Treatment options for premenstrual syndrome (PMS) vary according to the type and severity of symptoms and how bothersome they are to the patient. Patients are advised to keep a menstrual diary to better understand symptoms so they can be treated more effectively.

If symptoms are mild and do not interfere with daily living, a variety of lifestyle changes are recommended to patients. These may include:

• Nutrition. Making dietary changes can relieve symptoms of PMS or reduce their severity. This includes eating a balanced diet with whole grains, fresh fruits and vegetables, and avoiding excess salt, sugar, caffeine and alcohol, particularly when experiencing PMS symptoms. Some patients benefit from eating six small meals during the day instead of three large ones.
  
  
• Vitamins. Taking a multivitamin every day may help women with PMS.
  
  
• Exercise. Engaging in brisk walking, cycling, swimming or other aerobic activity at least 30 to 60 minutes most days of the week is recommended. Regular daily exercise can help improve overall health and alleviate symptoms. Yoga may be helpful for some patients.
  
  
• Stress reduction. Performing muscle relaxation or deep-breathing exercises may help reduce symptoms such as headaches, anxiety or insomnia. Patients may also benefit from scheduling stressful events for the week after their period.
  
  
• Rest. Getting adequate rest is important. The body may have different sleep requirements at different times during a woman’s menstrual cycle.

If lifestyle changes do not lessen PMS symptoms, then medications are sometimes used. These may include:

• Over-the-counter medications. These may include pain-relievers and anti-inflammatories. There are also some medicines marketed specifically for PMS symptom relief. These usually combine a pain reliever with caffeine, antihistamines and/or diuretics.
  
  
• Diuretics (medications that increase the rate of urine production). These may help minimize bloating and weight gain associated with PMS by eliminating excess fluid in the body tissue.
  
  
• Birth control pills. These may help ease some PMS symptoms by “evening out” hormone levels throughout the menstrual cycle. However, not all women are helped by the use of birth control pills.
  
  In October 2006, the Food and Drug Administration (FDA) approved the use of Yaz, a new type of birth control pill, for the treatment of premenstrual dysphoric disorder (PMDD). The new pill was found to be effective in reducing the physical and emotional symptoms of PMDD in clinical trials.
  
  
• Antidepressants. In severe cases, particularly in women with PMDD, antidepressants may be helpful. One example is selective serotonin reuptake inhibitors (SSRIs), which work by regulating the levels of serotonin (a brain chemical linked to mood). People with depression often have low levels of serotonin.
  
  Although traditionally reserved for more severe cases, SSRIs also may help alleviate symptoms in some women with PMS. When taken in low doses two weeks before menstruation, at the start of PMS symptoms or daily during the menstrual cycle, sertraline (a type of SSRI) can be an effective and well-tolerated treatment for moderate-to-severe PMS, according to a new study.
  
  
• GnRh agonists. May be used in severe cases of PMS to induce anovulation (absence of ovulation) and create a temporary menopausal state. These medications are prescribed only for a short period of time to avoid side effects such as hot flashes and osteoporosis.

There are also vitamin supplements and other products that may help alleviate PMS symptoms. They include:

• Calcium. Taking 1,200 milligrams daily may reduce the physical and psychological symptoms of PMS.
  
  
• Magnesium. Taking 200 milligrams daily may help reduce fluid retention, breast tenderness and bloating in women with PMS.
  
  
• Vitamin B6. Taking 50 to 100 milligrams daily of vitamin B6 and other B vitamins may help some women with PMS symptoms.
  
  
• Vitamin E. Taking 400 international units (IU) daily may ease PMS symptoms by reducing the production of prostaglandins, which are hormone-like substances that cause cramps and breast tenderness.
  
  
• Herbal remedies. Some herbs may be marketed as relieving PMS symptoms, including black cohosh, ginger, red raspberry leaf, dandelion tea, chaste tree berry and evening primrose oil. However, studies have not proven the use of herbs to be effective, and the FDA does not regulate herbs, so their safety and effectiveness have not been proven.
  
  
• Natural progesterone creams. Creams derived from wild yams and soybeans have been marketed as relieving PMS symptoms. Some women experience relief, but their effectiveness has not been proven through scientific studies.

Because the cause of PMS is not known, the condition cannot be prevented. However, many of the lifestyle changes recommended for the treatment of PMS, such as regular exercise, a balanced diet, minimal alcohol and caffeine consumption and adequate rest, may be useful in preventing symptoms from developing or getting worse.