Premenstrual syndrome - Treating premenstrual syndrome (PMS)

There is no cure for premenstrual syndrome (PMS), but there are treatments that can help you manage your symptoms so they do not interfere with your daily life.

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

Lifestyle changes

Diet

The following tips can help you maintain a healthy balanced daily diet, and may help control the symptoms of PMS:

• eat smaller meals more frequently to help reduce bloating
• avoid eating salty foods to limit bloating and fluid retention
• drink plenty of water to avoid dehydration – 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
• eat calcium-rich foods such as cheese and milk to improve the physical and psychological symptoms of PMS – if you can't eat dairy products, try calcium-fortified soya alternatives
• eat plenty of fruit and vegetables, which are rich in vitamins and minerals and may ease your PMS symptoms – aim to eat at least five portions a day
• avoid caffeine and alcohol, which can affect your mood and energy levels

Read more information about healthy eating.

Exercise

If possible, aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of activities include walking, swimming and cycling.

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.

Read more about health and fitness and how to manage stress.

Complementary treatments

There are many non-prescribed alternative treatments and supplements that claim to help treat PMS that some women may find helpful in easing their symptoms. 

For example, supplements of calcium, vitamin D, magnesium and agnus castus (a herb known as chasteberry) may reduce some symptoms of PMS.

However, many complementary therapies and supplements have either not been tested or have not been proven to be effective.

Always see your GP before taking any supplements, as taking them alongside certain medications or in excessive amounts can be harmful.

If you decide to take a complementary treatment, take one at a time so you know it works for you. Go back to your GP if your symptoms don't change after three months, as another treatment may be recommended.

Psychological therapy

If you have psychological symptoms, such as feeling depressed or emotional, it may help to talk to a health professional.

Cognitive behavioural therapy (CBT) is the term for a group of therapies designed to help solve problems such as anxiety and depression. A cognitive behavioural therapist can help you learn new ways of managing some of your symptoms.

Read more about cognitive behavioural therapy.

Medical treatment

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

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

If you are prescribed treatment for PMS, you may be asked to record any changes to your symptoms so that you know how effective it is for you. If the treatment doesn't ease your symptoms, you may be prescribed an alternative.

Medical treatments for PMS include:

• painkillers
• a combined oral contraceptive pill
• oestrogen-only patches and implants
• selective serotonin reuptake inhibitors (SSRIs)
• gonadotrophin-releasing hormone (GnRH) analogues

These are described in more detail below.

Painkillers

Painkilling medication, including paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), can relieve some of the painful PMS symptoms such as stomach cramps, headaches, muscle pain and joint pain.

These medications are available over the counter without a prescription, so you should make sure you read the manufacturer's instructions before taking them to make sure they are suitable. For example, children under the age of 16 shouldn't take aspirin and people with asthma should not take ibuprofen.

Oral contraceptive pills

As well as preventing pregnancy, the combined contraceptive pill may help improve symptoms of PMS in some women by preventing ovulation (when an egg is released from your ovaries).

In particular, newer types of contraceptive pill containing certain versions of the hormone progestogen, such as the Yasmin pill, have been shown to be effective in treating some PMS symptoms, and may even be effective in improving symptoms of PMDD.

However, contraceptive pills do not help all women and they can have side effects similar to the symptoms of PMS, such as breast pain or a depressed mood.

Oestrogen-only patches and implants

Like combined contraceptive pills, oestrogen-only patches and implants may help improve some symptoms of PMS by preventing ovulation. However, they are usually only used to treat PMS under the guidance of a gynaecologist.

Unless you have had a hysterectomy (removal of your womb), oestrogen patches and implants also need to be combined with a low dose of the hormone progestogen to reduce the risk of thickening of the womb lining (endometrial hyperplasia), which can develop into womb cancer. This may be in the form of progestogen tablets or a progestogen-releasing intrauterine system (IUS).

Side effects of using an oestrogen patch can include skin irritation, itching and soreness, and the additional progestogen dose can have side effects similar to the symptoms of PMS.

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 antidepressants that can be taken daily to relieve tiredness, food cravings and sleep problems, and combat depression.

However, SSRIs also may have negative side effects that could outweigh their benefits, such as nausea, insomnia, headache and loss of libido (less interest in sex).

Gonadotrophin-releasing hormone (GnRH) analogues

Gonadotrophin-releasing hormone (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.

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, loss of libido and osteoporosis (thinning of the bones).

They should only be taken alone for up to six months. If GnRH analogues are used for longer than this, you will be advised to take hormone replacement therapy (HRT) to reduce menopausal complications such as osteoporosis.