Over the counter pms medication

PMS Treatment Overview: Remedies for Relief

Lots of women cope with at least one premenstrual syndrome (PMS) symptom in the week or two leading up to their periods. For up to 20 percent of women, these PMS symptoms are moderate to severe, and for another 5 percent — symptoms are severe enough to be diagnosed as premenstrual dysphoric disorder (PMDD). No matter how serious your symptoms, if you’re dealing with PMS, you should know that there are many treatment options available that can help.

The choices you make for PMS treatment will depend on the severity of your PMS symptoms, your goals, and your lifestyle. For example, while oral contraceptives are a good option for many women who want to end PMS symptoms, women hoping to become pregnant may want to investigate another treatment. When you seek treatment, it’s a good idea to keep track of your PMS symptoms so you and your doctor can work together to develop the best plan for you.

Medications and Surgery for PMS and PMDD

Many medications can help ease PMS symptoms:

  • Non-steroidal anti-inflammatory drugs (NSAIDS). Over-the-counter pain medications, such as ibuprofen (Advil, Motrin, and others) and naproxen (Aleve and others), may help with headaches, joint aches, breast tenderness, and menstrual cramps.
  • Oral contraceptives. Women who take YAZ (ethinyl estradiol and drospirenone) oral contraceptives for six months or more report a reduction in emotional and physical symptoms before their periods. YAZ is generally prescribed for the more crippling symptoms associated with PMDD. Other types of oral contraceptives have not shown consistent benefits.
  • Antidepressants. Antidepressants are effective in addressing the emotional symptoms of PMS in close to 60 percent of women who take them. Selective serotonin reuptake inhibitors (SSRIs) are the class of drugs shown to be most effective, although other types of antidepressants may also work. Antidepressant medication options include:
    • Prozac (Fluoxetine)
    • Zoloft (Sertraline)
    • Paxil (Paroxetine controlled release)
    • Anafranil (Clomipramine)
    • Lexapro (Escitalopram)
    • Effexor (Venlafaxine extended release)

Some women find that drugs like Xanax (alprazolam) can ease irritability, the most common PMS symptom.

A last resort treatment is the removal of one or both ovaries (oophorectomy). Oophorectomy and hysterectomy (removal of the uterus) are recommended only for women whose symptoms are quite severe and who do not respond to any other treatment approaches.

Treating PMS by Changing Your Behavior

Cognitive behavioral therapy is a style of psychotherapy that helps women identify and change negative thought patterns while reinforcing strong and positive choices. Several studies have shown this style of therapy to be more effective than information-based therapy in controlling PMS symptoms. When researchers compared the PMS experience for women who either received cognitive therapy or were on a waitlist for therapy, they found that those who received therapy reported improved symptoms.

Another proactive remedy for some women is exercise. While studies have not directly linked exercise to PMS relief, it’s good for your overall health to get 30 minutes of aerobic exercise a day to ease depression, anxiety, and, possibly, other PMS symptoms.

Don’t forget about alternative remedies: Yoga, meditation, massage, acupuncture, and other forms of relaxation training have all been shown to ease stress and tension.

If you’re having trouble sleeping — another PMS symptom — exposure to bright light during the day may regulate your body’s melatonin levels. Melatonin is a naturally produced substance necessary for a good night’s sleep.

Lifestyle Changes That May Help PMS

Some women find that changing their diet to focus on higher-quality carbohydrates, such as whole grains, fruits, and vegetables, while cutting out refined sugar and caffeine, improves PMS symptoms. Keep in mind that you may experience cravings for sugary carbs before your period, which will make sticking to this resolution more of a challenge. Certain dietary supplements, such as 1,200 milligrams of calcium per day, may also help ease symptoms.

Women whose PMS brings acne breakouts or other skin changes may want to work with a dermatologist to find the right skin care routine and products for the weeks leading up to their periods. For example, you may want to switch to oil-free products to discourage breakouts.

PMS symptoms can try any woman, but most symptoms can be treated using one or a combination of therapies. If lifestyle changes you make on your own, such as better diet and exercise, don’t solve the problem, work with your doctor to find the most effective PMS treatments for you.

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What to know about premenstrual syndrome (PMS)

Treatment options for PMS vary depending on a person’s specific symptoms.

People can manage PMS symptoms by taking medications, making dietary changes, exercising, trying self-care methods, and making other lifestyle changes.


Taking OTC and prescription medication can help relieve painful symptoms, such as abdominal cramps and headaches.

Examples of medication that people take to treat PMS include:

  • pain relievers such as acetaminophen, which can help relieve muscle pain, cramps, and headaches
  • nonsteroidal anti-inflammatory drugs, which can reduce cramp pain, headaches, and muscle aches
  • diuretics, which can help relieve bloating and breast soreness

For severe PMS symptoms, a doctor may recommend that a person starts taking hormonal birth control pills to reduce PMS symptoms. These drugs work by affecting the levels of estrogen and progesterone in the body.

Speak to a doctor about severe PMS. They may prescribe medications to relieve depression, anxiety, or other mood-related symptoms.

Use relaxation techniques

Share on PinterestGentle exercise, such as walking and stretching, can help ease PMS symptoms.

Managing stress and using relaxation techniques, such as deep breathing or meditation, can help regulate emotional imbalances due to PMS.

Other examples of stress management and relaxation techniques include:

  • yoga
  • tai chi
  • stretching
  • taking a bath
  • going for a walk
  • journaling
  • speaking with a close friend or loved one
  • meeting with a mental health counselor or therapist

Try gentle exercise

Exercising gently can increase estrogen and progesterone levels, which may help reduce PMS symptoms.

