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Table of Contents > Conditions > Premenstrual Syndrome
Premenstrual Syndrome
Also Listed As:  PMS
Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
Treatment Options
Treatment Plan
Drug Therapies
Surgical and Other Procedures
Complementary and Alternative Therapies
Prognosis/Possible Complications
Following Up
Supporting Research

Women who have premenstrual syndrome (PMS) experience a variety of physical and emotional symptoms that occur each month from 2 to 14 days before their menstrual cycle. The symptoms usually disappear once the cycle begins. PMS may begin at any age and ends after menopause. Approximately 75 percent of women experience PMS to some degree, with 20 to 50 percent finding that symptoms disrupt their daily activities, and 3 to 5 percent becoming incapacitated.

Signs and Symptoms

PMS is often accompanied by the following signs and symptoms.

  • Abnormal bloating and weight gain
  • Breast swelling, tenderness
  • Mood swings
  • Depression and anxiety
  • Skin disorders
  • Changes in appetite, food cravings
  • Changes in interest in sex
  • Headaches, backaches, cramps
  • Inability to concentrate, loss of interest in usual activities, confusion

What Causes It?

While the exact cause of PMS is unknown, the most popular theories include hormonal changes (estrogen excess or progesterone deficiency), hypoglycemia (low blood sugar), vitamin B6 deficiency, abnormal metabolism of prostaglandin (hormone-like substances), excessive fluid retention, and endorphin (a substance in the brain that provides pain relief) withdrawal.

Who's Most At Risk?

Women with a history of the following conditions are at a higher-than-average risk for having PMS.

  • Dysmenorrhea (painful menstruation)
  • Depressive, mood, anxiety, or bipolar disorders (family history, too)
  • Postpartum depression or psychotic episodes
  • High stress

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with PMS, you should see your health care provider. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you.

You'll need to chart your symptoms and their severity daily for one to two months. Your provider will take a detailed history of symptoms, do a physical and gynecologic examination to rule out other medical conditions, and conduct a psychosocial evaluation. Certain laboratory and imaging studies may be used, such as a Pap smear, complete blood count, chemistry screen, fasting blood glucose test, and thyroid studies.

Treatment Options

Reducing stress, increasing exercise, and making dietary changes around the time of menstruation can prevent PMS symptoms from worsening.

Treatment Plan

Preventive measures and, in some cases, drug therapy, are most often used for treating PMS.

Drug Therapies

Your provider may prescribe the following medications.

  • Diuretics, for bloating and water retention
  • Analgesics, for headaches and cramps
  • Beta-blockers and calcium-channel blockers, to prevent the onset of migraine headaches
  • Prostaglandin inhibitors for painful menstruation
  • Spironolactone for skin conditions
  • Medications that block ovulation
  • Bromocriptine for breast soreness
  • Anti-anxiety medications
  • Antidepressants
  • Progesterone, for relief of symptoms

Women who are planning to become pregnant should avoid medications such as prostaglandin inhibitors, diuretics, spironolactone, and danazol.

Surgical and Other Procedures

Women whose symptoms are severe and do not respond to treatment may need to undergo a hysterectomy, including removal of the ovaries, followed by estrogen replacement therapy.

Complementary and Alternative Therapies

A comprehensive treatment plan for PMS may include a range of complementary and alternative therapies.


Decreasing or avoiding caffeine (including chocolate), saturated fats, sugar, salt, dairy, meat, poultry, and alcohol can help reduce the intensity and duration of symptoms. Nutritional deficiencies may be addressed with these supplements.

  • Vitamin B6 (100 to 200 mg a day) with B-complex (50 to 100 mg a day)
  • Magnesium (400 mg a day)
  • Vitamin E (400 to 600 IU a day), especially with breast tenderness
  • Essential fatty acids: omega-3 and omega-6 (3,000 to 4,000 mg a day for three months, then decrease dose by 1,000 mg every two months)
  • Chromium (250 mcg one to two times per day) to reduce sugar cravings


Herbal remedies may be helpful in alleviating symptoms. The following herbs should be used in combination, either as tincture (60 drops three times a day or tea (1 cup three to four times a day):

  • Chaste tree (Vitex agnus castus) (175 mg a day)
  • Black cohosh (Cimicifuga racemosa) (100 to 600 mg a day)
  • Valerian (Valeriana officinalis) (150 to 300 mg one to four times a day, or before bed for insomnia) or kava kava (Piper methysticum) (200 mg one to four times a day, or before bed). Reduce dose of either herb if drowsiness occurs.
  • Milk thistle (Silybum marianum) (200 to 600 mg a day)
  • Dandelion (Taraxacum officinale) root and/or leaves as a tea or tincture can be used as a diuretic. If you have liver problems, consult with an experienced practitioner before using dandelion.
  • St. John's wort (Hypericum perforatum) (300 mg two to three times per day) for depression associated with PMS. Must be taken consistently throughout the month; direct sun exposure may cause rashes in some people.

Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20 minutes). For PMS, teas or tinctures are preferred.


There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for PMS based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

  • Chamomilla — for intense menstrual pain; this remedy is most appropriate for individuals who are extremely irritable, angry, and have frequent mood swings
  • Cimicifuga — for feelings of hysteria, frustration, and being overwhelmed; this remedy is most appropriate for individuals who have labor-type pains that migrate from one side of the body to the other and may involve the back or even sciatic nerve (the largest nerve in the body; extends from the lower back down through the legs and knees)
  • Colocynthis — for cramps that are relieved by bending forward, abdominal massage, and warmth (such as a heating pad); this remedy is most appropriate for individuals who are extremely irritable and restless
  • Ignatia — for emotional symptoms such as grief, panic, and mood swings; this remedy is most appropriate for individuals who feel particularly vulnerable
  • Lachesis — for individuals who tend to be annoyed, caustic, talkative, and envious and whose pain and bloating is worse on the left side; symptoms tend to worsen upon awakening in the morning and with exposure to heat or light pressure; symptoms improve dramatically when menstruation begins
  • Lycopodium — for bloating with backaches and gas that are the worst during early evening and in warm weather
  • Magnesia phos — for sharp cramps that are relieved by bending forward, abdominal massage, and warmth (such as a heating pad), but are worsened by cold air
  • Nux vomica — for individuals who are extremely irritable, confrontational, and feel nauseous
  • Pulsatilla — for irregular periods with cramps, bloating, and/or mood swings as the predominant symptoms; an appropriate candidate for Pulsatilla is gentle and yielding but clingy and cries easily; may have nausea and water retention that is aggravated by heat
  • Sepia — for bloating, mood swings, constipation, drowsiness, and irritability


Although scientific evidence regarding the use of acupuncture for PMS is lacking, this condition is frequently treated by acupuncturists. Acupuncturists treat people with PMS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of PMS, a qi deficiency is usually detected in the liver and/or spleen meridians. Many treatments include moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points), and qualified practitioners may also recommend herbal treatment or dietary modifications.


Some studies suggest that chiropractic spinal manipulation may be effective for women with PMS. Women with PMS have been found to have a higher rate of spine-related problems (such as tenderness and muscle weakness) than those who do not have PMS. In one study, researchers found that women with PMS experience a significant decrease in symptoms after receiving spinal manipulation and soft tissue therapy compared to those who do not receive the chiropractic treatment. The researchers note that these effects may be short-lived and that monthly chiropractic treatment would probably be needed to maintain these positive results.

Prognosis/Possible Complications

Severe PMS can disrupt a woman's life. Psychological and emotional support as well as treatment of the physical symptoms may help.

Following Up

Ongoing follow-up and regular evaluations are necessary.

Supporting Research

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994:715-718.

Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City, NY: Avery Publishing; 1997:443-445.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:352.

Beck WW. Obstetrics and Gynecology. 2nd ed. New York, NY: John Wiley; 1989: 216.

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:119-20, 108, 90, 226-7.

Bowman MA. Ambulatory Care for the Adult. Madison, Conn: Fence Creek Publishing; 1998:121, 139, 140, 438.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 188-189.

Cunningham FG, et al. Williams Obstetrics. 19th ed, Norwalk, Conn: Appleton & Lange; 1993:97-99.

Danforth's Obstetrics and Gynecology. 7th ed. Philadelphia, Pa: J. B. Lippincott; 1994:599-600, 677-678.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:290.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998:1222-3, 1175, 7476-8, 1204-6.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 185-186.

Keye WR Jr. The Premenstrual Syndrome. Philadelphia, PA: W. B. Saunders; 1988: 48, 55, 62, 74, 78, 114-118, 120, 147-149, 151-152, 180-183.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:112-118.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:58-62, 68-9, 82-6, 210-1, 274-6, 310-5, 343-7.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin, Calif: Prima Publishing; 1998:470-479.

Rivlin ME, Martin RW. Manual of Clinical Problems in Obstetrics and Gynecology. 4th ed. Boston, Mass: Little, Brown; 1994:401-404.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 190-191.

Walsh MJ, Polus B. The frequency of positive common spinal clinical examination findings in a sample of premenstrual syndrome sufferers. J Manipulative Physiol Ther. 1999a;22(4):216-220.

Walsh MJ, Polus B. A randomized placebo controlled clinical trial on the efficacy of chiropractic therapy on premenstrual syndrome. J Manipulative Physiol Ther. 1999b;22(9):582-585.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing Inc; 1987:364-369.

Review Date: March 2000
Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace, Cambridge, MA; Gary Guebert, DC, DACBR, (Chiropractic section October 2001) Login Chiropractic College, Maryland Heights, MO; Richard A. Lippin, MD, President, The Lippin Group, Southampton, PA; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New York, NY; Ira Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

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