Diuretics have been one of the most commonly prescribed drugs for bloating and breast tenderness associated with premenstrual syndrome (PMS), based on the assumption that increased levels of aldosterone in the premenstrual phase causes fluid retention. The results of trials using different types of diuretics has been conflicting, and due to a tendency for some women to take more tablets than recommended, their use has diminished.

Some diuretics deplete potassium levels and supplements may be required, but ask the prescribing doctor first before self-prescribing. Herbal diuretics such as dandelion leaf, one or two teaspoons per cup, twice daily, is a suitable alternative. Dandelion leaf has high levels of potassium and additional supplements are not required.

Anti-depressants and Anxiolytics

A number of recent trials have verified the effectiveness of the selective serotonin re-uptake inhibitors (SSRIs) in the treatment of severe premenstrual syndrome or premenstrual dysphoric disorder (PMDD). Fluoxetine (Prozac, Luvox), sertraline (Zoloft), nefazodone (Serzone) and citalopram (Cipramil) given throughout the menstrual cycle have been shown to be well tolerated and effective. Some of the SSRIs such as citalopram have also been shown to be effective when used during the luteal phase of the cycle only. Despite their effectiveness, the SSRIs have considerable side-effects, including gastrointestinal disturbances, headache, sedation, insomnia, weight gain, impaired memory, excessive perspiration and sexual dysfunction.

Venlafaxine (Efexor), a new-generation anti-depressant that selectively inhibits serotonin and noradrenaline re-uptake, has also been evaluated for effectiveness in the treatment of premenstrual dysphoric disorder (PMDD). Venlafaxine is significantly more efficacious than placebo for premenstrual dysphoric disorder treatment.

The tricyclic anti-depressants have also been used successfully, particularly nortriptyline (Allegron) and clomipramine (Anafranil, Clomipramine). The benzodiazepine Alprazolam has also been suggested as a treatment for premenstrual syndrome and PMDD; however, dependence and tolerance occur quickly and make these types of drugs less attractive options for these conditions.

The SSRIs are also increasingly prescribed for menopausal symptoms, but this is a controversial practice.

The herbal alternatives to reduce tension and the effects of stress are the nervines. These are milder in action than drugs and tend to have fewer side-effects. They are described on site.

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