A 2018 study involving college-age females found that 1.5 hours of aerobic exercise each week led to improvements in the following physical PMS symptoms:

  • nausea
  • constipation or diarrhea
  • swelling of breasts
  • bloating
  • flushing
  • increased appetite

It is worth noting that uncontrolled external factors, such as sleep patterns, nutrition, and the participants’ living environments, could have affected these results.

In contrast, the results of a 2017 cross-sectional study did not find a significant association between physical activity and improvements in PMS symptoms.

Relieve bloating

Bloating can make a person feel heavy and lethargic. People can reduce PMS-related bloating by:

  • not eating salty foods, which make bloating worse
  • eating potassium-rich foods, such as bananas
  • staying hydrated
  • doing gentle exercise

Learn more about how to relieve menstrual bloating here.

Relieve menstrual cramps

Menstrual cramps usually arise a few days before the period starts and can last for several days. Trying home remedies such as applying heat to the abdomen, doing gentle exercise, trying massage, and using essential oils can help.

Learn more about how to relieve menstrual cramps here.

Eat certain nutrients

Making some dietary changes may reduce mild to moderate PMS symptoms. The following are some examples of nutrients that may help a person manage their PMS symptoms:

  • Magnesium may help relieve migraine episodes related to PMS. Leafy green vegetables, such as kale and spinach, contain magnesium.
  • Fatty acids may help reduce abdominal cramps related to PMS. Good sources include fish, nuts, and green vegetables.
  • Calcium supports bone strength and density. Having adequate calcium levels also helps regulate mood, sleep, and food cravings. A 2017 double-blind trial study reported that college-age females who consumed 500 milligrams of calcium daily for 2 months had significant reductions in depression, anxiety, and water retention related to PMS.

SEVENTY-FIVE PERCENT OF WOMEN SUFFER from headaches, mood swings, bloating, and other problems that threaten their relationships, work life, and well-being.

It’s a statement that most of us unconsciously accept without a second thought. But it doesn’t have to be this way …

It’s true that the symptoms of premenstrual syndrome (PMS), like mood swings, irritability, depression, anxiety, fluid retention, bloating, breast tenderness, sugar cravings, headaches, and sleep disturbances, affect 75 percent of women. And in 20 percent of those women, the symptoms are so severe that they need medical treatment. About 8 percent have such extreme symptoms that the problem has been given a new name: premenstrual dysphoric disorder (PMDD).

But just because you’re a woman doesn’t mean you have to live with these symptoms. The real fact is that suffering related to menstrual cycles is unnecessary — and not caused by bad luck, but by bad habits, environmental toxins, and stress.

Of course, the drug companies don’t want you to know that! So the conventional treatments for PMS range from anti-inflammatory drugs such as Advil or Aleve to birth control pills. And then there are the big guns …

These include prescription medications such as danazol, a drug that suppresses ovulation and causes increased facial hair, acne, and a deep voice. Newer, very expensive drugs called gonadatropin-releasing hormone (GnRH) analogs actually change brain chemistry to turn off the ovaries’ production of estrogen and progesterone — but they also lead to osteoporosis.

Sometimes, diuretics like spironolactone are used to treat fluid retention. A drug called bromocriptine can be used to stop prolactin production and is used to treat breast tenderness.

No wonder the drug companies want you to believe that PMS is inevitable. Recently, they even helped create a new disease — PMDD — and a new indication for a drug whose patent was running out: Prozac (now called Sarafem). What’s wrong with this picture?

It’s based on the assumption that the symptoms of PMS are an inevitable part of being a woman and require “medical intervention” with serious medication to correct them. Nothing could be further from the truth!

To think that 75 percent of women have a design flaw that requires medical treatment to live a normal life is just absurd.

If you are one of the many women that suffer from PMS, you an end your suffering using five simple dietary and lifestyle interventions. I will explain how to do that. But first, I want to tell you a story.

Curing PMDD Without Medications

This is the story of a patient of mine with PMDD who was barely able to work or function in her family — suffering three weeks out of the month. She was 37 years old (many women feel worsening PMS symptoms as they get into their later reproductive years).She was severely depressed, fatigued, and anxious, and suffered severe food and sugar cravings, which led to overeating and weight gain.

The real cause for PMS is simply this: Your hormones become unbalanced, your estrogen levels increase and progesterone levels decrease, either relatively or absolutely.

She also had joint pain, breast tenderness, heavy bleeding, hot flashes, dry skin, acne, hair loss, memory problems, poor sleep, and no sex drive. She also complained of gas and bloating.

What about her diet?

Well, she didn’t drink alcohol, but was a big coffee drinker. And she started the day with a bagel and cheese, ate a cafeteria lunch, snacked on chocolates in the afternoon, and had a healthy dinner but binged later on ice cream, chips, and Cheerios. She also ate a lot of dairy.

Hers is a story that I hear all too often. But the good news is that I was able to give her a simple solution that didn’t involve taking medication.

We know that sugar, caffeine, alcohol, stress, and lack of exercise all contribute to worsening PMS. It is also true that dairy consumption can worsen hormonal imbalances because of all the hormones in milk.

So I had her change her diet, take a few supplements and herbs, and start exercising — and within just one cycle, her life changed. The results were dramatic. All of her symptoms resolved, she lost weight, and dramatically increased her energy. Her mood stabilized and her acne and dry skin cleared up.

