Lifestyle and dietary changes generally provide some degree of relief to all women who experience PMS-related distress. If your condition improves only modestly, however, your doctor may suggest a medical approach. Since there are many claims made for the benefits offered by vitamins, food supplements, and some over-the-counter medications, you should not use any of them without consulting your physician. It is important to remember that while some physicians support the use of certain vitamins and supplements and believe in their possible effectiveness, others cite the lack of scientific evidence of any benefit, and warn of possible harm if the products are consumed in large doses. Among the many "PMS formulas" on the market are a number of multivitamins containing some combination of vitamin B6, magnesium, zinc, and vitamin A. The use of vitamin B6 for PMS dates back to the 1940s. For those who believe in its effectiveness, the connection is thought to be in the vitamin's interaction with certain brain chemicals. However, its effectiveness has not been clinically proven and large amounts have been shown to be harmful. As little as 200 to 300 milligrams a day has been reported to cause toxic reactions resulting in pain or numbness in the hands or feet, awkwardness in walking or general clumsiness and nerve damage.
Some physicians have claimed that the dietary supplement oil of evening primrose, which contains linoleic acid and gamma-linoleic acid, helps relieve breast tenderness. However, while it's true that evening primrose oil has an anti-inflammatory effect, there is no conclusive evidence that it helps in PMS.
The benefits of some vitamins and food supplements, though still unproven, seem a bit more promising. In one study, vitamin E in dosages of 150 to 300 milligrams daily was reported to reduce PMS symptoms. Another study suggested that a daily 200 milligram magnesium supplement may counter some of the physical and behavioral changes associated with PMS, though magnesium can also be toxic in high doses and can impair calcium absorption. Finally, the amino acid L-tryptophan, banned from over-the-counter sales but available by prescription from a few qualified pharmacies, has seemed to help some women. It may raise the serotonin level, allowing for a more restful sleep and reducing restlessness and food cravings.
Your physician may also choose from an array of prescription medications, though no "PMS drug" has yet been developed, and the effectiveness of pharmaceuticals in treating PMS has generated considerable debate. In fact, some of the medications used for PMS are potentially harmful, so you and your doctor should plan a conservative course of symptom management rather than generalized drug therapy.
Diuretics, or "water pills," help the body eliminate excess fluid through the kidneys. Your doctor may prescribe a diuretic to reduce bloating if restricting your salt intake does not help. Although studies on the benefits of diuretics for PMS have shown mixed results, they have been used longer in PMS treatment than any other medication, and have been shown to ease other symptoms, such as fatigue and depression.
Because it inhibits the action of the hormone that causes water retention, spironolactone (Aldactone) is also selected to treat PMS symptoms. Physicians typically prescribe 25 milligrams of spironolactone four times a day from the time of ovulation to the onset of menstruation.
Bromocriptine, a drug that suppresses lactation after childbirth, is sometimes used to reduce PMS-related breast discomfort, though there is no evidence that women taking this medication show greater improvement than those who don't. The usual dosage is 2.5 milligrams once or twice daily from the date of ovulation until your period begins. Because there is a risk of side effects, your doctor will probably start this drug cautiously at low doses.
Mefenamic acid (Ponstel) is a non-steroidal, anti-inflammatory drug that is sometimes used to relieve premenstrual pain. The usual starting dose is 500 milligrams when symptoms appear, followed by 250 milligrams twice a day for two to three days. A major risk with this medication is its uncertain effect on a developing baby. Since PMS follows ovulation, you may not know you are pregnant until your period is late. Therefore, your physician may advise you to use a barrier contraceptive before prescribing mefenamic acid or other medications used to treat PMS symptoms. A variety of nonsterodial anti-inflammatory drugs are available, including such over-the-counter products as ibuprofen (Advil, Motrin IB) and naproxen (Aleve). However, all carry a risk of stomach inflammation with habitual use. Other over-the-counter remedies, such as Midol and Women's Tylenol, promise relief from cramps, bloating, and pain without harm to the stomach.
Progesterone therapy has also gained many advocates, despite the fact that neither natural progesterone nor synthetic progestins has been shown to be effective in scientific studies. In fact, the use of progesterone to treat PMS has not been approved by the FDA, and some scientists question the long-term safety and consequences of this therapy. Nevertheless, because some physicians claim to have seen improvements in their own patients, the use of progesterone to treat PMS symptoms remains common. According to the American College of Obstetricians and Gynecologists, the standard dosage for treating PMS is 50 to 100 milligrams of progesterone administered daily by intramuscular injections or 200 to 400 milligrams twice a day by vaginal or rectal suppositories. Treatment is started several days before symptoms are expected and is continued through the onset of a woman's period.
A few studies indicate that medicines used to block ovarian function, known as "medical ovariectomy," can halt the symptoms of PMS. In clinical trials, this has been accomplished by using Lupron as an injection or Synarel as a nasal spray to block the action of GnRH, the hormone that starts the menstrual cycle with stimulation of the ovaries.
However, blocking ovarian function essentially creates an artificial menopause, which can lead to osteoporosis and other postmenopausal medical problems. As a result, this approach is considered only in severe and disabling cases of PMS: the 5 to 10 percent of women whose PMS symptoms cause incapacitating disruptions to their jobs or family life. Therapy is generally discontinued after six months.
Some physicians prescribe tranquilizers or antidepressants, including fluoxetine hydrochloride (Prozac) for patients diagnosed with PMS. However, unless you suffer from the depressive effects of PMDD, such drugs are probably not justified. They can cause serious, even fatal, reactions in combination with other drugs and can lead to a wide range of side effects. They are generally reserved for serious illnesses such as major depression.
On the other hand, if you have been diagnosed with PMDD, the doctor may prescribe a version of Prozac called Sarafem. This antidepressant has proven effective when taken in doses of 20 milligrams a day throughout the entire menstrual cycle. The most common side effects are headache, nausea, and runny nose.
