Journal of Medicinal Plants Research Vol. 5(26), pp.

6122-6127, 16 November, 2011

Available online at http://www.academicjournals.org/JMPR
ISSN 1996-0875 ©2011 Academic Journals
DOI: 10.5897/JMPR11.1198

Review

Treatment of premenstrual syndrome

Muhammad Akram1*, Naveed Akhtar2, H. M. Asif1, Pervaiz Akhtar Shah3, Tariq Saeed3,
Arshad Mahmood4 and Nadia Shamshad Malik5
1
Department of Basic Medical Sciences, Faculty of Eastern Medicine, Hamdard University, Karachi, Pakistan.
2
Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Pakistan.
3
University College of Pharmacy, The University of Punjab Lahore, Pakistan.
4
Department of Pharmaceutical Sciences, COMSATS Institute of Information Technology, Abbottabad, Pakistan.
5
School of Pharmacy, The University of Lahore, Islamabad Campus, Islamabad, Pakistan.
Accepted 26 September, 2011

Premenstrual syndrome (PMS) is characterized by a spectrum of physical and mood symptoms, which
appear during the week before menstruation and usually resolve within a week after the onset of
menses. Most women in their reproductive years experience some premenstrual symptoms. In some
women, the symptoms can badly affect quality of life before periods. The treatment of PMS is a
changing area as research continues to clarify which treatments actually work and to try to find better
treatments. The main objective of the present article is to review the potential treatment for
premenstrual disorders. Various treatments have been advocated for PMS. Treatment strategies include
either eliminating the hormonal cycle associated with ovulation or treating the symptom(s) causing the
most distress to the patient. Herbal drugs are effective and well tolerated treatment for the relief of
symptoms of the premenstrual syndrome.

Key words: Premenstrual syndrome, research study, treatment option.

INTRODUCTION

A syndrome that occurs in many women from two to
fourteen days before the onset of menstruation is known
as premenstrual syndrome (PMS). It is a collection of
physical, psychological, and emotional symptoms related
to a woman's menstrual cycle. PMS is now viewed as a
complex psychoneuroendocrine disorder (Jarvis et al.,
2008). Premenstrual syndrome affects emotional and
physical well being of women (Halbreich, 1995).
Premenstrual syndrome is not a single disorder, but a
group of menstrually related disorders and symptoms
(Braverman, 2007). Premenstrual syndrome is the
constellation of emotional, behavioral, and physical
symptoms that occur during the premenstrual (luteal)
phase of the menstrual cycle and resolve after the start of
menses (Whitehead et al., 1986). A premenstrual
symptom affects daily life. PMS most commonly affects
women aged 30 to 40 years. Preliminary studies suggest
that up to 40% of women with symptoms of PMS have a
significant decline in their circulating serum levels of
beta-endorphin (Bancroft et al., 1994). Many treatments
have been suggested for PMS, including diet or lifestyle
changes, and other supportive means. Different
treatments have been advocated for PMS. The treatment
of PMS is a changing area as research continues to
clarify which treatments actually work and to try to find
better treatments (Facchinetti et al., 1994). By staying up
to date with current research on premenstrual disorders
and new management options, physicians can help
women to better understand their symptoms and benefit
from a rational, individualized treatment plan (Halbreich
et al., 1993).
The main objective of this study is to review the
potential treatment for premenstrual disorders, data are
obtained from published articles identified using the
search terms premenstrual syndrome (PMS) and
premenstrual syndrome symptoms and treatment.
Pubmed gives 1231 hits with the search terms
“Premenstrual syndrome, symptoms, and treatment.

ETIOLOGY OF PREMENSTRUAL SYNDROME

*Corresponding author. E-mail: makram_0451@hotmail.com.
Tel: 92-021-6440083. Fax: 92-021-6440079. The true etiology of PMS is the consequence of complex
 Akram et al. 6123

and poorly understood interactions between ovarian
hormones, endogenous opioid peptides, neurotrans-
mitters, prostaglandins, and the circadian, peripheral,
autonomic, and endocrine systems. Secondary causes of
deficient corpus luteum production are defective liver,
heart, or kidney function and hyperprolactinemia.
Hormonal changes
citalophara (celexa), certain selective serotonin reuptake
inhibitor (SSRI).
Progesterone suppositories/ pessaries
Progesterone suppositories/ pessaries are used for the
treatment of the pre-menstrual syndrome including pre-
menstrual tension and depression.