The approach I used to treat this patient is part of an approach called systems, or functional medicine. That means that I define the imbalance (in this case, severe hormonal imbalances), address the causes (diet and lifestyle), and then help the body repair and regain balance. Once this is done, the body’s natural intelligence takes care of the rest.

So what is the REAL underlying cause of PMS?

The Real Causes of PMS

The real cause for PMS is simply this: Your hormones become unbalanced, your estrogen levels increase and progesterone levels decrease, either relatively or absolutely.

There are many things that promote these hormone imbalances, such as a high-sugar, refined carbohydrate diet, caffeine, stress, dairy, hormones in dairy products and meat, and estrogen-like toxins from pesticides and pollution. Alcohol also contributes to problems because it damages the liver and prevents it from excreting excess estrogen.

Constipation and imbalances in the gut bacteria can worsen the situation, because they lead to the reabsorption of estrogen from the gut back into your blood, even after your liver has tried to get rid of it.

Your body also needs exercise to help balance hormones. So if you aren’t moving your body enough, it’s likely this is part of the problem as well.

Fortunately, good research shows that there many ways to get hormones back in balance — without drugs. Here’s my plan for preventing PMS and PMDD. Even though some of my suggestions may seem severe, science shows that they work. Give them a try and you will see in just one or two cycles how much better you feel.

5 Simple Steps to Eliminate PMS

1. Clean up your diet.

This means:

  • Stop eating refined flour, sugar, and processed foods.
  • Cut out caffeine.
  • Stop drinking alcohol.
  • Balance your blood sugar by eating protein, such as a protein shake, eggs, and nut butters, for breakfast.
  • Eat evenly throughout the day and don’t skip meals.
  • Don’t eat within three hours of bedtime.
  • Cut out all dairy and consider eliminating other common allergens for a few months, especially gluten.
  • Increase fiber in your diet from vegetables, fruit, nuts, seeds, beans, and whole grains. Two tablespoons of ground flax seeds a day are especially helpful in correcting constipation and balancing hormones. Put them in a shake or sprinkle them on salads or food.
  • Increase omega-3 fats by eating more wild fish like sardines, herring, and wild salmon, as well as omega-3 eggs and walnuts.
  • Eat organic food, especially animal products, to avoid environmental estrogens from pesticides.

2. Take supplements.

A number of supplements have been shown to help ease PMS symptoms by improving metabolic function and hormone metabolism. Here are the superstars:

  • Magnesium citrate or glycinate — Take 400 to 600 mg a day.
  • Calcium citrate — Take 600 mg a day.
  • Vitamin B6 — Take 50 to 100 mg a day along with 800 mcg of folate and 1,000 mcg of vitamin B12.
  • Evening primrose oil — Take two 500mg capsules twice a day.
  • EPA/DHA (omega 3 fats) — Take 1,000 mg once or twice a day.
  • Taurine — Take 500 mg a day to help liver detoxification.
  • A good daily multivitamin (all the nutrients work together)

Herbs and phytonutrients can also be very helpful. Here are the best studied and most effective:

  • Chasteberry fruit extract (Vitex Agnus-astus) can help balance the hormones released by the pituitary gland that control your overall hormone function. Studies of over 5,000 women have found it effective. Take 100 mg twice a day of a 10:1 extract.
  • Wild yam (Dioscorea villosa) and cramp bark (Viburum opulus) can help regulate cycles and relieve menstrual cramps.
  • Dandelion root can help with liver detoxification and works as a diuretic.
  • Isoflavones from soy, red clover, or kudzu root improve estrogen detoxification by boosting the activity of specific detox enzymes. They can be taken as supplements or consumed in the diet.
  • Flax seeds contain lignans that help balance hormone metabolism and block the negative effects of excess estrogens.
  • Chinese herbal formulas may also help. One of the most effective is Xiao Yao San, or Rambling Powder. It contains: Bupleurum Root (Bupleurum chinense), Chinese Peony Root (Paeonia lactiflora), Dong Quai Root (Angelica sinensis), Bai-Zhu Atractylodes Root (Atractylodes macrocephala), Poria Sclerotium (Poria cocos), Ginger Rhizome (Zingiber officinale), Chinese Licorice Root (Glycyrrhiza uralensis),and Chinese Mint Leaf (Mentha haplocalyx)
  • Replacing healthy bacteria in the gut also helps normalize estrogen and hormone metabolism. Take 5 to 10 billion live organisms in a daily probiotic supplement.
  • For intractable cases, I will occasionally use topical, natural bioidentical progesterone in the last two weeks of the menstrual cycle. The usual dose is 1/2 tsp (20 to 40 mg) applied at night to thin skin areas for the last two weeks of the menstrual cycle.

3. Get moving.

Exercise is very important for balancing hormones. Aim for 30 minutes of aerobic exercise, 4 to 5 times a week.

4. Address stress.

Dealing with stress is also critical. Take a hot bath at night, get a massage, try yoga, learn deep breathing or meditation. These techniques and others can help balance hormones.

5. Try alternative therapies.

Therapies such as acupuncture and homeopathy may help. One clinical trial showed that individualized homeopathy is effective in treating PMS. Five homeopathic medicines were used: Lachesis, Natrum muriaticum, Nux vomica, Pulsatilla, and Sepia.

If my patients are any indication, a plan such as this can have impressive effects on premenstrual symptoms.

Remember, women are not defective. You can thrive and be healthy by paying attention to a few natural laws of biology. You don’t need drugs to survive!

