OBJECTIVE: To evaluate the current nonpharmacologic and pharmacologic treatment 
options for symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric 
disorder (PMDD).
DATA SOURCES: Literature was obtained through searches of MEDLINE Ovid 
(1950-March week 3, 2008) and EMBASE Drugs and Pharmacology (all years), as well 
as a bibliographic review of articles identified by the searches. Key terms 
included premenstrual syndrome, premenstrual dysphoric disorder, PMS, PMDD, and 
treatment.
STUDY SELECTION/DATA EXTRACTION: All pertinent clinical trials, retrospective 
studies, and case reports in human subjects published in the English language 
were identified and evaluated for the safety and efficacy of pharmacologic and 
nonpharmacologic treatments of PMS/PMDD. Data from these studies and information 
from review articles were included in this review.
DATA SYNTHESIS: Selective serotonin-reuptake inhibitors (SSRIs) have been proven 
safe and effective for the treatment of PMDD and are recommended as first-line 
agents when pharmacotherapy is warranted. Currently fluoxetine, 
controlled-release paroxetine, and sertraline are the only Food and Drug 
Administration-approved agents for this indication. Suppression of ovulation 
using hormonal therapies is an alternative approach to treating PMDD when SSRIs 
or second-line psychotropic agents are ineffective; however, adverse effects 
limit their use. Anxiolytics, spironolactone, and nonsteroidal antiinflammatory 
drugs can be used as supportive care to relieve symptoms. Despite lack of 
specific evidence, lifestyle modifications and exercise are first-line 
recommendations for all women with PMS/PMDD and may be all that is needed to 
treat mild-to-moderate symptoms. Herbal and vitamin supplementation and 
complementary and alternative medicine have been evaluated for use in PMS/PMDD 
and have produced unclear or conflicting results. More controlled clinical 
trials are needed to determine their safety and efficacy and potential for drug 
interactions.
CONCLUSIONS: Healthcare providers need to be aware of the symptoms of PMS and 
PMDD and the treatment options available. Treatment selection should be based on 
individual patient symptoms, concomitant medical history, and need for 
contraception.