++
++
Explanation, support, reassurance and stress management; CBT (good evidence)
Advise recording a daily symptom diary for 2–3 mths
Attend to lifestyle factors: diet, exercise, relaxation
++
++
COC with 20 mcg ethinyloestradiol + drospirenone 3 mg (if contraception required) on days 1–24 of a 28-d cycle, but weak evidence for PMS otherwise
Pyridoxine (vitamin B6) 50–100 mg/d (high doses >200 mg/d may → irreversible peripheral neuropathy)
Moderate-to-severe PMS: fluoxetine 20 mg/d or sertraline 50 mg daily in morning for 14 d before anticipated onset of menstruation, through to the first full day of menses of each cycle
++
Alternative therapy: sometimes conflicting evidence (usually weak) for use of calcium, magnesium, vitex agnus castus, evening primrose oil.