Dr Rigotti's Advice
I generally recommend that a woman suffering from PMS start by paying attention to lifestyle factors. Women spend much of their lives caring for others and need to be reminded how important it is for them to take extra care of themselves, particularly at the time of the month when they feel most vulnerable.
This means simple things like getting regular aerobic exercise; avoiding caffeine, alcohol, salt, and concentrated sweets; eating frequent small meals instead of a few large meals a day; and practicing stress reduction techniques such as the relaxation response. Adding a supplement such as vitamin B6 to their diet also helps some women.
If several months of following these steps are not enough to control symptoms, I usually recommend trying an SSRI (selective serotonin reuptake inhibitor)type antidepressant medication as the next step. There is clear evidence that these drugs help, especially with mood swings and other psychological symptoms that are often the most troublesome.
Nancy Rigotti, MD
Massachusetts General Hospital
Harvard Medical School