Menstrual Pain Relief: Natural PMS Remedies & Tips

  • Menstruation
  • January 13th, 2020
  • by Sarah Wander

It’s estimated that women have 451 menstrual cycles during their lifetime. That’s almost 35 years that half the population must endure and navigate the menstrual cycle landscape of constant mood swings, period cramping, bloating, breast pain, menstrual headaches, and hormonal acne. Some women have these period cramps and pains worse than others, but almost every woman experiences some sort of monthly menstrual-related discomfort. And even with the prevalence of menstruation, only recently, and only in some parts of the world, has it become a bit less taboo. The stigma around periods is likely a huge contributor to the lack of information around and resources for menstrual pain relief.

So, what is out there to help us get through these Shark Week pains? Midol always comes to mind. And of course, there are hot pads, teas, suppositories, and other over-the-counter painkillers for menstrual pain relief. But here are a couple of natural PMS remedies and things to keep in mind that I’ve learned throughout my own menstrual journey.

Menstruation Tips & Tricks

Keep Track

This is key! Make sure you are aware of when your period is expected to arrive so you can plan and prepare accordingly. I should have started doing this years ago. I would get super irritable and start seeing a couple pimples, and then finally, it dawned on me—I’m about to start my period. If I know my period is coming on or around a specific day, I can plan work meetings and social gatherings so that I don’t have to be dealing with fluctuating hormones and period cramps during these important times. There are many good apps out there that can help you do this. The app that I use to track my period is Flo. Flo is also a great tool to use while trying to get pregnant and during pregnancy.

Eat a Nutritious Diet

Being conscious of what you are putting in your body is much more proactive and effective than eating an unbalanced diet and trying to fix it later with medications and even exercise (although exercise is always good, too!). However, don’t be afraid of giving into some cravings or all your well-balanced eating might give way to binging on your favorite chocolatey treats. A little ice cream or some chips and dip may give you a much-needed mood boost! But it’s all about balance.


Exercising releases the naturally occurring endorphins in our body and can improve our overall mood. This is so important in warding off those feelings of anxiety, depression, and fatigue before and during your period. While exerting yourself physically might be the last thing you feel like doing while you’re battling PMS, you’re bound to feel rejuvenated coming out of your favorite workout class.

Assess Underlying Conditions for Mood Swings

Not all hormonal fluctuations and mood swings are related to PMS and menstruation. If your mood swings are severe or if you constantly feel anxious, depressed, or tired, there may be something else going on. These feelings could be from a chemical imbalance in your body or related to negative life situations.

Over-the-Counter Menstrual Pain Relief, Heating Pads, TENS

Midol, Tylenol, Ibuprofen, Advil

There are quite a few over-the-counter options to help address period cramping, bloating, and headaches. Probably the most well-known is Midol. In an Extra Strength Menstrual Midol Complete caplet, the three active ingredients are Acetaminophen (the active ingredient in Tylenol), Pyrilamine Maleate, and caffeine. Acetaminophen provides menstrual pain relief. Pyrilamine Maleate is an antihistamine and diuretic, which helps to alleviate water retention. Caffeine is used to reduce bloating and fatigue.

External Applications

Maybe one of the most natural PMS remedies and immediate means to get menstrual pain relief is by using an externally applied device. A heating pad is a great way to relax your uterine muscles which increases blood flow to the area, reducing period cramp pain. Another device you can try is a TENS (transcutaneous electrical nerve stimulation) unit which sends electrical currents via electrodes that are placed on the skin. This stimulates the nerves in the area needing relief, which keeps pain signals from reaching the brain. And always remember that the kind of tampons and pads we use during our periods can affect how we feel as well. So look for certified organic cotton tampons free of chemicals, pesticides or toxins.

Natural PMS Remedies: CBD + 4 magical supplements


Some believe hemp CBD to be the newest effective natural PMS remedy for menstrual pain relief to hit the market, but cannabis has been used for menstrual maladies for centuries. CBD is an abbreviation for a compound called cannabidiol. This compound is naturally found in the hemp plant. Along with 113 other active compounds, CBD is grouped under an umbrella term called cannabinoids. CBD does not produce a high or cause any psychoactive effects. Instead, CBD is a therapeutic compound that helps your body achieve a natural balance by protecting your body’s endocannabinoid system. Hemp CBD has been reported to help restore your hormonal balance, minimize changes in mood, and reduce inflammation, all helping you ease those monthly menstrual pains. You can administer CBD either topically via tinctures and creams, intravaginally via suppositories, or orally via ingestible capsules.


In addition to relaxing uterine muscles and aiding in quality sleep, magnesium may also reduce anxiety and hormonal acne by impacting the production of cortisol in your body. It has been shown to work best for PMS relief when used in combination with Vitamin B6.

B-6 Vitamin

B-6 is beneficial for a wide range of ailments related to brain development and keeping the nervous and immune system healthy. But it can also address quite a few discomforts which can help with menstrual pain relief. B-6 may help alleviate breast soreness by increasing progesterone. It can also act as a mood enhancer and hormone stabilizer by regulating serotonin levels which reduces food cravings and back pain caused by hormonal fluctuations.

Cramp Bark

Well, you guessed it, as the name suggests, this herb targets period cramps. It has historically been used by Native Americans for a wide range of illnesses, including inflammation of the uterus. It may help block spasms of the smooth muscle in the uterus, reducing PMS and endometriosis-related discomfort. It has also been used to reduce migraines and fluid retention (aka period bloat)!

