From the Guidelines
Premenstrual syndrome (PMS) should be diagnosed based on physical and emotional symptoms that occur before menstruation, and treatment should start with lifestyle changes, including regular exercise, stress reduction techniques, and dietary modifications. The diagnosis of PMS involves identifying a pattern of symptoms that occur during the luteal phase of the menstrual cycle and resolve within a few days of menstruation 1.
Key Symptoms
- Physical symptoms: bloating, breast tenderness, and cramps
- Emotional symptoms: irritability, anxiety, and depression For mild PMS, lifestyle changes and over-the-counter pain relievers such as ibuprofen (200-400mg every 4-6 hours) or naproxen sodium (220mg every 8-12 hours) can help manage symptoms 1.
Treatment Options
- Hormonal birth control pills to regulate hormone fluctuations
- Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (20mg daily) for emotional symptoms, particularly for premenstrual dysphoric disorder (PMDD)
- Calcium supplements (1200mg daily) and vitamin B6 (50-100mg daily) for some women
- Diuretics like spironolactone for bloating The most effective treatment approach for PMS is a personalized plan that addresses the individual's specific symptoms and needs, and may involve a combination of lifestyle changes, medication, and supplements. It is essential to consult a healthcare provider for personalized treatment if symptoms significantly impact daily life.
From the Research
Diagnosis of Premenstrual Syndrome (PMS)
- The diagnosis of PMS is based on the criteria recommended by the International Society for Premenstrual Disorders (ISPMD) 2
- A woman is diagnosed with PMS if she has 1-4 symptoms, which may be physical, behavioral, or affective/psychological, or at least five symptoms, which may be physical or behavioral 2
- If a woman has 5 or more symptoms, and one of these is affective (e.g., irritability, mood swings, anger) in addition to physical or behavioral symptoms, a more accurate diagnosis of premenstrual dysphoric disorder (PMDD) can be made 2
- Prospective scales, such as the Prospective record of the impact and severity of menstrual symptoms (PRISM) and the Daily record of severity of problems (DRSP), completed daily by the physician, are helpful in confirming the diagnosis of PMS and PMDD 2
Treatment Options for PMS
- Therapeutic options for PMS include regular aerobic exercise, stress relief, cognitive behavioral therapy, and drug treatments such as selective serotonin reuptake inhibitors (SSRIs), combined oral estrogen-progestin contraceptives (COCs), and GnRH agonists 2
- SSRIs, such as fluoxetine, have been shown to be effective in reducing premenstrual emotional and physical symptoms and improving premenstrual psychosocial functioning 3, 4, 5, 6
- SSRIs can be taken either in the luteal phase or continuously, with no clear evidence of a difference in effectiveness between these modes of administration 4, 6
- However, a 2024 study found that SSRI treatment was probably more effective when administered continuously than when administered only in the luteal phase 6
- Other treatment options, such as venlafaxine, duloxetine, alprazolam, and buspirone, have also been found to be useful in treating PMS and PMDD 5
Adverse Effects of SSRIs
- SSRIs have been associated with adverse effects, including nausea, insomnia, sexual dysfunction, fatigue, dizziness, tremor, somnolence, sweating, dry mouth, asthenia, diarrhea, and constipation 4, 6
- The risk of adverse events is higher with SSRI treatment, with the most common being nausea, asthenia, and somnolence 6
- The certainty of the evidence for the adverse effects of SSRIs is moderate, with the main weakness being poor reporting of study methodology 6