Over-the-Counter Options for PMDD
Calcium supplementation (1000-1200 mg daily) is the only over-the-counter option with consistent evidence for treating PMDD symptoms, though it provides modest benefit and should not be considered first-line therapy. 1, 2
Evidence-Based OTC Treatments
Calcium Supplementation
- Calcium at 1000-1200 mg daily has demonstrated consistent therapeutic benefit for PMDD symptoms across multiple studies 1, 2
- This represents the strongest evidence among all OTC supplement options 1
- Benefits are modest compared to prescription SSRIs, which remain first-line treatment 1, 2
Limited Evidence OTC Options
Chasteberry (Vitex agnus-castus):
- May provide some symptom relief but evidence remains less substantiated than calcium 2
- Could be considered as an adjunct treatment rather than monotherapy 2
St. John's Wort (Hypericum perforatum):
- Has been studied for PMDD but evidence is not robust enough to recommend as primary treatment 2
- May serve as an adjunct therapy in select cases 2
Omega-3 Fatty Acids:
- Mentioned as a complementary option but lacks strong evidence specifically for PMDD 3
- Not recommended as standalone treatment 3
Critical Clinical Context
Important limitations of OTC approaches:
- PMDD affects 3-8% of menstruating women with significant functional impairment requiring effective treatment 1, 2
- SSRIs (sertraline 50-150 mg/d, fluoxetine 10-20 mg/d, escitalopram 10-20 mg/d, paroxetine 12.5-25 mg/d) are established first-line treatments with substantially greater efficacy than any OTC option 4, 2, 5
- SSRIs can be dosed intermittently (luteal phase only) or continuously, both showing effectiveness 1, 2
- Cognitive behavioral therapy also demonstrates effectiveness for reducing functional impairment, mood symptoms, and daily life impact 4
Practical Recommendation Algorithm
For mild symptoms: Trial calcium supplementation 1000-1200 mg daily for 2-3 menstrual cycles 1, 2
For moderate-to-severe symptoms or inadequate response to calcium: Refer for prescription SSRI therapy, as OTC options will likely be insufficient 1, 4, 2
Common pitfall: Delaying effective treatment by prolonged trials of multiple unproven supplements when prescription SSRIs have robust evidence and can be used intermittently to minimize exposure 2, 5