Green Tea

Many PMS products include caffeine to help fight fatigue. But having an all-natural caffeine ingredient such as green tea is good for more than just energy. It helps curb any coffee cravings, which you should try to avoid while menstruating as coffee and cramping are not a good duo! Green tea is also high in theanine, which has been found to relax muscles, including those found in your nervous system, thereby decreasing some mood swings associated with PMS. In addition, green tea is loaded with antioxidants, which help keep you hydrated and have been reported to have anti-inflammatory and antimicrobial effects. These can respectively reduce period cramps and period acne.

ALLEVITA – Natural Menstrual and PMS Relief

But what about an all-natural menstrual pain relief support system that addresses all the various menstrual symptoms in an easy-to-take capsule? Not to mention affordable! Enter, Allevita.

As the founder of Allevita, my mission was not only to create a product for this hole in the market but, in doing so, educate and support other women. Like a lot of women, I had been on birth control for a large portion of my menstruating life. I wanted to start a family, so I got off the Pill after being on it for almost 15 years. I had forgotten how horrible PMS pains can be and while my body was trying to regulate itself again, my hormones were insane. When I searched the market for an all-encompassing natural PMS relief remedy, the options for menstrual pain relief were limited.

With this natural PMS remedy and support supplement I hope to offer women an effective tool to help them have more control over their bodies and hormones so that Aunt Flow doesn’t ruin another family gathering, business trip, or turn your best friend’s wedding into the red wedding…

Learn more about our ingredients and try out the best natural PMS relief system to hit the market. We hope it brings you the menstrual pain relief it has brought us here at Allevita!

A Monthly Experience Unlike Any Other. Shop Cora.

Premenstrual Dysphoric Disorder (PMDD)

US Pharm. 2011;36(5):12-19.

Female patients may approach the pharmacist with questions about treatment of menstrual problems. The only conditions that are amenable to self-treatment are premenstrual syndrome and primary dysmenorrhea.1 Other concerns must be referred.

Premenstrual Syndrome (PMS)

PMS is the term applied to a rather comprehensive list of psychological and somatic problems affecting the emotions and the body.1,2-4 To qualify as PMS, these symptoms must occur during the premenstrual days of the cycle and typically cease following onset of the menstrual flow.

Prevalence of PMS: PMS is experienced by at least 75% to 85% of females who have menstrual flow.1,5,6 Approximately 31% to 61% of adolescents have the condition.3,4

Epidemiology of PMS: PMS is more common in females aged from the late 20s to the early 40s.5 Symptom severity often worsens during the late 30s to 40s as menopause approaches. PMS is less common in those who have never been pregnant. Certain mental disorders increase the risk, such as a personal or family history of major depressive disorder, postpartum depression, or any affective mood disorder (e.g., seasonal affective disorder).5

Manifestations of PMS: Symptoms include a lengthy list of problems, which often vary greatly from patient to patient and from cycle to cycle in the same patient.5-7 Some involve emotional states, such as depression, crying spells, feelings of sadness or hopelessness, a tense or irritable feeling, edginess, anxiety, difficulty in handling stressful situations, and mood swings. The woman may exhibit overt hostility and aggression, displaying outbursts of anger directed at herself or others. She may experience confusion, difficulty in concentrating, forgetfulness, impaired judgment, and memory lapses. Lights and noises may cause discomfort. She may feel tired or fatigued, and her movements may alter to become slow, sluggish or lethargic; these changes can result in an abnormal clumsiness in carrying out routine tasks, whether they are new or have previously been mastered. She may experience lowered self-image, feelings of guilt, and increased fears. Some women report difficulty in sleeping; others sleep to excess.6

The woman may notice problems related to water retention, such as edema of the hands and feet, weight gain, and swelling and/or tenderness of the breasts. Gastrointestinal (GI) problems such as upset stomach, abdominal fullness, bloating, and constipation or diarrhea may arise. Unusual hunger may result in food cravings. The sex drive can be increased or decreased. Discomfort includes headache, joint and muscle pain, and backache. Acne can appear or existing acne can worsen. Women are advised to keep a calendar with a list of symptoms and the days they were present so it can be taken to her physician to assist in PMS diagnosis.6

PMDD is a diagnosis applied to approximately 3% to 8% of females who have a more severe version of PMS.6,8,9 Some symptoms overlap with PMS, such as bloating, breast tenderness, headaches, muscle/joint pain, trouble sleeping, tiredness/low energy, food cravings/binge eating, trouble thinking/focusing, mood swings, frequent crying, tension, and anxiety.8 Others go beyond simple PMS, such as feelings of sadness or despair so intense that they may invoke suicidality, lasting irritability or anger that affects others, lack of interest in normal daily activities and relationships, and feeling out of control. If five or more of the above are present, PMDD is diagnosed (TABLE 1).8 Symptoms begin the week prior to onset of the menstrual flow and remit with the beginning of the flow.


Dysmenorrhea refers to discomfort that begins several days before or at the onset of menstrual flow.10

Prevalence: Perhaps 90% of adolescents suffer from dysmenorrhea.11 It is the most common cause of lost time from school and work in women aged in their teens or 20s.10

Epidemiology: Dysmenorrhea is most common in younger patients. Due to a lower occurrence with aging, the overall prevalence is 25%.11 There are no racial epidemiologic differences in the occurrence of dysmenorrhea.11 However, smoking, obesity, and a positive family history of the condition all increase the risk of dysmenorrhea.11

Manifestations: The pain of dysmenorrhea includes cramping pain in the lower abdominal area, a sharp intermittent pain, aching pain, or back pain.10 The discomfort tends to remit as menstrual flow decreases.