Hormone levels may fluctuate due to the decreased

production of sex hormones after ovulation has taken Progesterone vaginal gel
place (Freeman et al., 1997).
Progesterone vaginal gel is prescribed for the
management of disorders associated with progesterone
Brain chemicals deficiency such as premenstrual syndrome.
Fluctuations of serotonin in the brain may lead to mood
swings and depression. Norethisterone tablets

Norethisterone tablets are used for treatment of

Opioid peptides premenstrual syndrome including premenstrual
mastalgia.
These are also brain chemicals that fluctuate in response
to the hormones. Other possible causes may include a
poor diet, mineral and vitamin deficiency, and stress. Dydrogesterone tablets

Dydrogesterone tablets are prescribed for treatment of

Sign and symptoms of premenstrual syndrome premenstrual syndrome, 10 mg twice daily from day 12 to
(Lopez et al., 2009) 26 of cycle.
(1) Bloating and weight gain
(2) Breast swelling, tenderness
(3) Mood swings Levonorgestrel
(4) Depression and anxiety
(5) Skin problems Levonorgestrel is prescribed in premenstrual tension.
(6) Changes in appetite, food cravings
(7) Changes in interest in sex
(8) Headaches, backaches, cramps Bromocriptine
(9) Not being able to concentrate, loss of interest in usual
activities, confusion. Bromocriptine is usually prescribed in cyclical benign
breast disease/ cyclical pronounced mastalgia. In the
premenstrual syndrome there is some evidence that
Management of premenstrual syndrome other symptoms such as headache, mood changes and
bloatedness may be alleviated.
Common pharmacologic treatments include the use of
natural progesterone and synthetic progestins, diuretics
for edema, antiprostaglandins, bromocriptine, a Gamolenic acid
dopamine receptor agonist, and pyridoxine, a water-
soluble B vitamin for PMS. Nonpharmacologic inter- It is prescribed for symptomatic treatment of
ventions such as cognitive therapy, relaxation responses, premenstrual cyclical mastalgia and non-cyclical breast
reflexology, and massage therapy result in effective PMS pain.
control.

Danazol
Allopathic prescription
It is prescribed for treatment of severe cyclical breast
Fluoxetin (prozole), setraline (zoloft), paraxetin (paxil), pain.
6124 J. Med. Plants Res.
Bendroflurazide
It is prescribed in premenstrual oedema.
Hydrochlorothiazide
It is prescribed in premenstrual edema (James et al.,
2007).
Mefruside
It is prescribed in premensterual edema (Auld et al.,
1971).
Ayurvedic treatment
Saraca indica, Cyperus rotundas, Mesua ferrea, Lotus
flower.
Complementary and alternative therapies
A comprehensive treatment plan for PMS may include a
range of complementary and alternative therapies
(Moline et al., 2005).
Herbal treatment
There are different types of Unani medicine dosage forms
which are being prescribed for the treatment of
premenstrual syndrome. The dosage form prescribed is
categorized as follows: aqueous extract (Joshanda), pills
(Hab), tablet (Qurs), electuary (Majun), ointment
(Marham). The different prescriptions are delineated
herewith. Further the proprietary herbal medicine are
prescribed according to sign and symptoms. All these are
described alongwith the component and composition
(Eisenberg et al., 1998).
Herbs used in uteritis
Marham dakhlioon is usually prescribed in uteritis. It
contains Plantago ovata seeds, Linum usitattisimum
seeds, Althae officinale seeds, Phyllanthus emblica
seeds, Trigonella foenum graecum, Sesamum indicum
oil, Ricinus communis, honey bee wax (Blumenthal et al.,
2000; Nosal’ova et al., 1992).
Majoon dabeed ul warid
Majoon dabeed ul warid is prescribed for liver disorders.
It is also effective in premenstrual syndrome due to its
anti-inflammatory activity. Majoon dabeed ul warid
contains Cymbopogon jawarancusa, Aqeullaria
agallocha, Valariana officinalis, Bambusa arundinaceae,
Cichorium intybus, Apium graceolens, Commiphora
stocksiana, Cinnamomum cassia, Aristolochia indica,
Saussurea cappa, Rosa damascene, Delphinium zalil,
Laccifer lacca, Rubia cordifolia, Crocus sativus, Pistacia
lentiscus (Barrero, 2005).
Treatment of appetite changes in premenstrual
syndrome
Jawarish Kamoni is herbal coded formulation that is
prescribed for indigestion. It helps in digestion and
increases appetite. Jawarish Kamoni contains Ruta
graveolens, Armenian bole, Zingiber officinale (Kawai,
1994), Corum carv and Piper nigrum.
Direction: To be taken in the morning or after principal
meals.
Dose: 5 to 10 g
Treatment of insomnia in premenstrual syndrome
Somina is a herbal formulation that is usually used fro
treatment of insomina. Somina contains Prunus
amygdalus (Badam), Lagenaria vulgaris (Kaddu),
Papaver somniferum (Khaskhash), S. indicum (Til),
Lactuca serriola (Kahu) Freeman et al., 2010; Kest et al.,
2001; Medina et al., 1997).
Treatment of anxiety in premenstrual syndrome
Sherbet Ahmed Shah is usually used for treatment of
anxiety. Sharbat Ahmed Shah contains Cuscuta reflexa
(Aftimun), Lavandula stoech as (Ustukhuddus), Nepeta
hindostana (Badrang Boya), Cassia senna (senna),
Polypodium vulgare (Bisfaij), Nymphea alba (Nilofar),
Rosa damascena (Gulab), Ocimum basilicum
(Franjmushk), Terminalia belerica (Halilah Siyah), Viola
odorata (Banafshah), Onosma echoides (Gaozaban)
(Mustafa et al., 1990; Paladini et al., 1999).
Treatment of depression in prementrual syndrome
Selective serotonin reuptake inhibitors (SSRIs) may be
prescribed continuously throughout the menstrual cycle,
or may be given in intermittent fashion during the luteal
phase of the cycle. Muffareh Shaikh-al-Rais is Unani
formulation. It has been used as a brain tonic since
centuries. Muffareh Shaikh-al-Rais contains Aquillaria
agallocha (agar), Onosma echioides (gaozaban),
Elettaria cardamomum (Ilaichi Khurd), Santalum album
(Sandal Safaid), Pterocarpus santalinus Sandal Surkh),
Bambusa arundinacea (Banslochan), Centurea behen

