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Premenstrual syndrome (PMS or PMT)
Written by Dr Philip Owen, consultant obstetrician and gynaecologist
Non-hormonal treatments
There is some scientific support for its use for mild symptoms, but you need to be careful not to take too high a dose. It is advisable to consult your doctor before starting treatment.
Evening primrose oil (EPO)
Capsules of EPO can be helpful in alleviating premenstrual breast pain in some women. However, the evidence in favour of its effect is slight and it has been withdrawn from NHS prescription for this reason.
Bromocriptine and cabergoline
Bromocriptine and cabergoline reduce the output from the brain of a hormone called prolactin. Prolactin is the hormone that stimulates the breasts to produce milk.
These drugs may be useful if premenstrual breast pain is a major symptom, but their long-term use should be avoided.
Diuretics (water tablets)
Diuretics (water tablets) may give relief from ankle swelling. They will not relieve abdominal bloating, which is not caused by fluid retention but by relaxation and distension of the muscle in the wall of the bowel.
Diuretics need to be prescribed by a doctor and should only be taken for a few days each month in the lowest of doses.
Antidepressants
There is much enthusiasm for the use of a class of antidepressants called SSRIs (eg Prozac) in the treatment of severe PMS where the symptoms are mostly depression, mood swings, irritability, etc.
The results of treatment are often dramatic and are supported by scientific studies. Side effects can sometimes be a problem. Discussion with a GP or specialist is essential before starting treatment.
Hormonal preparations
It was once thought that PMS was due to a lack of progestogen in the bloodstream, but it is now recognised this isn't the case.
Some women do gain short-term relief of mild symptoms with progestogens. Most scientific studies do not support their use.
Combined oral contraceptive (COC) pill
There is some initial evidence to suggest the combined Pill called Yasmin, which contains a novel progestogen, may be of some benefit to women with PMS. However, more data is needed.
Danazol
It has a number of side effects, such as encouraging the growth of body hair and other masculinising effects, which means it is only suitable for use in low doses and will not be tolerated by all women.
Pregnancy must be avoided while taking this medication.
Oestrogen patches and implants
There is some evidence to support its use in PMS. Usually patches and implants will only be used on the advice of a gynaecologist.
Mirena intra-uterine system (IUS)
Most women experience a reduction in the heaviness and duration of their periods and some say it improves their PMS. It may be combined with an oestrogen patch or implant.
Treatments for severe PMS
They temporarily 'switch off' a woman's ovaries, which usually gives relief from PMS within two months. They are only suitable for short-term use up to six months.
LHRH analogues may be used to confirm the diagnosis of PMS and to help guide you and your gynaecologist towards considering surgery. They are used only in severe and difficult-to-treat PMS.
One of the potential disadvantages of using these particular drugs is they cause flushings and sweats due to the drop in oestrogen output from the ovaries (like that which occurs in the menopause).
They also accelerate the natural rate of bone loss and can therefore increase your chances of developing osteoporosis (fragile bones).
To counter this, they are usually combined with a drug called tibolone
that mimics HRT. Doctors call this 'add-back' treatment.
Surgery
This is because you can still get PMS if one or both ovaries are still present and functional.
There is no good evidence that the Pill works in PMS, but it is often prescribed, especially if contraception is required. Some women find the COC gives them PMS because of the hormones contained in the pill.
Danazol is a synthetic hormone based on the male hormone testosterone. Its use in PMS is supported by scientific studies.
Extra oestrogen (one of the female hormones) via patches or implants can suppress ovulation and reduce the naturally occurring hormone fluctuations.
Mirena is in fact a contraceptive device, which is placed inside the uterus (womb). It releases a small dose of progestogen hormone into the body.
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