Premenstrual Syndrome (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Premenstrual syndrome (PMS) facts
- What is premenstrual syndrome?
- How common is PMS?
- When was PMS discovered?
- What causes PMS?
- What are the symptoms of PMS?
- How is the diagnosis of PMS made?
- What conditions are like PMS?
- How is PMS distinguished from other conditions?
- What treatments are available for PMS?
- What medications are used to treat PMS?
- Are there herbal or natural remedies for PMS?
- Can exercise help relieve some of the symptoms of PMS?
- Is there a "cure" for PMS?
- Find a local Obstetrician-Gynecologist in your town
What treatments are available for PMS?
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:
- emotional support during the premenstrual period;
- salt restriction before the menstrual period;
- decreased caffeine intake prior to menstruation;
- smoking cessation;
- limitation of alcohol intake; and
- reduction of refined sugar intake.
All of the above have been recommended and may help symptoms in some women. Furthermore, some studies suggest that calcium and magnesium supplements may provide some benefit.
What medications are used to treat PMS?
A variety of medications are used to treat the different symptoms of PMS. Medications include diuretics, analgesics, oral contraceptives, antidepressants, and drugs that suppress ovarian function.
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, and either caffeine or pamabrom. Spironolactone (Aldactone) is a prescription diuretic that has been widely used to treat premenstrual swelling of the hands, feet and 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 anti-inflammatory drugs (NSAIDs). Examples include ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox), and mefenamic acid (Ponstel).
Benzodiazepines: The benzodiazepine 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.
Learn more about: Ponstel
Oral contraceptive pills (OCPs): OCPs are sometimes prescribed to even out ovarian hormone fluctuations. While older studies failed to provide evidence that oral contraceptive pills can consistently provide relief for symptoms of PMS, the newer birth control pills, with their improved hormonal formulations, seem to be more beneficial for many women. Oral contraceptive pills containing the progestin drospirenone have been approved by the FDA for the treatment of PMS and premenstrual dysphoric disorder (PMDD).
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 over the long term (more than six months) because of their potential for adverse effects on bone density causing 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 neurotransmitters 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.
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