Premenstrual Syndrome: Drug Therapy

Therapeutic target

Improvement of symptoms and thus increase in well-being.

Therapy recommendations

  • According to the diverse symptomatology of premenstrual syndrome (PMS), there are a variety of different therapeutic measures:
    • Estrogen-progestin combinations (drospirenone (progestin) first-line agent).
    • Selective serotonin reuptake inhibitors (application: second half of the cycle or only on the days of discomfort or also as continuous therapy).
    • Aldosterone antagonists (for diuresis; onset of action only after one to two days).
    • GnRH analogues (therapy of last choice).
  • Therapy of menstrual migraine (migraine without aura, whose attacks occur in at least two of three cycles in the days around menstruation (menstruation); frequency: about 10-15% of women):
    • Exogenous supply of estrogens, e.g., 100 µg E2 transdermally (“through the skin“; patch therapy).
    • In case of occurrence during the “pill break” in conventional intake (21/7) of a monophasic combination preparation (classical contraceptive pill): continuous intake of the preparation (off-label use; use outside the indication areas or the group of persons for which the drugs are approved by the drug authorities)
    • If necessary, triptans (frovatriptan, naratriptan, almotriptan, sumatriptan and zolmitriptan); for prophylaxis one to two days before the expected onset of the period and continued for four to six days (tripane therapy see below migraine/medicinal therapy)
  • Micronutrient therapy (see below supplements).
  • See also under “Further therapy”.

Supplements (dietary supplements; vital substances)

Suitable dietary supplements should contain the following vital substances: