Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 2002 Nov;48:1789–1797.

Premenstrual syndrome. Evidence-based treatment in family practice.

Sue Douglas 1
PMCID: PMC2213956  PMID: 12489244

Abstract

OBJECTIVE: To evaluate the strength of evidence for treatments for premenstrual syndrome (PMS) and to derive a set of practical guidelines for managing PMS in family practice. QUALITY OF EVIDENCE: An advanced MEDLINE search was conducted from January 1990 to December 2001. The Cochrane Library and personal contacts were also used. Quality of evidence in studies ranged from level I to level III, depending on the intervention. MAIN MESSAGE: Good scientific evidence shows that calcium carbonate (1200 mg/d) and selective serotonin reuptake inhibitors are effective treatments for PMS. The most commonly used therapies (including vitamin B6, evening primrose oil, and oral contraceptives) are based on inconclusive evidence. Other treatments for which there is inconclusive evidence include aerobic exercise, stress reduction, cognitive therapy, spironolactone, magnesium, nonsteroidal anti-inflammatory drugs, various hormonal regimens, and a complex carbohydrate-rich diet. Although evidence for them is inconclusive, it is reasonable to recommend healthy lifestyle changes given their overall health benefits. Progesterone and bromocriptine, which are still widely used, are ineffective. CONCLUSION: Calcium carbonate should be recommended as first-line therapy for women with mild-to-moderate PMS. Selective serotonin reuptake inhibitors can be considered as first-line therapy for women with severe affective symptoms and for women with milder symptoms who have failed to respond to other therapies. Other therapies may be tried if these measures fail to provide adequate relief.

