Premenstrual Syndrome (cont.)

The treatment of PMS can sometimes be as challenging as making the diagnosis of PMS. Various treatment approaches have been used to treat this condition. Some measures lack a solid scientific basis but seem to help some women. Other treatments with a sound scientific basis may not help all patients.

General management includes a healthy lifestyle including:

• exercise;
• family and friends can provide emotional support during the time of a woman's cycle;
• avoid salt before the menstrual period;
• reduce caffeine intake;
• quite smoking;
• reduce alcohol intake; and
• reduce intake of refined sugars.

All of the above have been recommended and may help symptoms in some women. Furthermore, some studies suggest that vitamin B6, vitamin E, calcium, and magnesium supplements may have some benefit.

A variety of medications are used to treat the different symptoms of PMS. Medications include diuretics, pain killers, oral contraceptive pills, drugs that suppress ovarian function, and antidepressants.

Diuretics: Diuretics are medications that increase the rate of urine production, thereby eliminating excess fluid from the body tissues. Several nonprescription menstrual products (including Diurex PMS, Lurline PMS, Midol PMS, Pamprin Multisymptom and Premsyn PMS) contain diuretics, for example, either caffeine or pamabrom. Spironolactone (Aldactone) is a prescription diuretic that has been widely used to treat premenstrual swelling of the hands, feet or face. Unfortunately, it has not been effective in all patients.

Analgesics (pain killers): These are commonly given for menstrual cramps, headaches, and pelvic discomfort. The most effective group of analgesics appear to be the nonsteroidal antiinflammatory medications (NSAIDs). Examples of these are ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox) and mefenamic acid (Ponstel).

Benzodiazepines: The benzodiazepam alprazolam (Xanax) has been shown in some studies to relieve the depressive symptoms of PMS or PMDD. However, this drug is not considered a first-line treatment for these conditions because of its addictive potential.

Oral contraceptive pills (OCPs): OCPs are sometimes prescribed to even out ovarian hormone fluctuations. While older studies failed to provide evidence that OCPs can consistently provide relief for symptoms of PMS, the newer birth control pills, with their improved hormonal formulations, seem to be more beneficial

Ovarian suppressors: Drugs like danazol (Danocrine) have been prescribed to suppress ovarian hormone production. Unfortunately, Danocrine cannot be used over long periods because of side effects.

Complete suppression of ovarian function by a group of drugs called gonadotropin-releasing hormone (GnRH) analogs has been found to help some women with PMS. These GnRH analogs are not given long term (more than six months) because of their adverse effect on bone density and an increased risk of bone thinning (osteoporosis). In some cases these drugs may be prescribed along with hormone supplementation.

Antidepressants: These are widely used in treating the mood disturbances related to PMS. Antidepressants appear to work by increasing brain chemical (opioids, serotonin, and others) levels that are affected by the ovarian hormones. These opioids are important in the control of mood and emotions. The serotonin reuptake inhibitor group of antidepressants seem to be the most effective for symptoms of PMS.  Fluoxetine (Prozac) and paroxetine (Paxil) are examples of antidepressant medications from this group that have been found to be effective in treating the mood changes associated with PMS.

It is important to know that these drugs, although useful in treating mood disturbances in some women, are not necessarily effective in treating the physical symptoms. Often, it is a combination of diet, medications and exercise that is needed to afford the maximum improvement from the many symptoms of PMS.

Source: MedicineNet.com
http://www.medicinenet.com/premenstrual_syndrome/article.htm