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Don't let PMS get you down
Well, it's official. Ever since 1987, when premenstrual syndrome was given an approved psychiatric label -- "late luteal phase dysphoric disorder" -- we've known that there really is something special about being a woman. And since 70% to 90% of women report having symptoms of PMS, it's about time things got official!
What to do about it is still something of a controversy. For the most part, women handle symptoms with lifestyle and dietary changes -- rest, chocolate, and a hot water bottle do just fine in a lot of homes. And sometimes over-the-counter medications can help with bloating or cramping.
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The Menstrual Pain Lowdown
Premenstrual syndrome (PMS) is frequently blamed for monthly moodiness, but the physical symptoms of PMS are less well known. Women suffering from PMS usually experience some of the following symptoms about a week before menstruation:
- Water retention
- Weight gain
- Abdominal bloating
- Tender breasts
- Headache
- Fatigue
- Feelings of depression
- Irritability, tension, and anxiety
About 40% of women suffer painful cramps, a condition called dysmenorrhea. Other symptoms of dysmenorrhea include the following:
- Nausea
- Vomiting
- Diarrhea
- Headache
- Dizziness
- Fatigue
The culprits in both PMS and menstruation pain are chemicals called prostaglandins. These compounds are associated with pain and inflammation in the body, and their levels are elevated in menstruating women. Luckily, over-the-counter medications like aspirin and other salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, are all prostaglandin inhibitors.
Getting Rid of Excess Water
Fluid retention is also a part of PMS. By avoiding high-sodium foods like potato chips in the three or four days before menstruation, some of the distress caused by water retention can be avoided. Over-the-counter diuretics, which also help relieve water retention, contain ammonium chloride, caffeine, or pamabrom. Once bloating is relieved, much of the discomfort and irritability disappears as well.
Diuretics help relieve fluid retention, but they are not without their drawbacks. The water balance in the body needs to be maintained for many physiological functions. Avoid problems caused by diuretics by only taking them temporarily for relief of premenstrual bloating. Also, be aware that diuretics which contain caffeine may cause some of the very symptoms you are trying to avoid: anxiety, restlessness, and insomnia.
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Analgesics (acetaminophen)
Reduces pain and fever but has no anti-inflammatory activity. Works by acting directly on the central nervous system and blocking pain messages.
Analgesics (NSAIDs)
NSAIDs, also known as non-steroidal anti-inflammatory agents, are a class of drugs that reduce inflammation and pain. They work by blocking the production of prostaglandins, chemicals linked to pain sensations and inflammation in the body. NSAIDs available without a prescription include ibuprofen, ketoprofen, and naproxen.
Analgesics (salicylates)
A class of drugs that reduce fever and relieve pain. Included are aspirin, choline salicylate, magnesium salicylate tetrahydrate, and magnesium salicylate. They work by blocking the production of prostagladins, chemicals linked to pain sensations and inflammation in the body.
Antihistamines
While not FDA-approved for use in menstrual relief, antihistamines are commonly included in many over-the-counter menstrual products. It is thought that they work by producing a mild pain-relieving effect and blocking the production of irritating histamines in the body.
Diuretics
| Analgesics (Acetaminophen) | Ingredient | Description |
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| Acetaminophen | | Safe and effective for treating minor aches and pains. If you have liver or kidney disease, consult a doctor before taking this drug. | | Analgesics (NSAIDs) | Ingredient | Description |
|---|
| Ibuprofen | | Effective in preventing cramps and relieving moderate pain. Should not be used by anyone with gastrointestinal or bleeding disorders. | | Naproxen | | Effective in preventing cramps and relieving moderate pain. Naproxen lasts longer (8 to 12 hours) than ibuprofen and ketoprofen. Should not be used by children under age 12 or anyone with gastrointestinal or bleeding disorders. | | Ketoprofen | | Effective in preventing cramps and relieving moderate pain. Should not be used by anyone under age 16 or with gastrointestinal or bleeding disorders. | | Analgesics (Salicylates) | Ingredient | Description |
|---|
