Treatment
Some experts recommend a stepped approach for treatment of symptoms that meet the full criteria for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).
- The first line therapies are treatments that do not include prescription medications. Lifestyle modifications, especially exercise, are advised for any stage of treatment. Over-the-counter pain relievers may be helpful. Vitamin B6 and calcium are sometimes recommended.
- In severe cases, particularly in women who have premenstrual dysphoric disorder, antidepressants may be helpful. Currently, the first options are antidepressants known as a serotonin-reuptake inhibitors (SSRIs) that are taken only during the premenstrual phase. (If this regimen fails or if depression is a major problem, the patient might take an SSRI daily.)
- Cognitive behavioral therapy can be considered as an alternative to antidepressants. (There does not seem to be any extra advantage in combining both treatments. Either one is effective.)
- Altering the menstrual cycle with hormonal agents, including oral contraceptives and progestins is sometimes tried when other methods have failed, but to date have not been very successful. In spite of the lack of success, a 2002 British study reported that progestins were the most commonly prescribed agent (40%) of all medications used for PMS.
- Drugs for specific symptoms. Patients who experience severe anxiety are sometimes given anti-anxiety agents. The standard drugs are benzodiazepines, usually alprazolam (Xanax), but they can become addictive and subject to abuse. Newer antianxiety agents, notably buspirone (BuSpar), may be effective and have fewer side effects. Diuretics may help women with severe fluid retention. Bromocriptine is a drug used for breast pain.
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