PMS Management

Premenstrual syndrome, commonly referred to as PMS, describes the physical and mood changes a woman may experience a week or two before her menstrual period. Symptoms of PMS include:

  • Breast tenderness
  • Bloating and weight gain
  • Fatigue
  • Abdominal pain
  • Headache
  • Skin problems
  • Food cravings
  • Gastrointestinal issues
  • Depression
  • Irritability
  • Anxiety
  • Crying spells
  • Outbursts of anger
  • Insomnia
  • Changes in sexual desire
  • Confusion

According to the US Office on Women’s Health, over 90% of women say they experience premenstrual symptoms. But, according to the American College of Obstetricians and Gynecologists (ACOG), the following criteria must be met for a PMS diagnosis:

  1. Symptoms must be present in the 5 days before her period for at least 3 cycles in a row.
  2. Symptoms must go away within 4 days after a woman’s period starts.
  3. Symptoms must interfere with normal activities.

Women who experience PMS symptoms can speak to the gynecologist or healthcare practitioner about ways to treat and manage symptoms.

Ways to Manage PMS

Hormonal Contraceptives

Doctors may prescribe hormonal birth control for PMS management because it prevents ovulation. Hormonal birth control is also used to treat painful or heavy periods for the same reasons. These medications can relieve the physical symptoms of PMS and some women get relief from mood symptoms as well. However, not all women get mood benefits from birth control. Therefore, antidepressants may also be prescribed for PMS management.


Because depression, anxiety, irritability, anger, and other mood changes are associated with PMS, antidepressants may be helpful for some women. There are several types of antidepressants, but selective serotonin reuptake inhibitors (SSRIs) are most commonly used to treat the mood symptoms of PMS. Antidepressants are usually most effective when taken daily, but some can be taken only in the two weeks before menstruation.

If you experience severe anxiety during PMS and it isn’t relieved by antidepressants, your doctor may also prescribe an anti-anxiety medication. Unlike antidepressants, anti-anxiety drugs can be taken as needed to treat symptoms.


If bloating and water retention is a major symptom, your doctor can prescribe diuretics. Diuretics are known as “water pills” and reduce fluid buildup. It’s important that your doctor knows all of the other medications you are on before prescribing diuretics, as drug interactions can cause problems. For example, if you are taking a diuretic and nonsteroidal anti-inflammatory drug (NSAID) at the same time, it can cause kidney problems.


Nonsteroidal anti-inflammatory drugs, or NSAIDs, are common pain relievers. Many NSAIDs are available over the counter. Ibuprofen (Advil, Motrin), Aspirin, and Naproxen Sodium (Aleve) are all NSAIDs. Prescription NSAIDs are also available, but over-the-counter varieties are usually suitable to treat pain associated with PMS. Talk to your doctor before starting to take any NSAID on a regular basis to get advice on doses and frequency. Prolonged NSAID use has been linked to stomach issues like bleeding and ulcers.

Lifestyle Changes

PMS symptoms can sometimes be managed with lifestyle changes. If your symptoms are mild, you may prefer these methods over medication. If your symptoms are more intense, you may want to make these changes in addition to using the medications described above.

  • Improve your diet:
    • Limit salt to reduce bloating.
    • Avoid caffeine and alcohol.
    • Eat foods high in calcium. If needed, take a calcium supplement.
    • Choose complex carbohydrates (fruits, vegetables, whole grains)
    • Eat smaller meals more frequently
  • Get more exercise
  • Reduce stress
  • Get plenty of sleep

Raleigh OB/GYN Centre has been providing comprehensive obstetric and gynecologic care to the women of Raleigh, NC since 1974. If you have questions about PMS management or any other women’s health issue, call (919) 876-8225 to schedule an appointment at one of our convenient locations.