Primary Versus Secondary: Primary dysmenorrhea is the only self-treatable subtype. It refers to menstrual discomfort that is not due to any underlying condition. It typically begins within a short time after the female’s first menstrual period, particularly after her body has established a regular menstrual cycle.11 The cause is hypothesized to be prostaglandin-induced uterine contractions forcing menstrual discharge through the cervical os.1,10 As the female ages and has children, the cervical opening enlarges, easing expulsion and reducing the incidence of cramps.

Secondary dysmenorrhea is caused by an underlying condition. It often develops in women in their later 20s or 30s who have not had menstrual discomfort for years. It can be caused by endometriosis, uterine fibroids (leiomyomata), adenomyosis, ovarian cysts, pelvic inflammatory disease, sexually transmitted disease, or a copper-containing intrauterine device.10,11 Clues to secondary dysmenorrhea include the following: pain that is sudden or severe or occurs at times other than menstruation (e.g., midcycle, during ovulation), pain that begins more than 5 days preperiod, pain that continues after the period is over, pain during defecation, presence of fever or other symptoms, infertility, dyspareunia, foul-smelling or excessive vaginal discharge, or passing of blood clots.1,10,11 If the pharmacist suspects at any time during the counseling session that the woman has secondary dysmenorrhea, she must be referred to her physician at once.1

Nonprescription Products

Nonprescription products may provide relief for patients with mild-to-moderate symptoms of PMS or primary dysmenorrhea. All FDA-approved nonprescription analgesics are approved for the pain and/or cramping of PMS and primary dysmenorrhea.1,11 NSAIDs (e.g., ibuprofen, naproxen) are a more logical choice for dysmenorrheal cramping than acetaminophen due to their ability to inhibit prostaglandin.11 However, acetaminophen may be useful for PMS-related discomfort and also for the extrauterine discomforts associate with dysmenorrhea. Single-entity ibuprofen products include Advil, Motrin IB, and Midol Liquid Gels. Single-entity naproxen products include Aleve, Midol Extended Relief, and Pamprin All Day Relief.

Heat can be applied to the lower abdomen to ease dysmenorrheal cramping.10 Heating pads or therapeutic heat wraps (e.g., ThermaCare Menstrual) can be recommended.1 Therapeutic heat wraps placed over the abdomen are more effective for dysmenorrheal cramping than placebo, acetaminophen, and ibuprofen.1

Diuretics are also safe and effective for relieving temporary water weight gain, bloating, swelling, and the full feeling that can often accompany PMS.1 They have little role in dysmenorrhea. The only diuretic commonly included in products sold for premenstrual syndrome is pamabrom, a safe and effective xanthine derivative. Single-entity pamabrom tablets include Aqua-Ban, Diurex Aquagels, and Diurex Water Capsules. The dose is 50 mg four times daily, up to a maximum of 200 mg daily.1

Pyrilamine is an antihistamine often included in menstrual products. It is alleged to provide relief of emotional or mood changes (e.g., anxiety, nervous tension, irritability), reduce water-retention symptoms, and reduce severity of cramps and backache.1 However, it is not yet proven to be safe and effective for any menstrual symptom.1 It also carries the risk of drowsiness. Until the FDA approves studies demonstrating its safety and efficacy, products containing pyrilamine should be avoided. They include Premsyn pms, Pamprin Multi-Symptom, Diurex PMS, and Midol Complete.

If the patient has found little relief from nonprescription products, she should be referred to a physician. Oral contraceptives reduce the frequency of cramps and headaches and may lighten flow.5 Selective serotonin reuptake inhibitors (e.g., sertraline, fluoxetine, paroxetine) may provide relief of PMDD. Beyaz and Yaz are oral contraceptives that are FDA-approved to treat PMDD.12

Conditions to Refer

Older women may ask for relief of the symptoms of menopause. No nonprescription product is known to be safe or effective for these symptoms. An example is Rejuvex, which claimed to “support menopausal comfort.” This essentially meaningless phrase was never evaluated by the FDA and the product was not known to be safe and effective for any menopausal symptom. Its unproven formula included boron and dong quai.13 Currently, it appears to be unavailable, although its former widespread availability may have spawned imitators.

Parents may express worries about their daughter’s menstrual flow. They may be concerned that it has ceased. There are several reasons for this. The young woman may be pregnant, engaging in long-distance running, or have a serious medical condition. Parents may also be concerned that their daughter’s first period has not begun at the expected time. The patient may have an imperforate hymen or a serious glandular condition. These patients should be seen by a physician.


There are some steps you can take to lessen the impact of PMS and dysmenorrhea on your life, including simple lifestyle adjustments and the use of nonprescription products.

Lifestyle Changes for PMS

The first step to managing the discomfort of PMS is to pay attention to simple, healthy lifestyle choices. Many women with mild symptoms improve markedly with these interventions. You should drink lots of fluid to help reduce the bloated feeling, lessen water that your body retains, and improve breast tenderness. However, the best fluids are water or juices. Soft drinks are not recommended, especially those with caffeine. Rather than two or three large meals, you should eat frequent small meals, with no more than 3 hours between meals or snacks. Increase the amount of complex carbohydrates (as found in whole grains, cereals, breads, pasta, vegetables, and fruit) in your diet. Avoid eating too much. Many women find that a low-salt diet is helpful, but it is best to check with your physician before beginning this on your own.

