Embarrassing Illnesses

A cure for premenstrual syndrome (PMS) does not currently exist, but there are treatments available to help you manage your symptoms so that they do not interfere with your daily life.

However, if your PMS is mild or moderate, you may want to try making some changes to your diet and lifestyle before resorting to medical treatment. This is because many of the medical treatments can have side effects that can be worse than your PMS symptoms.

Lifestyle changes

Diet

• Eat smaller meals more frequently to help reduce bloating.
• Avoid eating salty foods to limit bloating and fluid retention.
• Drink lots of water (about six to eight glasses a day). Being dehydrated can make headaches and tiredness worse.
• Eat lots of complex carbohydrates, which can be found in foods such as fruit, vegetables and wholegrains.
• To improve physical and psychological symptoms of PMS, eat calcium-rich foods such as cheese and milk. If you cannot eat dairy products, try calcium-fortified soya alternatives.
• Avoid caffeine and alcohol, which can affect your mood and energy levels.
• Eat plenty of fruit and vegetables, which are rich in vitamins and minerals, as these may help to ease your symptoms of PMS. You should aim to eat at least five portions a day.

Exercise

• Exercise for half an hour, at least five times a week (this is the minimum recommended amount for most adults). Exercise improves your overall health and can help alleviate depression and tiredness.
• Stretching and breathing exercises, such as yoga and pilates, can help you sleep better and reduce your stress levels.

Complementary medicines

There are many non-prescribed alternative treatments and supplements available for PMS, and many women find that they are helpful in easing their symptoms. However, there is little research to back up their effectiveness, and of the studies that do exist, most show mixed results.

Examples of complementary therapies that may help reduce some symptoms of PMT are magnesium, vitamin B6 and vitamin E.

You should always see your GP before taking any complementary medicine or supplement. If after talking to your GP you do decide to take a complementary treatment, only take one at a time so you know if it works for you. If you have had no change to your symptoms after three months, go back to your GP, who may recommend trying another treatment.

Psychological therapy

If you have psychological symptoms, such as feeling depressed or emotional, it may help to talk to a health professional about your situation. Cognitive behavioural therapy (CBT) is the term for a number of therapies that are designed to help solve problems in people's lives, such as anxiety and depression. Seeing a cognitive behavioural therapist can help you to learn new ways of managing some of your symptoms.

For more information, see Health A-Z: CBT

Medical treatment

If your PMS is severe or you have premenstrual dysphoric disorder (PMDD), you may wish to try a medical treatment. However, there is no single treatment that will work for everyone.

A wide range of treatments are available, and you may have to try several before you find one that suits you. Your choice of treatment will be influenced by the symptoms you are having and how severe they are, and the possible side effects of the medication.

If your GP prescribes you a treatment for PMS, they may ask you to record any changes to your symptoms so that you both know how effective it is for you. If the treatment does not help ease your symptoms, your GP may prescribe an alternative.

Medical treatments for PMS include:

• non-steroidal anti-inflammatory drugs (NSAIDs),
• oral contraceptives,
• selective serotonin reuptake inhibitors (SSRIs), and
• gonadotrophin-releasing hormone (GnRH) analogues.

Non-steroidal anti-inflammatory drugs (NSAIDs)

You can take NSAIDs, such as ibuprofen and aspirin, to ease stomach cramps and sore breasts. They may also relieve headaches, muscle pain and joint pain, but they can make fluid retention worse.

Children under 16 years of age should not take aspirin, and if you have asthma do not take ibuprofen.

For more information, see Health A-Z: NSAIDs

Oral contraceptives

As well as being prescribed for contraceptive purposes, the contraceptive pill can be prescribed to regulate symptoms of PMS. They stop ovulation (when an egg is released from your ovaries) and stabilise hormone levels, which can help to combat mood swings.

There is a brand of oral contraceptive known as the Yasmin pill that can be prescribed to help with acne, fluid retention and other symptoms of PMS, and it may even be effective in improving symptoms of PMDD. However, oral contraceptives do not work for all women with PMS and they can have side effects. The side effects can be similar to the symptoms of PMS and may include, for example, fluid retention and irritability.

For more information, see Health A-Z: combined contraceptive pill

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) may be the most effective treatment if you have severe PMS or PMDD. SSRIs, such as fluoxetine and sertraline, are a kind of antidepressant that can be taken daily to relieve tiredness, food cravings and sleep problems, as well as combating feelings of depression.

However, like oral contraceptives, SSRIs may have negative side effects that may outweigh their benefits, such as nausea, insomnia, headache and decreased libido (loss of interest in sex).

For more information, see Health A-Z: SSRIs

Gonadotrophin-releasing hormone analogues

Like danazol, GnRH analogues are synthetic hormones that create a temporary menopause and stop your periods by blocking the production of oestrogen and progesterone. They are taken as an injection and work in a similar way to gonadotrophin-releasing hormone (a natural female hormone).

GnRH analogues should only be used in women with severe PMS when all other treatments have failed. They often have side effects such as hot flushes, vaginal dryness and low libido.

Drug names include goserelin, nafarelin and leuprorelin.