Up to 85% of women normally have one or more troubling physical and emotional symptoms between the time they ovulate and the first days of their menstrual period.¹ These are called premenstrual symptoms. When premenstrual symptoms interfere with your relationships or responsibilities, they are called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), a severe form of PMS.

Although PMS cannot be cured, you do have a number of lifestyle and medication choices that can reduce your symptoms and improve your quality of life.

Basic PMS treatment

Experts recommend that all women with PMS start by keeping a menstrual diary, making lifestyle changes, and using home treatment measures.⁴ After a few menstrual cycles, you should notice some improvement in symptoms. Whether or not you then decide to add medication treatment, be sure to continue helping your body weather its premenstrual days by:

• Taking daily calcium [1200 mg] and vitamin B6 [50 mg to 100 mg]. Both of these nutrients affect the hormone-producing endocrine system. Calcium is strongly linked to PMS symptoms and relief.⁵ Although research and expert opinions are mixed, daily vitamin B6 is thought to improve PMS depression and physical symptoms.⁹
• Reducing your caffeine, refined sugar, and sodium intake, at least during the premenstrual phase of your cycle. These substances are linked to emotional and physical PMS symptoms, such as insomnia, tension and anxiety, food cravings, pain, and bloating.⁵
• Getting regular exercise. Exercise is proven to reduce depression.⁵ Women often report that exercise helps relieve tension, pain, and mood-related PMS symptoms.
• Reducing stress. While stress is not a cause of PMS, it may make your symptoms worse. In turn, coping with stress can be more difficult during the premenstrual period.⁴
• Using nonprescription medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), for headache, joint or muscle pain, or cramps. NSAIDs work best when taken before and continued at regular dosage intervals throughout the premenstrual pain period. For some women, this continues into the first days of menstrual bleeding, to relieve painful cramps.

See an example of a menstrual diary(What is a PDF document?).

Additional treatments for PMS

If you still have moderate to severe symptoms after two or three cycles of healthy lifestyle and home treatment measures, talk your health professional about further treatment options. Consider the following for specific symptoms.

All physical and mood-related symptoms

The selective serotonin reuptake inhibitor (SSRI) class of antidepressants is often the first-choice medication for moderate to severe premenstrual symptoms, including aggression, depression, anxiety, and physical symptoms. Most women gain relief by taking an SSRI either continuously or only during their premenstrual days.¹⁰ If you try an SSRI but find it ineffective, it's a good idea to try another type of SSRI before moving on to another class of medication. For more information, see:

Should I try an SSRI medication for PMS symptoms?