Treatment for PMS

Photo of woman taking medication
PantherMedia / Wawrzyniec Korona

Some women who have premenstrual syndrome (PMS) have such bad symptoms on the days before their period that they can’t go about their usual activities. But there are various ways to cope with and treat typical symptoms such as pain, breast tenderness and mood swings.

Most women who get PMS don’t have very severe symptoms, and they find ways to cope with them – like getting enough rest and avoiding stress around the time leading up to their period. There is a lot of advice out there about how to deal with PMS, including:

  • getting enough exercise and doing sports,
  • using relaxation techniques and meditating,
  • not smoking,
  • drinking less alcohol and caffeine, and
  • eating less salt.

Most of these lifestyle changes haven’t been looked at in high-quality scientific studies to see how they affect PMS. But that doesn’t mean that they don’t work. Women can try them out and see whether making these changes helps relieve their symptoms. Observing and recording symptoms and attempted "remedies" over the course of several menstrual cycles can help you find out whether the changes have affected the symptoms.

What medications can be used?

Various medications are used for the treatment of PMS. But only very few of them have been approved for this purpose. If a medication is used for the treatment of a medical condition that it hasn't been approved for, it is called “off-label use.” Doctors are obliged to tell you that the use will be off-label, and you might have to pay for it yourself.

Hormonal medications are often used to try to relieve typical PMS-related symptoms. These medications suppress the production of certain made naturally in the body and interfere with the menstrual cycle. Other medications used include antidepressants, diuretics ("water pills"), painkillers and anti-anxiety drugs.

Hormonal contraceptives

The most common way to influence the menstrual cycle using is by taking hormonal contraceptives, such as birth control pills. This treatment is, of course, not suitable for women who would like to become pregnant.

Two studies have provided weak that a contraceptive pill containing two particular – the progestin drospirenone and a low-dose estrogen – can help women with PMS. A comparison of women who took this pill and women who didn't take it revealed the following: Those who took this combination of had fewer symptoms, coped better in everyday life, were more socially active, and were happier in their relationships. But the women also reported side effects, including nausea, breakthrough bleeding (“spotting”) and breast tenderness.

Hormonal contraceptives also increase the risk of blood clotting (deep vein thrombosis). But the general risk of developing thrombosis is low: Depending on the specific product, an estimated 5 to 12 out of 10,000 women who take birth control pills will have deep vein thrombosis within one year, compared to about 2 out of 10,000 women who don't take the pill.

There are a lot of hormonal contraceptives, containing different in different combinations. They are available in the form of pills, coils, patches, vaginal rings and depot injections. There hasn't been enough research to be able to say which of these can help against PMS. Women who would like to use hormonal contraception can talk to their doctor about which type could be most suitable.

Antidepressants

If premenstrual dysphoric disorder (PMDD) is clearly affecting a woman's mental health – leading to things like , anxiety and feelings of despair – antidepressants may be an option. A type of antidepressant called SSRIs (selective serotonin reuptake inhibitors) are typically used. These medications increase the concentration of a neurotransmitter (chemical messenger) in the brain called serotonin. It is thought that serotonin influences the way in which women’s bodies react to certain that are released in greater amounts before menstruation.

Scientific research has shown that SSRIs can relieve the psychological symptoms of PMS or PMDD and help women cope better in everyday life. But you have to take SSRIs for at least three months before they start working. They weren't found to be more effective when taken continuously rather than only during the second half of the cycle.

It's important for women who are considering taking antidepressants to know what side effects they could have. SSRIs can cause things like nausea, sleep problems and decreased libido.

Painkillers

Various painkillers are used in the treatment of PMS, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid (the drug in medications like Aspirin) and ibuprofen. NSAIDs reduce , relieve pain and block the production of prostaglandin. Many women who frequently have back pain, a headache or abdominal pain before getting their period take these painkillers. NSAIDs can effectively relieve period pain and headaches, and are usually well tolerated. The most common side effects of NSAIDs are stomach problems, nausea, vomiting and drowsiness. If they are taken too much they can also cause headaches.

But there is hardly any research on whether they also help relieve PMS symptoms. Research on NSAIDs in PMS has mainly focused on the drugs naproxen and mefenamic acid.

Diuretics (“water pills”)

Some women who have very swollen and sore breasts use diuretics. Diuretics can cause side effects such as nausea and headaches. Your body can also get used to them: When you stop using them, your body might retain more water than it did before you started using them. So it's important to talk to your doctor about whether diuretics are suitable for you and, if so, use them cautiously. The maximum dose written on the package insert should not be exceeded because your body might lose too much fluid otherwise.

GnRH analogues (agonists)

GnRH (gonadotropin-releasing hormone) is a hormone that regulates the release of what are called gonadotropins. Gonadotropins are sexual that lead to the growth and maturation of egg cells and cause ovulation.

