Management of premenstrual syndrome follows a tiered approach and each treatment option may take up to three months to make a noticeable difference.

Initial management involves encouraging a woman to lead a healthy lifestyle, in terms of a balanced diet, regular exercise and minimising stress, as well as avoiding salt, caffeine and alcohol. There are a number of herbal and vitamin supplements that are suggested for treatment of premenstrual syndrome.

Some small studies have suggested that a good intake of the B vitamins thiamine and riboflavin as well as calcium and vitamin D may reduce the risk of premenstrual syndrome. Chasteberry Vitex agnus castus supplements are also supported by small studies.

Further research is required to clarify the benefits of all of these. Cognitive behavioural therapy a specific type of talking therapy has also been shown to be of benefit in the management of premenstrual syndrome. Medical treatments fall into two main groups: hormonal treatments and selective serotonin receptor inhibitors or SSRIs.

Hormonal treatments — premenstrual syndrome can be alleviated in a proportion of women by using hormonal contraceptives that suppress ovulation. There are a number of ways to do this.

The woman may be given oestrogen patches with progestogen progesterone in the form of tablets or a steroid-impregnated intrauterine device, called Mirena. Sometimes the combined oral contraceptive pill may be used.

Since the hormonal methods used to ameliorate symptoms of premenstrual syndrome are also contraceptive, they are not appropriate if the woman is planning a pregnancy.

Unlike in depression, it is possible to take the medication just when experiencing symptoms, i. just in the second half of the menstrual cycle. This group of antidepressants may be harmful in pregnancy, so women that are planning a pregnancy should seek advice on treatment options from their doctor.

Vitamin supplements and complementary therapies to relieve the symptoms of premenstrual syndrome can cause side-effects; for example, calcium supplements can cause indigestion.

With hormonal treatments, sometimes a woman can be sensitive to the hormone and experience side-effects such as nausea or breast tenderness. Some women feel nauseated or drowsy when they first take selective serotonin receptor inhibitors but these side-effects usually settle.

Women should discuss any concerns about the treatment options or side-effects mentioned with their doctor. The frequency and severity of premenstrual syndrome varies from woman to woman and in each individual woman from month to month.

The greatest prevalence appears to be among women aged 30 to 50 but women can also experience a worsening of their symptoms around the time of their menopause attributed to the erratic fluctuations in hormone levels at this time.

Also it is a common time for a woman to experience stress in her life, for example as children leave home and ageing parents become more dependent.

Hormone replacement therapy HRT can be used to treat symptoms due to the menopause and has a variable effect on symptoms experienced as part of premenstrual syndrome, which can occur during the perimenopausal period. Premenstrual syndrome should resolve when the woman has passed her menopause as the woman no longer has a menstrual cycle with the associated cyclic release of steroid hormones from the ovary.

Likewise, during pregnancy there will be no cyclical symptoms. However, women may experience similar symptoms such as abdominal bloating, breast tenderness and mood swings during pregnancy as levels of progesterone are high.

About Contact Outreach Opportunities News. Search Search. Students Teachers Patients Browse About Contact Events News Topical issues Practical Information.

You and Your Hormones. Students Teachers Patients Browse. Human body. A key challenge in PMDD diagnosis is differentiating between mild premenstrual symptoms, which may be annoying but are not disabling, and those severe enough to interfere with daily life.

Antidepressants that slow the reuptake of serotonin are effective for many women with PMDD. Usually, the first choice is one of the selective serotonin reuptake inhibitors SSRIs such as sertraline Zoloft , citalopram Celexa , escitalopram Lexapro , or fluoxetine Prozac.

Another option is the serotonin and norepinephrine reuptake inhibitor SNRI venlafaxine Effexor. Other types of antidepressants, which target neurotransmitters other than serotonin, have not proven effective in treating PMDD.

This suggests that serotonin reuptake inhibitors work in some way independent of their antidepressant effect — but their mechanism of action in PMDD remains unclear. These drugs also alleviate symptoms of PMDD more quickly than symptoms of major depression, which means that women don't necessarily have to take the drugs every day.

