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Premenstrual syndrome - treatment options

Premenstrual syndrome (PMS) is a term that refers to the range of physical and emotional symptoms that some women experience in the lead-up to menstruation. About 40 per cent of menstruating women are affected, with women aged between 30 and 40 years at most risk. The cause is unknown, but it’s thought that PMS symptoms are triggered by the high levels of the sex hormone progesterone that occur after ovulation. Since the cause remains unknown, PMS can’t be cured or prevented. However, it can be successfully managed with appropriate self-care and a range of different treatments. Consult with your doctor before embarking on any PMS treatment program.

Is it PMS?
There are more than 150 recognised PMS symptoms. PMS differs from one woman to the next, but common symptoms include moodiness, fluid retention, breast tenderness and food cravings. There are no specific tests for PMS, so diagnosis depends on ruling out other possible causes. In most cases, a woman can identify PMS by keeping a symptoms diary. Include the details of your menstrual cycle, - for example, the first and last days of your menstrual period - and ovulation symptoms (if any). Keep this diary for at least three cycles. If your symptoms are due to PMS, the following pattern should occur:

• Symptoms are experienced in the two weeks before your period starts.
• Symptoms resolve with menstruation.
• Once menstruation is over, you experience at least seven days with no symptoms.
• Symptoms start to return about mid-cycle.
• If symptoms continue without change, then PMS is probably not the cause - see your doctor for further investigation.

PMS management
PMS can be successfully managed with lifestyle changes, dietary modifications, supplements and medications. You may have to experiment to find the balance of treatments that work best for you. It’s a good idea to continue your PMS diary while you trial the remedies. Be sure to consult with your doctor or health care practitioner during this trial period.

Lifestyle changes
Recommended lifestyle changes include:

• Exercise regularly, at least three times per week.
• Don’t smoke.
• Cut back on caffeine and alcohol in the two weeks prior to menstruation.
• Ensure that you get sufficient sleep.
• Manage your stress in whatever way that works for you - for example, counselling, tai chi or meditation, walking or gardening.

Dietary changes
A recent Australian study found that women experiencing PMS symptoms crave high fat and high sugar foods (like chocolate, biscuits and icecream) and increase their food intake by about 20 per cent. Women with PMS can manage their weight and help reduce their PMS symptoms by making a few dietary changes, including:

• Eat smaller meals more often - for example, have six ‘mini-meals’ instead of three main meals.
• Reduce your intake of salty foods.
• Include more fresh fruits and vegetables and wholegrain foods in your daily diet.
• Boost your dairy food intake, but switch to reduced or non-fat versions.
• Don’t keep high fat and high sugar foods in the house.
• Make sure you have tasty and healthy snack alternatives on hand.
• Include your food choices in your PMS diary - charting your food intake may help you become more aware of high fat and high sugar snacking.

Supplements
Check with your doctor before taking any type of supplement. Please note that herbal supplements can be as powerful as pharmaceutical drugs, and should be treated with the same respect. Supplements that have been shown to help reduce PMS symptoms include:

• Calcium - about 1200mg per day of calcium carbonate can reduce PMS symptoms by half. You need to take these supplements for at least three cycles before you notice an improvement.
• Magnesium - about 200mg per day of magnesium can reduce PMS-related bloating, fluid retention and breast tenderness by 40 per cent. You need to take these supplements for at least two cycles before you notice any improvement.
• Vitamin E - about 400 units of vitamin E per day reduces breast tenderness.
• Chaste tree - a recent study showed that the herbal supplement chaste tree (vitex agnus castus) reduces PMS symptoms by half. About 20mg per day reduces symptoms of irritability, mood swings, anger, headache and breast fullness.
• Evening primrose oil - this supplement is said to reduce breast tenderness.
• Vitamin B6 - evidence is mixed on the effectiveness of vitamin B6 supplements. Keep in mind that high doses of vitamin B6 are toxic to the nervous system. Use with caution and avoid long term use.
• Other supplements - manganese, ginger, black cohosh, red raspberry leaf and dandelion are anecdotally thought to reduce PMS symptoms.

Medical treatments
PMS can’t be cured. Your doctor may first suggest trying lifestyle changes and supplements. Once these remedies have been explored, and if PMS symptoms remain, further medical treatment could include:

• Oral contraceptives - the results are mixed. Preventing ovulation relieves PMS symptoms for some women, but worsens symptoms for others.
• Depo-Provera - if stopping ovulation relieves PMS symptoms, depo-Provera injections could be considered as a more convenient option.
• Non-steroidal anti-inflammatory drugs (NSAIDS) - these drugs are taken in the premenstrual phase of your cycle and help to reduce breast tenderness. However, long term use of NSAIDS can cause serious side effects such as stomach ulcers.
• Antidepressants - such as selective serotonin reuptake inhibitors (SSRIs). About 60 per cent of women with PMS who take antidepressants experience a reduction in PMS symptoms. The drugs are only taken for the two weeks prior to menstruation, and in much lower doses than when prescribed for depression.
• Diuretics - to help reduce fluid retention.

Where to get help

• Your doctor
• Women’s health clinic
• Women’s Health Victoria Information Line Tel. (03) 9662 3742 or 1800 133 321
• Family Planning Victoria Tel. (03) 9257 0100

Things to remember

• Keep a detailed diary for at least three menstrual cycles to work out if your symptoms are caused by PMS.
• If symptoms don’t resolve with menstruation, PMS is probably not the cause - see your doctor for further investigation.
• Herbal supplements can be as powerful as pharmaceutical drugs and should be treated with the same respect.
  

  Related articles:

Calcium.
Menstrual cycle.
Menstruation - amenorrhoea.
Menstruation - athletic amenorrhoea.
Menstruation - dysmenorrhoea.
Premenstrual syndrome.


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Article publication date: 07/11/2003
Last reviewed: 29/11/2004

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