Behman Safaid), Lactuca serriola (Kahu), Rosa
damascene (Gulab), Doronicum hookeri (Daronj Aqrabi),
Portulaca oleracea (Khurfa Siyah), L. vulgaris (Kaddu),
Curcuma zeddoria (Zaranbad), Scilla serrata (Crab),
Cucumis melo (Khurbuza), Cucumis sativus (Khiyarain),
Cinnnamomum camphora (Kafur), Coralium rubrum
(Marjan, Coral), Bombyx moris (Abresham Muqraz),
Crocus sativus (Zafran), mixed with honey, apple, Pyrus
cydonia (Behi) juices (Kulkarni et al., 1996).
Treatment of pain in premenstrual syndrome
Thus, the management of PMS is important for women’s
health. However, there is considerable debate regarding
the nature and extent of PMS symptoms. Barshaasha is
Unani formulation that is usually prescribed in pain.
Barshaasha contains Valeriana walichii (Balchar),
Hyoscymus niger (Ajwain khurasani), Papver
somniferum, (Khaskhash), Violoa odorata (Banafshah),
Onosma echoides (Gaozaban), Anacyclus pyrethrum
(Aqarqrah), P. nigrum (Filfil Siyah), Euphorbia caudicifolia
(Halima, 2004).
PMS and traditional Chinese medicine (TCM)
One of the most commonly used TCM formulas,
employing the roots of bupleurum (Bupleurum Chinense),
dong quai (Angelica sinensis), peony (Paeonia lactiflora),
and licorice (Glycyrrhiza glabra), focuses on liver function
and strengthening the blood (Dhingra et al., 2006).
Homeopathy for premenstrual syndrome
Current treatments for premenstrual syndrome (PMS)
appear to offer, at best, a 25 to 50% reduction in
symptoms. Homeopathic treatments work to stimulate the
body into righting any emotional or physical upsets that
produce PMS symptoms. It uses highly diluted doses of
natural substances that would cause PMS symptoms if
given in full strength to a healthy person. The substances
are from plant, mineral, and animal sources (including
snakes). A remedy is individualized to each patient and
depends on her particular mix of emotional and physical
symptoms, as well as her general state of emotional and
physical health (Klein-Laansma et al., 2010). For
example, if a woman with PMS easily becomes weepy,
she may be prescribed one of several remedies,
including, Pulsatilla nigricans of Pulsatilla have been
used to treat reproductive problems such as
premenstrual syndrome and epididymitis. Other
applications of this plant include uses as a sedative and
for treating coughs (Ernst, 2005).
Sepia, a cuttlefish ink acts on the uterus, ovaries, and
vagina and is mainly used for gynecological problems, for
Akram et al. 6125
example, premenstrual syndrome, painful or heavy
menstruation, hot flashes during menopause, emotional
and physical symptoms during and after pregnancy,
candidiasis, and a sagging and prolapsed uterus (Steven,
1997).
Exercise
Not more than 30 min and thrice a week if aerobic activity
is practiced it can lighten up mood swings, internal
frustration could be minimized and tendency to tolerate
could be increased. Physical activity like exercise can
reduce body aches, fluid retention and tenderness of
breast. Production of endorphin is increased by exercise
endorphin which relevantly soothes mild depression
(Wyatt et al., 2000).
Nutrients
1. Vitamin E- 400 IU/day- Breast tenderness
2. Vitamin B-6- 50 mg/day- Premenstrual syndrome, 50
to 100 mg daily
3. Magnesium- 200 mg/day- Deficient in PMS, muscle
relaxant
4. Calcium- 200 mg/day- Deficient in PMS, water
retention, mood
5. Chromium- 200 mcg/day- Sugar cravings
6. Borage oil- 150 mg/day- Cramps, breast tenderness
7. 5-HTP- 100 mg before bed- Depression, PMDD
(Daugherty, 1998).
DISCUSSION
Premenstrual syndrome (PMS) is a condition of cyclical
and recurrent physical and psychological discomfort
occurring 1 to 2 weeks before menstrual period. More
severe psychological symptoms have been described for