You should set the goal of avoiding caffeine, alcohol, and simple sugars (e.g., candy, soda). Stop use of all tobacco products, as smoking worsens PMS.

You should engage in regular, aerobic exercise each day of the month. A good weekly goal is: 1) 2.5 hours of moderate to intense physical activity, and 2) 75 minutes of vigorous-intensity aerobic physical activity. You may choose to combine the moderate and vigorous activities and add muscle-strengthening exercises on two or more days.

Try to get 8 hours of sleep each night. Learn healthy sleep habits and sleep hygiene steps to control insomnia before taking medications.

Contact a health provider if these simple steps do not cause the symptoms to disappear, or if your symptoms are so severe that your ability to carry out normal activities is limited. You could be experiencing premenstrual dysphoric disorder (PMDD), which is a more severe form of PMS and includes symptoms such as depression, irritability, and tension before menstruation.

PMS Medications

If the lifestyle changes are not helpful, you may choose to try nonprescription products. You may find pain relievers will provide relief from backache, headache, and muscle and joint pains. Ibuprofen (e.g., Advil, Motrin IB) and naproxen (e.g., Aleve) are good choices. Naproxen has a longer duration of action than ibuprofen. Ibuprofen tablets must usually be repeated every 4 to 6 hours (check the dosing frequency on your product’s label), while naproxen tablets are repeated only every 8 to 12 hours. These products can also help alleviate the pain of menstrual cramping.

You may also choose a diuretic to draw out excess fluid, treating breast tenderness and swelling of the feet. Products with pamabrom in the formula are safe and effective for removing excess fluid. They include Aqua-Ban and Diurex Aquagels. Follow all dosing directions for these products.

If nonprescription medications do not help relieve symptoms, you may need to see a physician for treatment with oral contraceptives or antidepressants.

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“Because over-the-counter painkillers are easy to get, they’re easy to abuse, and that makes them dangerous,” Dr. Sackheim says. In the worst-case scenario, this could land you in a major surgery or even threaten your life. It doesn’t help that most people can’t tell the difference between ibuprofen and acetaminophen if their lives depended on it (which it sort of does). So, first things first:

Krystalina Tom

Acetaminophen vs. Every Other Common Pain Killer

If you remember one thing, let it be the difference between acetaminophen (aka Tylenol) and other common pain relievers. Acetaminophen poses special risks because it’s broken down by and can seriously damage your liver, a vital organ that filters out toxins including alcohol. You should never, ever chase acetaminophen with booze, which could stress out of the liver and contribute to irreversible damage.

That said, there is a time and place for acetaminophen, which targets the areas of the brain responsible for processing pain and body temperature. But Dr. Sackheim warns that acetaminophen isn’t quite as effective as NSAIDs at treating period cramps. (NSAIDs, or nonsteroidal anti-inflammatory drugs, are all over-the-counter painkillers other than acetaminophen.) Acetominophen doesn’t mess with your stomach, so it’s suitable for treating period cramps accompanied by an upset stomach, which can go hand in hand with PMS because life isn’t fair. Just mind your dosage (no more than two pills every six hours as needed, and no more than six pills per day).

Apart from cramps, if you’re suffering from a fever, taking acetaminophen as directed will do you a solid. But it won’t reduce inflammation in, say, a sprained ankle.

What You Need to Know About NSAIDs

NSAIDs provide relief by chilling out the nerve endings that process pain. NSAIDs include ibuprofen (found in Advil and Motrin), naproxen (found in Aleve), celecoxib (aka Celebrex), and aspirin. They don’t include acetominophen or multiple-symptom medications that contain it, like DayQuil, Midol, and Excedrin.

Unlike acetaminophen, NSAIDs reduce inflammation to reduce joint and muscle pain. And because NSAIDs are metabolized by the kidneys, they pose no risks to the liver whatsoever.

That said, NSAIDs can suppress an enzyme that protects the lining of the stomach, potentially triggering acid reflux, general stomach upset, and internal bleeding. It’s one reason why you shouldn’t drink alcohol, another stomach irritant, before or after taking any OTC painkiller. NSAIDs also thin your blood, which slows blood clotting and reduces the risk of heart attack and stroke. (It’s not a bad perk regardless of whether these conditions are top of mind.)

So, What Should You Take?

Krystalina Tom

The American College of Obstetricians and Gynecologists (ACOG) says NSAIDs are the best defense against painful cramps. (Another bonus: Some studies have found these drugs can actually lighten super-heavy bleeding better than placebo — just not as well as hormonal birth control, so don’t get too excited.)

Among your NSAID options:

  • Aspirin is most likely to irritate your stomach and won’t necessarily do the trick when the struggle is real: “A lot of patients tell me that ibuprofen or naproxen works better than aspirin for period cramps,” Dr. Sackheim says. In other words, it’s far from your best option.
  • Ibuprofen can effectively put you out of your misery, assuming your kidneys are fully functioning and you don’t have a particularly sensitive stomach. Just be sure to take it with food to prevent any issues.
  • Naproxen, like ibuprofen, is considered highly effective. Because naproxen can provide some sweet relief that’s longer lasting than other over-the-counter anti-inflammatories, it’s particularly good for cramps that last all freaking day, according to Dr. Sackheim.
  • Celecoxib is the drug you’ve probably never heard of since it’s typically associated with arthritis relief and available only by prescription. But if your PMS tends to trigger cramps and While taking too much celecoxib (i.e., multiple doses every day of the month) can ultimately cause stomach ulcers too, the formula is less likely than other NSAIDs to block enzymes protecting your stomach. It’s why celecoxib generally goes easier on your insides — a good thing at the onset of your period, when your body often needs some extra TLC.

