies, women treated with chasteberry showed a 50% decrease in symptoms of anger, mood swings and irritability compared to the placebo group.1 Women treated with vitamin B-6 also showed a two-fold reduction in symptoms compared to the placebo group.1

Due to the potential for negative drug interactions, always consult your physician prior to taking supplements. Moreover, herbal supplements aren’t regulated by the US Food and Drug Administration. Other popular home remedies include relaxation techniques like yoga, massage and chiropractic care. Development of a mindfulness-based approach to PMS can help to reduce some of the negative symptoms.5

Cognitive Therapy – This therapy uses psychological techniques focused on negative thoughts and emotions that accompany PMS. This approach has been used for some time to treat pain; however, recent studies have focused on its effectiveness for treating PMS. These studies have revealed that cognitive therapy can reduce the symptoms of depression, anxiety and body pain caused by PMS.3, 5

Hormonal Intervention – During this treatment, doctors prescribe hormone medications to help treat the symptoms of PMS. Common forms include:

Oral contraceptives – This class of medication stops ovulation. Some women suffering from PMS have reported that oral contraceptives have helped to reduce mood swings and other physical symptoms, such as headaches, breast tenderness and abdominal pain. A recent randomized control study of women administered oral contraceptives showed improvement in mood swings, bloating and breast tenderness compared to the placebo group.

Gonadotropin-releasing hormone agonists – This class of medication is used to suppress ovarian function. This drug stops the menstrual cycle completely and should be used as a last resort for treating the symptoms of PMS.  Moreover, there have been several negative side effects reported such as decreased bone density and hot flashes.

Danazol – This synthetic hormone medication helps to relieve breast tenderness by decreasing estrogen in the body through the suppression of ovulation. Several studies have corroborated that this medication provides therapeutic assistance in breast pain, lethargy and anxiety caused by PMS.3 Adverse side effects of this medication include increased appetite and weight gain.

Medication – In addition to hormonal treatment, women suffering from PMS have a variety of pharmaceutical options:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – Pain relievers, such as Naproxen and Ibuprofen help to decrease pain associated with menstruation. These drugs also help with cramping and breast discomfort. NSAIDs are most beneficial when started seven days prior to menstruation and continued for at least four days into the cycle. Long-term use of NSAIDs can increase the risk of heart attack, gastrointestinal bleeding and ulcers.

Diuretics – These drugs are used to limit water retention. They are also known to help symptoms, such as weight gain, swelling and bloating caused by PMS.

Antidepressants – This class of medication, known as selective serotonin reuptake inhibitors (SSRIs) affects serotonin levels in the brain. SSRIs are commonly used for severe symptoms of PMS such as anxiety, fatigue, insomnia and anger. Examples of this class of drug include – paroxetine (Paxil), fluoxetine (Prozac), sertaline (Zoloft), escitalopram (Lexapro) and others.7  

The overall effectiveness of SSRIs for PMS has been supported through the results of a recent meta-analysis of 15 controlled studies. The goal of this meta-analysis research was to compare and contrast the results of several studies through statistical research to prove the effectiveness of SSRIs for PMS symptoms.

The research indicated that Prozac, the most widely studied drug used for the treatment of PMS, has proven beneficial in the treatment of both physical and emotional sympoms.3  The other aforementioned SSRIs have also proven effective in treating physical and psychological symptoms. The research also revealed that SSRIs may need to be administered for three to four weeks to treat depression; however, other PMS symptoms usually disappear more rapidly.

Antianxiety Drugs – This class of medication, known as anxiolytics are sometimes used to treat premenstrual anxiety.  The most common drugs are benzodiazepines, such as alprazolam (Xanax). Side effects include drowsiness, increased appetite and the potential for addiction.

Another anti-anxiety drug used to reduce irritability associated with PMS is known as Buspirone (Buspar). Unlike Xanax, this drug is not addictive and also has less pronounced side effects.

Considerations

The history of PMS has not been without conflict. PMS was originally viewed as a psychosomatic disease. At first, doctors dismissed PMS as an “imagined” problem. It wasn’t until the 1980s that several clinical trials started to present direct evidence of this real medical condition.

One of the issues with the diagnosis of PMS is that a variety of medical problems, such as depression and other conditions are often wrongly diagnosed. Through the utilization of symptom journals and other diagnostic medical questionnaires, doctors now have tangible guidelines to help them treat the annoying symptoms of PMS.