Instead, women can take them on an intermittent basis, also known as luteal-phase dosing because it coincides with the roughly day span that begins just after ovulation and ends when menstruation starts.

The decision about whether to take a serotonin reuptake inhibitor every day or on an intermittent basis depends on the type of symptoms a particular woman experiences and if the symptoms of PMDD are superimposed on a more persistent depression.

Intermittent dosing is sufficient for treating irritability or mood, but daily medication may be necessary to control somatic symptoms such as fatigue and physical discomfort. Side effects of serotonin reuptake inhibitors are usually relatively mild and transient.

Nausea, for example, typically subsides after several days of taking a drug for the first time — and the problem tends not to recur even when the drug is taken intermittently. Sexual side effects, such as reduced libido and inability to reach orgasm, can be troubling and persistent, however, even when dosing is intermittent.

Of course, PMDD can also lessen sexual desire, so as a practical matter, taking a serotonin reuptake inhibitor on an intermittent basis may still seem like an acceptable strategy. Hormone therapies may be helpful for some women.

They seem to work in PMDD act not by countering hormonal abnormalities, but by interrupting aberrant signaling in the hypothalamic-pituitary-gonadal circuit that links brain and ovaries and regulates the reproductive cycle. The usual dietary advice given to women with mild or even moderate premenstrual symptoms — such as consuming less caffeine, sugar, or alcohol, and eating smaller, more frequent meals — is unlikely to help women with PMDD.

Below is a list of key nutrients that have been showed to help alleviate PMS as well as some foods that contain them. Research shows low dose calcium supplements can help with mood disorders associated with PMS including anxiety, depression and mood swings, as well as water retention.

Calcium may also have anti-inflammatory properties, which can help relieve headaches, cramps and bloating. For food sources that can help bump up your calcium levels try nuts, tofu calcium set , chickpeas, leafy greens like kale, broccoli and bok-choy, yoghurt, milk and calcium-fortified soy, almond and oat milks.

OMEGA 3 There is also emerging evidence to say that omega-3 may help alleviate a wide range of PMS symptoms both mood related depression, nervousness, anxiety, and lack of concentration and physical bloating, headaches and breast tenderness.

While seafood is well known as a source of omega-3 , there are plenty of plant foods you can enjoy to give your body more of this important fatty acid. Flaxseeds also contain lignan , a plant oestrogen, which may also help with PMS. MAGNESIUM There is also some research which shows that magnesium may help with PMS symptoms.

Magnesium levels in your body fluctuate during your monthly cycle. As your body makes more oestrogen or progesterone in the lead up to ovulation, these hormones can cause the levels of magnesium in your body to dip.

The lower magnesium levels can trigger cramps, depression, headaches and migraines. To help your body increase its magnesium levels try adding beans, pumpkin seeds, bananas, wholegrains and green leafy vegetables to your diet.

Unlike in depression, it is possible to take the medication just when experiencing symptoms, i. just in the second half of the menstrual cycle.

This group of antidepressants may be harmful in pregnancy, so women that are planning a pregnancy should seek advice on treatment options from their doctor. Vitamin supplements and complementary therapies to relieve the symptoms of premenstrual syndrome can cause side-effects; for example, calcium supplements can cause indigestion.

With hormonal treatments, sometimes a woman can be sensitive to the hormone and experience side-effects such as nausea or breast tenderness. Some women feel nauseated or drowsy when they first take selective serotonin receptor inhibitors but these side-effects usually settle.

Women should discuss any concerns about the treatment options or side-effects mentioned with their doctor. The frequency and severity of premenstrual syndrome varies from woman to woman and in each individual woman from month to month. The greatest prevalence appears to be among women aged 30 to 50 but women can also experience a worsening of their symptoms around the time of their menopause attributed to the erratic fluctuations in hormone levels at this time.

Also it is a common time for a woman to experience stress in her life, for example as children leave home and ageing parents become more dependent.

