Figure 25.3 is a flowchart showing the basic principles and options for treatment.

Figure 25.3

Some women find a discussion of their problem helpful even if it only provides reassurance that the majority of women experience similar symptoms. There have been numerous treatments that have been used to treat PMS. Academics have debated the true benefit of individual medications. It is not really surprising that it is difficult to determine the overall benefit of the various medications as PMS can manifest itself in a wide variety of symptoms occurring in varying severity. Ultimately, what really matters is whether you feel better with a particular therapy. If you only have very minimal problems reassurance alone may be all that is required. At the other extreme, if you have proven severe PMS that has not responded to relatively simple medication, you could benefit from suppression of the cycle by medical or surgical means. The problem for the clinician is that the majority of patients with PMS have moderate symptoms for which reassurance alone may be insufficient and suppression of the menstrual cycle seems excessive.

Ability to cope with the extra burden of premenstrual hormone changes may be enhanced by a variety of non-medical means. Regular exercise may improve your self-esteem and provide you with a feeling of being more healthy. Similarly, relaxation by a variety of means and improving your diet may have a beneficial effect. There is no evidence that special diets for PMS have additional benefit. Theoretically, pyridoxine (Vitamin B6) and magnesium may be beneficial as they are known to play an essential part in the chemistry of the brain: controlled trials (placebo & controlled trials), however, have shown little scientific evidence of clinical benefit. Counselling may assist some individuals to assess their problems in life and make a start on sorting them out.

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