PMS Health Center

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Bloating or breast tenderness

• Spironolactone. Taken during the premenstrual phase, this diuretic can relieve bloating and breast tenderness.
• Drospirenone, in the birth control pill called YAZ or Yasmin, acts like spironolactone. It relieves bloating, breast tenderness.
• Daily vitamin E (400 IU), taken during the premenstrual phase, may help with breast tenderness.
• Evening primrose oil contains essential fatty acids that may offer mild relief of some PMS symptoms for some women.

For more information about complementary, alternative, and supplement therapies for PMS, see the Other Treatment section of this topic.

Other hormonal, sedative, or surgical treatments for severe PMS

The goal of hormonal and surgical treatments is to stop a part of the hormonal (endocrine) system that is linked to premenstrual symptoms. These treatments are not commonly used to treat PMS symptoms, either because they are now known to be ineffective or because they have severe side effects.

• Birth control pills (estrogen-progestin) are widely prescribed for PMS, but they do not always relieve PMS. Although they may improve bloating, headache, abdominal pain, and breast tenderness for some women, other women report that they have worse symptoms or they develop mood problems. Birth control pills are known to be ineffective for treating mood symptoms. Estrogen alone may offer some benefit for some women, but when taken without progestin, it increases the risk of uterine (endometrial) cancer.
• Progestin has been used in the past for PMS, but for some women, it may make physical and emotional symptoms worse.
• Danazol is a synthetic male hormone that can relieve breast pain by decreasing estrogen production. It isn't often prescribed.
• Benzodiazepine treatment with alprazolam is occasionally used for PMS-related anxiety. It depresses the central nervous system, loses effectiveness over time, and can be addictive. Because long-term use can be complicated by withdrawal and life-threatening symptoms, this medicine is only recommended for a few days' use when other treatments have been ineffective.
• Gonadotropin-releasing hormone agonists (GnRH-a) are a last-resort treatment for severe PMDD symptoms. This medicine stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.
• Surgery to remove the ovaries (oophorectomy) is a rarely used, controversial treatment, because it irreversibly causes early menopause. Menopause symptoms caused by surgery, such as hot flashes, depression, and insomnia, are often more severe than those of natural menopause.

What to think about

No single therapy is effective for all women. You and your health professional may have to try more than one type of treatment before finding the right choice for you.