Non-pharmacologic

Non-pharmacologic methods should be explored initially, in all women with PMS in view of the many environmental, psychological and personal factors involved.

When considering non pharmacological therapy, clinicians should remember that most complementary therapeutical methods lack strong evidence to support them and they may interact with other conventional medicine (1).

Approaches include:

• lifestyle changes -
  • education about premenstrual syndrome
  • relaxation and stress management – reflexology, psychotherapy, hypnosis, yoga, acupuncture
  • exercise e.g. - regular aerobic exercise (at least 20-30 minutes, three times a week)
  • cognitive behavioural therapy
    • in severe PMS, CBT should be considered routinely as a treatment option
      • CBT was associated with better maintenance of treatment effects compared with fluoxetine (1)
  • quitting smoking
• dietary changes
  • although no diet modifications have been systematically evaluated the following have been mentioned in the literature
    • eating smaller portions of meal more often
    • consuming meals that are high in complex carbohydrates and low in salt or refined sugar
    • reducing the consumption of caffeine and alcohol
• supplements
  • several herbal and mineral supplements have been reported to be effective in reducing the severity and duration of premenstrual symptoms
    • calcium/vitamin D
    • extract of the Agnus castus (chasteberry) fruit (Vitex agnus castus)
    • saffron
    • magnesium
    • vitamin B-6 supplements (dose not to exceed 100 mg/day) (1,2,3)

Reference:

• (1) Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG. 2017;124(3):e73-e105.
• (2) Khajehei M. Aetiology, Diagnosis and Management of Premenstrual Syndrome. J Pain Relief. 2015:4: 193
• (3) Rapkin AJ, Lewis EI. Treatment of premenstrual dysphoric disorder. Women's Health. 2013;9(6): 537–556