After you determine that you do indeed have premenstrual syndrome (PMS), it's important to do 2 things: find out what you can do for yourself, and find a physician sympathetic to your concerns and who does not simply dismiss your symptoms as something you have to put up with.

In terms of self-help, many women find exercise helps a lot, as do yoga and relaxation techniques for others.

Taking 600 mg of calcium twice a day has also been found to be very effective.

Many women try to find factors in their diet that worsen symptoms, especially caffeine, salt, chocolate, sugar, and alcohol, although objective studies have not found these to be consistently linked with PMS. Still, it always pays to try to minimize your intake of anything you suspect might be making your symptoms worse to see if that helps.

Among the most popular treatments for PMS are "natural" remedies such as Vitamin B6, vitamin E, evening primrose oil, magnesium, herbal teas, fish oils (for bloating), and gingko, although objective studies have not found any of these to be effective.

A small study found that chaste tree berry (Vitex agnus-castus) might help with some PMS symptoms, although this report requires validation with much larger randomized studies.

Many medications have been tried in PMS. One of the most popular is progesterone, usually in vaginal or rectal suppository form, although studies have shown that progesterone is not generally effective for PMS, and should probably be reserved for special cases. On the other hand, a study using a pill that releases a steady dose of progesterone has shown some promise.

Although birth control pills produce lighter periods, they do not often help with PMS symptoms, and some women even report worse symptoms on the pill.

Specific PMS symptoms can sometimes be treated with medications, such as, for example, diuretics to treat fluid retention, and anti-inflammatories for pain.

For the more severe psychological symptoms, especially in premenstrual dysphoric disorder (PMDD), SSRI antidepressants such as fluoxetine (Prozac®) are currently popular. These are, however, potent medications that often produce troublesome side effects such as sleep problems and disturbances in sexual functioning, and should also be reserved for special cases.

For the most severe cases of PMS, GnRH agonists (medications that induce a menopause-like state) can help, but these controversial medications produce many side effects such as hot flashes, mood swings, sleep and sexual function disturbances, and because of long-term risks of osteoporosis and heart disease, these medications should not be used for more than 6 months.

Danazol, a synthetic testosterone, is also sometimes used for severe cases of PMDD. Danazol, however, produces many side effects (hot flashes, acne, weight gain, masculinization effects such as voice deepening and growth of the clitoris, mood swings, and others), and it has also been linked recently to an increased risk of ovarian cancer, so its use should be very limited.

As to potential new therapies, a medication called Ph80, which is taken as a nasal spray, has shown some promise and is now in advanced testing.

Art Hister, MD 
in association with the MediResource Clinical Team