Diagnosing Premenstrual Syndrome

Kimberly Raines

Disclosures

Journal for Nurse Practitioners. 2010;6(3):224-225. 

In This Article

Treatment Options

There is no consensus regarding PMS treatment; however, all current interventions focus on management of the most troubling symptoms. PMS management is highly individualized and consists of lifestyle changes or medications, or a combination of the 2 approaches. Patient preferences and treatment costs must also be considered. The good news is that the prognosis for the woman with PMS can be excellent with proper counseling and an individualized treatment plan.

The first step in effective treatment is knowledgeable and compassionate counseling. Your patient should first be reassured that the symptoms she is experiencing are legitimate and have valid pathophysiological causes.

Nonpharmacologic options such as dietary modifications, regular exercise, and stress-reduction techniques should be attempted first. Recommend a balanced diet that includes whole grains, fresh fruits, and vegetables, while avoiding excess salt, sugar, caffeine, and alcohol, particularly when experiencing PMS symptoms. Nutritional supplements such as calcium, magnesium, and vitamins B6 and E have been helpful in alleviating symptoms.

Recommended activities for regular exercise include brisk walking, swimming, cycling, or other aerobic activity for at least 30 to 60 minutes 3 to 5 days a week. Suggest stress-reduction techniques such as biofeedback, massage therapy, and yoga. Although the safety and efficacy of herbal remedies have not been established, many women report relief with black cohash root and evening primrose oil.

The most effective pharmacological treatment options are the non-steroidal anti-inflammatory drugs (NSAIDs). Oral contraceptives (OCs) are often prescribed to eliminate cyclic fluctuations in estrogen and progesterone. While approximately 25% of women taking OCs find improvement, 50% report no improvement, and the remainder may even experience exacerbation of symptoms. A growing body of research supports the role of selective serotonin-reuptake inhibitors (SSRIs) for women experiencing more severe emotional symptoms. Taken in lower-range doses 2 weeks before the period begins, at the onset of symptoms, or daily during menses, SSRIs can be an effective and well-tolerated treatment for moderate-to-severe PMS and PMDD.

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