GnRH analogues are used to treat severe PMS in rare cases. These medications really interfere with the balance of in the body, greatly reducing the production of in the ovaries. They often cause things like hot flashes and insomnia. They may also lead to symptoms similar to PMS symptoms, such as a depressive mood. GnRH analogues should not be taken for longer than six months.

When using this treatment for several months, women often also take a low dose of estrogen every day. This approach is called “add-back therapy.” It aims to reduce the estrogen deficiency caused by the GnRH analogues.

There hasn't been enough research to be able to say whether women can benefit from taking GnRH analogues. It isn't possible to become pregnant during treatment with GnRH analogues.

Progesterone

Some women take the hormone progesterone in the days leading up to their period even though it hasn't been approved for the treatment of PMS. The aim is to prevent symptoms that may be caused by low progesterone levels or by progesterone levels falling too rapidly during the second half of the menstrual cycle. But this theory is now considered to be outdated.

Research on the use of progesterone for the treatment of PMS has shown that women who took the hormone did not feel better than those who took just a placebo (dummy tablet). These women were also more likely to have irregular periods.

The only product containing progesterone that has been approved for the treatment of PMS in Germany is a gel for relieving premenstrual breast tenderness. There is not good research on the benefits and harms of this gel, though.

Can herbal products or dietary supplements help?

Some women try to relieve their PMS using herbal products or dietary supplements such as , pyridoxine (vitamin B6), magnesium, evening primrose oil, chaste tree extracts (Vitex agnus castus), St. John’s wort, saffron or Ginkgo biloba.

Research has produced weak suggesting that can relieve PMS symptoms when taken at a dose of between 1,000 and 1,200 mg a day. Pyridoxine (vitamin B6) may possibly help when taken at a dose of about 50 to 100 mg per day. Both of these supplements have to be taken continuously throughout the month.

There is also weak suggesting that chaste tree extracts (Vitex agnus castus) are effective in the treatment of PMS symptoms. No clear conclusions can be drawn about the effectiveness of St. John's Wort, saffron or Ginkgo biloba in the treatment of PMS. The studies on magnesium and evening primrose oil produced conflicting results.

What other treatments are there?

It's still not clear whether cognitive behavioral therapy (CBT) can help women cope better with PMS. There aren't enough good-quality studies to be able to answer this question. CBT mainly aims to help people cope better in everyday life by identifying and changing unhelpful thought patterns and behavior. One aim of CBT for PMS could be to learn to deal with it in such a way that the impact in everyday life is reduced to a minimum.

It's also not clear how much women benefit from and reflexology massages. There is no that homeopathic medicines like Pulsatilla or Sepia are effective or offer any benefits.

Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM). Antidepressiva: Wissenschaftliche Neubewertung der SSRI / SNRI abgeschlossen – Neue Warnhinweise auf suizidales Verhalten bei Kindern und Jugendlichen. July 12, 2005

Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM): Drospirenonhaltige orale Kontrazeptiva (z.B. Yasmin®) – Aktualisierung der Produktinformationen zum Risiko venöser Thromboembolien. May 30, 2011.

Busse JW, Montori VM, Krasnik C, Patelis-Siotis I, Guyatt GH. Psychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials. Psychother Psychosom 2009; 78(1): 6-15.

Canning S, Waterman M, Dye L. Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy. J Reprod Infant Psychol 2006; 24(4): 363-378.

Cho SH, Kim J. Efficacy of acupuncture in management of premenstrual syndrome: a systematic review. Complement Ther Med 2010; 18(2): 104-111.

Dante G, Facchinetti F. Herbal treatments for alleviating premenstrual symptoms: a systematic review. J Psychosom Obstet Gynaecol 2011; 32(1): 42-51.

European Medicines Agency (EMA). Ethinylestradiol + drospirenone-containing oral contraceptives (YASMIN, YASMINELLE and other products) – Risk of venous thromboembolism. May 26, 2011.

Ford O, Lethaby A, Roberts H, Mol BWJ. Progesterone for premenstrual syndrome. Cochrane Database Syst Rev 2012; (3): CD003415.

Hausenblas HA, Heekin K, Mutchie HL, Anton S. A systematic review of randomized controlled trials examining the effectiveness of saffron (Crocus sativus L.) on psychological and behavioral outcomes. J Integr Med 2015; 13(4): 231-240.

Kleinstäuber M, Witthöft M, Hiller W. Cognitive-behavioral and pharmacological interventions for premenstrual syndrome or premenstrual dysphoric disorder: a meta-analysis.J Clin Psychol Med Settings 2012; 19(3): 308-319.

Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid 2015.

Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid 2009.

Lawrie TA, Helmerhorst FM, Maitra NK, Kulier R, Bloemenkamp K, Gülmezoglu AM. Types of progestogens in combined oral contraception: effectiveness and side-effects. Cochrane Database Syst Rev 2011; (5): CD004861.

Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev 2012; (2): CD006586.

Marjoribanks J, Brown J, O'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev 2013; (6): CD001396.

van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Medica 2013; 79(7): 562-575.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on June 14, 2017
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.