Innumerable things have been proposed for treatment of PMS. Despite valiant and persistent trials, there is little evidence of a relationship between PMS and hormone levels. There have been many, many studies trying to blame estrogen and progesterone as a cause or to use them as a treatment. None of these studies have had more than equivocal results. Some people may improve with natural progesterone pills or suppositories taken during the later part of the menstrual cycle. This may be due to the hormonal effect or it may be due to the natural tranquillizing effect of the medicine. Lots of people respond to the effect of exercise and diet for PMS. This effect has been well documented in multiple studies. Vigorous aerobic exercise improves all facets of PMS and the menstrual cycle. Dietary changes including avoidance of alcohol, caffeine, sugar and salt seem to have a beneficial effect but are the exact opposite of the cravings of which many people complain. Herbal and vitamin therapy suggestions include Vit E, B6, Evening Primrose oil, and possibly Vitex.

I would like to take a moment to talk about herbals and natural remedies. This may eventually end up as a page in itself. There are many herbal and homeopathic combinations that are advertised for PMS and other symptoms. They may be helpful but I have some reservations. First, there is no guarantee that these mixtures contain the advertised herbs. There is no body in America that certifies herbals for identity, purity or effectiveness. Studies in this country have shown that your chance of getting the herbal that is on the label is sometimes as low as 50%. In Germany there is a governmental "E Commission" that certifies the purity and some sort of effectiveness in herbal medicines, but this is lacking here. Some of the herbals listed as ingredients have no realistic role in treating the symptoms but they sound good and wholesome and so the companies toss them in. You have to look out for yourself on herbal medicines. Get a good directory, possibly the PDR for Herbals or a critical, hardheaded book on herbal medicine. Just because something is "natural" doesn’t mean it is harmless or good for you. Nicotine, arsenic and belladonna are natural but deadly. There was no lack of natural ingredients to poison people for centuries before we came up with "unnatural" medicines. There is no little man in the bottle that decides what you need and sends the remedy to help it. Claims to "cleanse the blood" or "purify the liver" make no sense at all. Be skeptical and critical. Develop a BS detector. Some herbal medicines are very useful and there are some that are just weeds. Any drug, "natural" or manufactured, that is strong enough to have an effect on your body is strong enough to have a bad effect on your body.

There are a bewildering number of things that are recommended for the treatment PMS symptoms, especially the prostaglandin group of symptoms. Careful reading of the labels will show that most of the brand name products have only a few ingredients and most of these are Non Steroidal Anti-Inflammatory Drugs or NSAID’s. They are a good choice for this purpose but don’t pay for the name. MotrinPMS is the same ibuprofen in Regular Motrin and generic ibuprofen. Some of the PMS formulas have the addition of a weak diuretic or other compound. It probably isn’t worth the extra money. People with prostaglandin type symptoms should try to begin taking an NSAID such as ibuprofen, naproxen, or a prescription NSAID like  Ponstel or Celebrex  a short time before the anticipated onset of symptoms. Swelling and bloating may respond to a diuretic like HCTZ or spironolactone. There are some good herbal diuretics available. Sometimes one NSAID will work better for an individual than another. If the over-the-counter NSAID’s don’t work for you, ask your doctor for a prescription one.

Depressive symptoms may actually represent an ongoing depression that should be treated with an anti-depressant like Prozac or Zoloft. St John’s wort is an herbal anti-depressant that may be useful in some people, though the evidence is mixed. Like most of these type drugs, some work better for some people than others do. It frequently just requires some experimentation to find out what works for you. These medicines apparently can be taken for two weeks out of the month though it may be better to start with a continuous dosage to see if it works. If the symptoms are completely absent except for the immediate premenstrual time, most people will not want to take medicine for the whole month. When the symptoms are of short duration, many people have had success with a low dose of alprazolam (Xanax) for a few days. Valerian  may be a herbal alternatives. Sadly there are a few people that are not helped by medicines or herbals or much of anything else. When all else has failed and the symptoms are truly life altering, some people have opted for hysterectomy, removing either the uterus alone or the uterus and ovaries. Usually the precipitating symptom is severe dysmenorrhea or cramping. When this is the case the results of surgery are frequently good. I don’t like the idea of hysterectomy for PMS but I have to admit that many people who have had hysterectomy for related causes will find that most of the PMS has disappeared. If PMS is truly hormonal, and some forms may really be, it would be necessary to remove the ovaries also and then to replace the missing hormones medically as necessary.