the premenstrual dysphoric disorder (PMDD). No single
treatment is universally recognised as effective and many
patients often turn to therapeutic approaches outside of
conventional medicine. It has been suggested that some
of the symptoms typically attributed to menopause may
be more related to premenstrual syndrome (PMS) than
menopause, as perimenopausal women appear to be
more prone to PMS-like symptoms, or at least to tolerate
them less well (Van Die et al., 2009).
Increased levels of the hormone prolactin are often
responsible for menstrual irregularities and pre-menstrual
syndrome; agnus-castus has been shown to inhibit its
production and clinical trials have demonstrated that this
can help regularise the menstrual cycle, improving
symptoms such as breast tenderness, mood swings, fluid
retention and headache. Agnus-castus may also be used
to treat acne with a hormonal cause (Atmaca et al.,
6126 J. Med. Plants Res.
2003). Retrospective community surveys estimate that
some 30 to 90% of women have suffered from
premenstrual symptoms (Chung et al., 1996; Jeong et al.,
2001; Lee et al., 1994). Antidepressants called SSRIs (for
example, Prozac) are usually in the treatment of severe
PMS where the symptoms are mostly depression, mood
swings, irritability (Brown et al., 2009). Hormonal
contraceptive methods suppress ovulation; thus,
combined oral contraceptive pills or a progestin-only
contraceptive agent may provide relief of PMS. Diuretic
like spiranolactone is effective for treatment of fluid
retention.
Several nonsteroidal anti-inflammatory drugs (NSAIDs)
are effective for treatment of dysmenorrhea, and their use
has been recommended for other perimenstrual
discomforts (Woods et al., 1985). Extra estrogen (one of
the female hormones) via patches or implants can
suppress ovulation and reduce the naturally occurring
hormone fluctuations (Lopez et al., 2009). Danazol (for
example, Danol) is a synthetic hormone based on the
male hormone testosterone. Its use in PMS is supported
by scientific studies (Yonkers et al., 1997).
Recommended daily dosage includes calcium 1,000 mg,
magnesium 400 mg, manganese 6 mg and Vitamin E 400
IU. A study was carried out to evaluate the efficacy of
Agnus castus for treatment of premenstrual syndrome. It
was observed that dry extract of Agnus castus fruit is an
effective and well tolerated treatment for the relief of
symptoms of the premenstrual syndrome (Schellenberg,
2001). Calcium supplementation is a simple and effective
treatment in premenstrual syndrome, resulting in a major
reduction in overall luteal phase symptoms (Thys et al.,
1998). A study was carried out that shows a yearly
decrease in the number of prescriptions linked to
diagnoses for premenstrual syndrome. Progestogens
including progesterone, are the most commonly
prescribed treatment for premenstrual syndrome despite
the lack of evidence demonstrating their efficacy (Katrina
et al., 2002).
CONCLUSION
Herbal medicines are effective for managing the
symptoms of PMS. Premenstrual symptoms are complex
but highly treatable disorders. Premenstrual syndrome
(PMS) can be successfully managed with lifestyle
changes, dietary modifications, complementary therapies
and prescription medications. Lifestyle changes to
manage PMS include regular exercise, not smoking,
cutting back on alcohol and caffeine and getting more
sleep. Nutritional supplements are helpful in reducing
symptoms of premenstrual syndrome. Although some
women report relief of PMS symptoms with the use of
herbs such as evening primrose oil and saffron, few
scientific studies prove the effectiveness of herbs thought
to help reduce the effects of PMS.
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