Comprehensive management of premenstrual syndrome (PMS) is reviewed, including assessment, counseling, diet, relaxation techniques, exercise, social adaptation, hormonal and medical treatment. Studies of PMS are remarkable for high (40-95%) placebo response, and good results with any treatment, especially in the 1st cycle in uncontrolled studies, but poor performance of therapies in random, double-blind, placebo-controlled studies. Heterogeneous groups of subjects, small numbers and too few cycles may contribute to these findings. The 1st step in treating PMS is thorough assessment and counseling, with at least a hour of listening to the patient. A healthy, varied diet should be suggested, limiting refined sugars, salt, red meat, diary products, chocolate, caffeine products, tobacco, alcohol, and increasing complex carbohydrates and PUFAs, in several small meals. PMS patients rarely have abnormal glucose tolerance tests, but they often exhibit related symptoms. Relaxation and exercise should be prescribed so as to raise endorphins, lower stress, increase control and provide enjoyment. Starting with non-hormonal medications, 100 mg vitamin B6 daily and 1.5 g evening primrose oil bid are suggested to regulate dopamine, serotonin and prostaglandin metabolism. Depending on symptoms, spironolactone diuretics, non-steroidal antiinflammatory drugs or anxiolytics may be prescribed. Hormone treatment ranges from progesterone per rectum or vagina, or oral progestins (usually didrogesterone), estradiol sc, implants, orally or transdermally, oral contraceptives, to hormonal antagonists such as bromocriptine, danazol or LH-RH analogues. The theoretical case for hormone treatments is not established, although some women obtain relief from certain treatments.
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Massil et al. (1987) studied this question.