Hormone replacement therapy HRT can be used to treat symptoms due to the menopause and has a variable effect on symptoms experienced as part of premenstrual syndrome, which can occur during the perimenopausal period.

Premenstrual syndrome should resolve when the woman has passed her menopause as the woman no longer has a menstrual cycle with the associated cyclic release of steroid hormones from the ovary.

Likewise, during pregnancy there will be no cyclical symptoms. However, women may experience similar symptoms such as abdominal bloating, breast tenderness and mood swings during pregnancy as levels of progesterone are high. About Contact Outreach Opportunities News.

Search Search. Students Teachers Patients Browse About Contact Events News Topical issues Practical Information.

You and Your Hormones. Students Teachers Patients Browse. Human body. Home Endocrine conditions Premenstrual syndrome.

Premenstrual syndrome Premenstrual syndrome PMS is a condition that affects women during the days leading up to her monthly period; it can cause distressing physical and emotional symptoms.

Fortunately, treatment options exist for PMDD. Brain areas that regulate emotion and behavior are studded with receptors for estrogen, progesterone, and other sex hormones. These hormones affect the functioning of neurotransmitter systems that influence mood and thinking — and in this way may trigger PMDD.

But it's not clear why some women are more sensitive than others. Genetic vulnerability likely contributes. Other risk factors for developing PMDD include stress, being overweight or obese, and a past history of trauma or sexual abuse.

Also, it's important to rule out other conditions that cause symptoms similar to PMDD, such as depression, dysthymia, anxiety , and hypothyroidism. A key challenge in PMDD diagnosis is differentiating between mild premenstrual symptoms, which may be annoying but are not disabling, and those severe enough to interfere with daily life.

Antidepressants that slow the reuptake of serotonin are effective for many women with PMDD. Usually, the first choice is one of the selective serotonin reuptake inhibitors SSRIs such as sertraline Zoloft , citalopram Celexa , escitalopram Lexapro , or fluoxetine Prozac.

Another option is the serotonin and norepinephrine reuptake inhibitor SNRI venlafaxine Effexor.

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Health Information Policy. Media Requests. News Network. The association between the risk of premenstrual syndrome and vitamin D, calcium, and magnesium status among university students: a case control study.

Health Promot Perspect. The effects of magnesium supplementation on subjective anxiety and stress — a systematic review. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents.

Gynecol Endocrinol. The association between vitamin D and premenstrual syndrome: a systematic review and meta-analysis of current literature. J Am Coll Nutr. Published online May 10, Vitamin D supplementation for premenstrual syndrome-related mood disorders in adolescents with severe hypovitaminosis D.

J Pediatr Adolesc Gynecol. The effect of vitamin D supplement consumption on premenstrual syndrome in vitamin D-deficient young girls: a randomized, double-blind, placebo-controlled clinical trial.

Complement Med Res. Published online May 17, Herbal treatments for alleviating premenstrual symptoms: a systematic review. J Psychosom Obstet Gynaecol. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

Arch Womens Ment Health. Systematic review of premenstrual, postmenstrual and infertility disorders of Vitex agnus castus. Electron Physician. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials.

New England Journal of Medicine. Steiner M, Born L. Diagnosis and treatment of premenstrual dysphoric disorder: an update. Int Clin Psychopharmacol ;15 Suppl 3 :S5-S Brauser, D. Progesterone, Anxiety Affect Premenstrual Dysphoric Disorder. Malin Gingnella, b, Arvid Morellc, Elin Bannbersa, Johan Wikströmc, Inger Sundström Poromaaa Received 22 February , Revised 3 July , Accepted 9 July , Available online 17 July 5.

Todd, MD, N. Estrogen and Women's Emotions. Pearlstein, T. Estrogen and Progestin Oral Contraceptives : MedlinePlus Drug Information. html 8. Luteinizing hormone. Donate About Events PMDD PMD Self-Screen For Patients For Professionals Support Surgery FAQ Search Get Involved Shop Blog Join Subscribe Donate Now.

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