And as for acetaminophen:

  • Acetaminophen can certainly help with cramps if you find yourself in pain in a place where acetaminophen’s the only option or have a super sensitive stomach. But don’t even if you plan on drinking. “Medically speaking it is best not to take any medications when drinking alcohol,” Dr. Sackheim says. But if it’s absolutely necessary to drink and treat cramps with medicine (i.e., it’s girls’ night out and you’ve tried alternative remedies, like heating pads and exercise and self massage, to no avail), it’s better to take a low-dose NSAID, like an ibuprofen a few hours before ingesting alcohol. The only exception is when you’re dealing with chronic health issues, including high blood pressure, in which case talk to your doctor.

And then there’s always the stronger stuff:

  • Prescription opioids could be your ticket to sweet relief if acetaminophen and most NSAIDs typically upset your stomach, but your cramps are no joke. If hormonal birth control, which can make periods less painful, isn’t an option, Dr. Sackheim might recommend a prescription opioid painkiller. “Everything you put into your body has a risk and a benefit,” she says, of their addictive nature. “If taken appropriately, taking one to two stronger pills a month is safer for the kidneys and liver than taking 30 Advil.” (That said, for the average person with no existing kidney or liver issues, it’s no big deal to take any NSAID a couple times a month.)


If you end up treating cramps with whatever’s sitting in your medicine cabinet out of laziness or desperation, be sure to use it only on an as-needed basis as opposed to prophylactically. In other words, if the bottle’s directions say to take one dose every six to eight hours as needed, that doesn’t mean you should be taking pills that often, lest you damage your insides. “If you’re really not feeling well six to eight hours later, you’re allowed to take them,” Dr. Sackheim clarifies. Another thing: Make note of what you’ve taken. Otherwise, “if you have side effects, you won’t know what caused them, and if you feel better, you want to know what helped,” she says.

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Elizabeth Narins Senior fitness and health editor Elizabeth Narins is a Brooklyn, NY-based writer and a former senior editor at Cosmopolitan.com, where she wrote about fitness, health, and more.

Premenstrual syndrome (PMS)


In the days leading up to your period, do you have bloating, moodiness, or some other feelings that you’d rather avoid? If so, you are not alone. Many women have uncomfortable feelings starting a week or two before their period that usually stop when their period starts. These feelings can be mild or severe.

Symptoms of PMS are often a normal part of having your period. Doctors generally consider such feelings PMS if they happen month after month and they interfere with some part of your life.

Keep reading to learn more about PMS. You can read about:

  • PMS symptoms
  • What causes PMS?
  • Steps to help with PMS
  • Medications for PMS

PMS symptoms top

You may have some emotional and physical symptoms from PMS. See the chart below for some examples.

Emotional changes Physical changes
  • Crying spells
  • Depression
  • Feeling tense or anxious
  • Feeling crabby
  • Angry outbursts
  • Having mood swings
  • Trouble focusing
  • Wanting to be alone more
  • Constipation and other digestive symptoms
  • Hunger and food cravings
  • Being tired
  • Headaches
  • Aches and pains
  • Breast tenderness
  • Trouble sleeping
  • Swollen hands or feet
  • Bloating or weight gain

What causes PMS? top

No one knows for sure what causes PMS, but it seems to be linked to the changes in hormone levels that happen during your menstrual cycle. PMS is not caused by anxiety or depression. They can make your PMS symptoms worse, though, and your PMS can make these conditions worse, too.

Steps to help with PMS top

There are many steps you can take to help you feel better. You may need to try different things to figure out what works for you. Your doctor can offer some suggestions.

Consider these tips for dealing with PMS:

  • Eat a healthy diet, including foods high in calcium (such as low-fat dairy products), fruits, vegetables, and complex carbohydrates (found in whole grain breads, pasta, and cereals).
  • Stay away from salt the few days before your period to help with bloating.
  • Drink less caffeine (found in soda, tea, and coffee) to feel less crabby and help ease breast soreness.
  • Eat small, frequent meals rather than fewer, big ones.
  • Make sure you are getting enough physical activity every day (and not just during your period).
  • Make sure to get enough sleep. Try to go to bed and get up the same time each day.

You may have heard that vitamins and other pills such as vitamin B6, vitamin E, magnesium, and calcium can help relieve PMS. It’s important that you talk to your doctor before trying any supplements or herbal treatments.

Medications for PMS top

If you are having symptoms of PMS, let your doctor know. There is no cure for PMS, but your doctor can help with the symptoms. In addition to changes in your diet and exercise, he or she may suggest medicines.

Many medicines for menstrual cramps are over-the-counter, so you can buy them without a doctor’s prescription (order). These include pain relievers that have ibuprofen (say: eye-byoo-PROH-fen) and naproxen (say: nuh-PROK-sen). You should talk to your parents/guardians and doctor before taking these. For some medicines, you will need a doctor’s prescription.

Your doctor may suggest diuretics (say: deye-yoo-RET-ihks), which help your body get rid of extra fluid. This can help with symptoms like bloating and breast soreness.

Sometimes, a doctor will suggest birth control pills to help with hormones that can affect PMS.

If you’re having strong emotional symptoms, a doctor may also suggest medicines that treat anxiety or depression, such as antidepressants. It can help to talk about your emotions and get support from your family and friends.

Content last reviewed April 15, 2014
Page last updated June 13, 2014


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