Treatment

Some experts recommend a gradual approach for treatment of symptoms that meet the full criteria for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).

• First-line therapies are those 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 supplements are sometimes recommended.
• In severe cases, particularly in women who have PMDD, antidepressants may be helpful. The first options are usually antidepressants known as serotonin-reuptake inhibitors.
• Cognitive behavioral therapy may be an alternative to antidepressants.
• Hormonal drugs such as birth control pills may help some women. Certain types of oral contraceptives may especially help mood symptoms associated with PMDD.
• Patients who experience severe anxiety are sometimes given anti-anxiety drugs. The standard drugs are benzodiazepines, usually alprazolam (Xanax), but they can become addictive and subject to abuse. Newer antianxiety drugs, notably buspirone (BuSpar), may work better and have fewer side effects.
• Diuretics may help women with severe fluid retention.
• Bromocriptine is a drug used for relieving breast pain.