PMS/PMDD: A Review of Treatment Options

SSRIs and drospirenone-containing oral contraceptives are considered first-line
SSRIs and drospirenone-containing oral contraceptives are considered first-line

Recent data regarding the treatment of premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD) has "triaged therapy options into first, second, third, and last lines", according to a new review published in the journal Clinical Obstetrics and Gynecology. 

Treating patients with severe PMS and PMDD can include lifestyle modifications, psychological treatments, and pharmacological agents for both somatic and psychological symptoms.

Lifestyle changes, such as diet and exercise, may alleviate some symptoms but they are usually insufficient for those experiencing severe symptoms. Trial modifications are encouraged during the patient's prospective symptom tracking. A qualitative review on exercise and PMS symptoms demonstrated little to no evidence to support the recommendation. Although diet changes "lack any systematic evaluation of their efficacy," a reduction in alcohol, caffeine, and sugar with an increase in complex carbohydrates during the luteal phase may reduce PMS/PMDD symptoms. 

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Calcium supplements have been shown to lower both negative mood symptoms and somatic symptoms, however the evidence is not as strong for vitamin B6 or vitamin E supplementation. The use of chasteberry (Vitex agnus castus), an herbal, proved superior to placebo in relieving breast fullness, headache, irritability, anger, and mood lability; it was also shown to be as effective as fluoxetine in treating PMD/PMDD symptoms in a randomized controlled trial.