What causes PMS?
The cause of PMS is still uncertain although it is thought to be related to the hormonal changes that occur around ovulation. One theory is that it is caused by a deficiency of progesterone but, while progesterone replacement therapy is effective treatment for many women, for others it is of no benefit. Many women with PMS have normal levels of progesterone. Another theory is that estrogen may interfere with the body’s use of vitamin B6 (pyridoxine). This vitamin is responsible for the production of a chemical in the brain known as serotonin. An inadequate supply of serotonin can cause depression.

How is PMS treated?
Oral contraceptives may reduce the symptoms of PMS but only in a small number of women. Conversely, they can sometimes cause the symptoms to become worse. Physical symptoms can be eased with over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) and naproxen (Aleve). Vitamin B6 may be prescribed for PMS and can be purchased over the counter, but should not be used in high doses (over 50mg per day). Diuretics (water pills) may be prescribed to alleviate the symptoms caused by water retention. A few women may have elevated levels of the hormone prolactin and bromocriptine may be prescribed to suppress the action of the pituitary gland in releasing prolactin. There are other treatments that may be tried if PMS is severe—your doctor will discuss these options with you if appropriate.

Self-help measures

  • Restrict the amount of salt in your diet—this can help to prevent fluid retention in the body.
  • Cut down on alcohol and caffeine and drink plenty of water instead.
  • If you smoke, try to cut down or stop.
  • Take regular exercise.
  • Try relaxation techniques, such as yoga, meditation and massage—these can help to relieve tension.

Further information
The National Women’s Health Information Center: www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.cfm

Last Reviewed: May 2013