Full Text

The Full Text of this article is available as a PDF (242.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aganoff J. A., Boyle G. J. Aerobic exercise, mood states and menstrual cycle symptoms. J Psychosom Res. 1994 Apr;38(3):183–192. doi: 10.1016/0022-3999(94)90114-7. [DOI] [PubMed] [Google Scholar]
  2. Andersch B. Bromocriptine and premenstrual symptoms: a survey of double blind trials. Obstet Gynecol Surv. 1983 Nov;38(11):643–646. doi: 10.1097/00006254-198311000-00001. [DOI] [PubMed] [Google Scholar]
  3. Andersch B., Hahn L. Progesterone treatment of premenstrual tension--a double blind study. J Psychosom Res. 1985;29(5):489–493. doi: 10.1016/0022-3999(85)90082-0. [DOI] [PubMed] [Google Scholar]
  4. Bancroft J., Rennie D. The impact of oral contraceptives on the experience of perimenstrual mood, clumsiness, food craving and other symptoms. J Psychosom Res. 1993;37(2):195–202. doi: 10.1016/0022-3999(93)90086-u. [DOI] [PubMed] [Google Scholar]
  5. Chakmakjian Z. H. A critical assessment of therapy for the premenstrual tension syndrome. J Reprod Med. 1983 Aug;28(8):532–538. [PubMed] [Google Scholar]
  6. Christensen A. P., Oei T. P. The efficacy of cognitive behaviour therapy in treating premenstrual dysphoric changes. J Affect Disord. 1995 Jan 11;33(1):57–63. doi: 10.1016/0165-0327(94)00073-i. [DOI] [PubMed] [Google Scholar]
  7. Dimmock P. W., Wyatt K. M., Jones P. W., O'Brien P. M. Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. Lancet. 2000 Sep 30;356(9236):1131–1136. doi: 10.1016/s0140-6736(00)02754-9. [DOI] [PubMed] [Google Scholar]
  8. Eriksson E. Serotonin reuptake inhibitors for the treatment of premenstrual dysphoria. Int Clin Psychopharmacol. 1999 May;14 (Suppl 2):S27–S33. [PubMed] [Google Scholar]
  9. Facchinetti F., Borella P., Sances G., Fioroni L., Nappi R. E., Genazzani A. R. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991 Aug;78(2):177–181. [PubMed] [Google Scholar]
  10. Facchinetti F., Fioroni L., Sances G., Romano G., Nappi G., Genazzani A. R. Naproxen sodium in the treatment of premenstrual symptoms. A placebo-controlled study. Gynecol Obstet Invest. 1989;28(4):205–208. doi: 10.1159/000293579. [DOI] [PubMed] [Google Scholar]
  11. Freeman E., Rickels K., Sondheimer S. J., Polansky M. Ineffectiveness of progesterone suppository treatment for premenstrual syndrome. JAMA. 1990 Jul 18;264(3):349–353. [PubMed] [Google Scholar]
  12. Goodale I. L., Domar A. D., Benson H. Alleviation of premenstrual syndrome symptoms with the relaxation response. Obstet Gynecol. 1990 Apr;75(4):649–655. [PubMed] [Google Scholar]
  13. Graham C. A., Sherwin B. B. A prospective treatment study of premenstrual symptoms using a triphasic oral contraceptive. J Psychosom Res. 1992 Apr;36(3):257–266. doi: 10.1016/0022-3999(92)90090-o. [DOI] [PubMed] [Google Scholar]
  14. Graham C. A., Sherwin B. B. The relationship between retrospective premenstrual symptom reporting and present oral contraceptive use. J Psychosom Res. 1987;31(1):45–53. doi: 10.1016/0022-3999(87)90097-3. [DOI] [PubMed] [Google Scholar]
  15. Johnson S. R. Premenstrual syndrome therapy. Clin Obstet Gynecol. 1998 Jun;41(2):405–421. doi: 10.1097/00003081-199806000-00022. [DOI] [PubMed] [Google Scholar]
  16. Kirkby R. J. Changes in premenstrual symptoms and irrational thinking following cognitive-behavioral coping skills training. J Consult Clin Psychol. 1994 Oct;62(5):1026–1032. doi: 10.1037//0022-006x.62.5.1026. [DOI] [PubMed] [Google Scholar]
  17. London R. S., Murphy L., Kitlowski K. E., Reynolds M. A. Efficacy of alpha-tocopherol in the treatment of the premenstrual syndrome. J Reprod Med. 1987 Jun;32(6):400–404. [PubMed] [Google Scholar]
  18. Maddocks S., Hahn P., Moller F., Reid R. L. A double-blind placebo-controlled trial of progesterone vaginal suppositories in the treatment of premenstrual syndrome. Am J Obstet Gynecol. 1986 Mar;154(3):573–581. doi: 10.1016/0002-9378(86)90604-6. [DOI] [PubMed] [Google Scholar]
  19. Meden-Vrtovec H., Vujić D. Bromocriptine (Bromergon, Lek) in the management of premenstrual syndrome. Clin Exp Obstet Gynecol. 1992;19(4):242–248. [PubMed] [Google Scholar]
  20. Mira M., McNeil D., Fraser I. S., Vizzard J., Abraham S. Mefenamic acid in the treatment of premenstrual syndrome. Obstet Gynecol. 1986 Sep;68(3):395–398. doi: 10.1097/00006250-198609000-00022. [DOI] [PubMed] [Google Scholar]
  21. O'Brien P. M., Craven D., Selby C., Symonds E. M. Treatment of premenstrual syndrome by spironolactone. Br J Obstet Gynaecol. 1979 Feb;86(2):142–147. doi: 10.1111/j.1471-0528.1979.tb10582.x. [DOI] [PubMed] [Google Scholar]
  22. O'Brien P. M. Helping women with premenstrual syndrome. BMJ. 1993 Dec 4;307(6917):1471–1475. doi: 10.1136/bmj.307.6917.1471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Prior J. C., Vigna Y., Sciarretta D., Alojado N., Schulzer M. Conditioning exercise decreases premenstrual symptoms: a prospective, controlled 6-month trial. Fertil Steril. 1987 Mar;47(3):402–408. doi: 10.1016/s0015-0282(16)59045-1. [DOI] [PubMed] [Google Scholar]
  24. Sampson G. A. Premenstrual syndrome: a double-blind controlled trial of progesterone and placebo. Br J Psychiatry. 1979 Sep;135:209–215. doi: 10.1192/bjp.135.3.209. [DOI] [PubMed] [Google Scholar]
  25. Sayegh R., Schiff I., Wurtman J., Spiers P., McDermott J., Wurtman R. The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstet Gynecol. 1995 Oct;86(4 Pt 1):520–528. doi: 10.1016/0029-7844(95)00246-n. [DOI] [PubMed] [Google Scholar]
  26. Smith R. N., Studd J. W., Zamblera D., Holland E. F. A randomised comparison over 8 months of 100 micrograms and 200 micrograms twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome. Br J Obstet Gynaecol. 1995 Jun;102(6):475–484. doi: 10.1111/j.1471-0528.1995.tb11321.x. [DOI] [PubMed] [Google Scholar]
  27. Steege J. F., Blumenthal J. A. The effects of aerobic exercise on premenstrual symptoms in middle-aged women: a preliminary study. J Psychosom Res. 1993;37(2):127–133. doi: 10.1016/0022-3999(93)90079-u. [DOI] [PubMed] [Google Scholar]
  28. Thys-Jacobs S., Starkey P., Bernstein D., Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 1998 Aug;179(2):444–452. doi: 10.1016/s0002-9378(98)70377-1. [DOI] [PubMed] [Google Scholar]
  29. Vellacott I. D., Shroff N. E., Pearce M. Y., Stratford M. E., Akbar F. A. A double-blind, placebo-controlled evaluation of spironolactone in the premenstrual syndrome. Curr Med Res Opin. 1987;10(7):450–456. doi: 10.1185/03007998709112403. [DOI] [PubMed] [Google Scholar]
  30. Walker A. F., De Souza M. C., Vickers M. F., Abeyasekera S., Collins M. L., Trinca L. A. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998 Nov;7(9):1157–1165. doi: 10.1089/jwh.1998.7.1157. [DOI] [PubMed] [Google Scholar]
  31. Watson N. R., Studd J. W., Savvas M., Garnett T., Baber R. J. Treatment of severe premenstrual syndrome with oestradiol patches and cyclical oral norethisterone. Lancet. 1989 Sep 23;2(8665):730–732. doi: 10.1016/s0140-6736(89)90784-8. [DOI] [PubMed] [Google Scholar]
  32. West C. P. Inhibition of ovulation with oral progestins--effectiveness in premenstrual syndrome. Eur J Obstet Gynecol Reprod Biol. 1990 Jan-Feb;34(1-2):119–128. doi: 10.1016/0028-2243(90)90015-s. [DOI] [PubMed] [Google Scholar]
  33. Wood C., Jakubowicz D. The treatment of premenstrual symptoms with mefenamic acid. Br J Obstet Gynaecol. 1980 Jul;87(7):627–630. doi: 10.1111/j.1471-0528.1980.tb05018.x. [DOI] [PubMed] [Google Scholar]
  34. Woods N. F., Most A., Longenecker G. D. Major life events, daily stressors, and perimenstrual symptoms. Nurs Res. 1985 Sep-Oct;34(5):263–267. [PubMed] [Google Scholar]
  35. Wyatt K. M., Dimmock P. W., Jones P. W., Shaughn O'Brien P. M. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999 May 22;318(7195):1375–1381. doi: 10.1136/bmj.318.7195.1375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Wyatt K., Dimmock P., Jones P., Obhrai M., O'Brien S. Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review. BMJ. 2001 Oct 6;323(7316):776–780. doi: 10.1136/bmj.323.7316.776. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES