What is the treatment of choice for severe premenstrual syndrome (PMS)?

The treatment of choice for severe premenstrual syndrome (PMS) is selective serotonin reuptake inhibitors (SSRIs). SSRIs are effective in alleviating the emotional and physical symptoms associated with PMS, particularly for those who experience significant mood disturbances, such as depression and anxiety during the luteal phase of their menstrual cycle. Clinical studies have demonstrated that SSRIs can help reduce both the emotional symptoms and some physical symptoms of PMS, making them a preferred option for women who meet the criteria for severe PMS or premenstrual dysphoric disorder (PMDD).

Hormonal therapy may be beneficial for some women, especially those with significant hormonal imbalances, but it is generally considered when SSRIs are ineffective or not tolerated. Non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve physical symptoms like menstrual cramps and headaches, but they do not address the emotional symptoms associated with PMS. Dietary changes may offer some benefit in symptom management, yet they alone are not adequate for treating severe cases. Thus, SSRIs stand out as the most effective and evidence-based treatment for those experiencing severe PMS symptoms.