| Aspirin (Acetasalicylic Acid) | | Useful in treatment of mild pain symptoms only. Does not have much of an effect on prostaglandin production. Present in many over-the-counter analgesics. Never administer to children with flu-like symptoms or fever due to the risk of the rare, but fatal, Reye's syndrome. | | Choline Salicylate | | A salicylate salt comparable to aspirin. Less irritating to the stomach. | | Magnesium Salicylate | | Comparable to aspirin but less potent and less irritating to the stomach. | | Potassium Salicylate (conditionally approved) | | Similar to magnesium and sodium salicylate. Safe and effective for minor pain relief. | | Sodium Salicylate | | A salicylate salt comparable to aspirin. Be cautious about using if you are on a low-sodium diet. Not commonly used in nonprescription products. | | Antihistamines | Ingredient | Description |
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| Phenyltoloxamine (conditionally approved) | | A safe antihistamine included in some combination menstrual-relief products. Has not been proven effective in relief of menstrual symptoms. Not commonly found in nonprescription products. | | Pyrilamine (conditionally approved) | | While pyrilamine maleate may provide mild pain-relieving and anesthetic effects, its overall effectiveness in menstrual relief has not been proven. May cause drowsiness. | | Diuretics | Ingredient | Description |
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| Ammonium Chloride | | Safe and effective in low doses (less than eight grams daily) for relieving water retention. Higher doses have frequent side effects (nausea, vomiting, and stomachache.) Has a short-lasting effect. Do not use this drug if you have kidney or liver disease. Not commonly used in nonprescription products. | | Caffeine | | Mild diuretic and stimulant. Increases the rate at which the kidneys excrete water, therefore increasing urinary output. Caffeine-containing products can cause stomach irritation, restlessness, and insomnia. | | 2-Amino-1-Methyl-Propanol-9-Bromothephyllinate (Pamabrom) | | Safe and effective. In combination products, relieves pain, cramps, and general menstrual symptoms, but does not significantly reduce fluid level. No significant level of toxicity or adverse side effects. | | Theobromine Sodium Salicylate (conditionally approved) | | Caffeine-like compound which causes kidneys to increase urine output. Safe but only a very weak diuretic effect. Not commonly found in nonprescription products. | | Theophylline (conditionally approved) | | Toxic effects make this potent diuretic unsafe for use. Not commonly found in nonprescription products. |
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FDA-Approved Uses
General menstrual products
- For the relief of painful premenstrual and menstrual cramps (dysmenorrhea) and backache.
- For the relief of emotional changes or mood changes such as anxiety, nervous tension, and irritability.
- For the relief of water-retention symptoms, including temporary weight gain and swelling.
Products with diuretics
- For the relief of temporary weight gain, bloating, swelling, and/or full feeling associated with the premenstrual and menstrual periods.
Products with caffeine
- For the relief of fatigue associated with the premenstrual and menstrual periods.
Recommended Dosage
| Analgesic (Acetaminophen) | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Acetaminophen | 650 mg every 4 to 6 hrs | 4000 mg | Refer to package or consult a physician | | Refer to package or consult a physician | | Analgesic (NSAID) | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Ibuprofen | 200 to 400 mg every 4 to 6 hrs | 1200 mg | Refer to package or consult a physician | | Refer to package or consult a physician | | Naproxen | 200 mg every 8 to 12 hrs, or
200 every 12 hrs if over age 65 | 600 mg
400 mg if over 65 | Not recommended | | Not recommended | | Ketoprofen | 12.5 mg every 4 to 6 hrs
A second dose may be taken after one hour if needed.
Not recommended for those age 16 and under. | 75 mg | Not recommended | | Not recommended | | Analgesic (Salicylates) | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Aspirin (Acetylsalicylic Acid) | 650-1000 mg every 4 to 6 hours
Not recommended for those age 16 and under. | 4000 mg | Not recommended | | Not recommended | | Choline salicylate | 870 mg every 3 to 4 hrs
Not recommended for those age 16 and under. | 5220 mg | Not recommended | | Not recommended | | Magnesium salicylate | 650 mg every 4 hours or 1000 mg three times daily
Not recommended for those age 16 and under. | 3000 mg | Not recommended | | Not recommended | | Sodium salicylate | 325 to 650 mg every 4 hrs
Not recommended for those age 16 and under. | 4000 mg | Not recommended | | Not recommended | | Diuretics | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Pamabrom | 50 mg 4 times per day | 200 mg | Consult a physician | | Not recommended |
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Warnings
Analgesic (acetaminophen)
Consult a physician before using or do not use if you have:
- Alcoholism
- Allergy to acetaminophen or any component in acetaminophen products
- Kidney impairment
- Liver impairment
Or if you:
- Plan to use more frequently or at higher than recommended doses
- Still have a fever after three days
- Are using to treat symptoms for more than 10 days in adults
Or if you are taking:
- Chronic alcohol use: may increase the risk for acetaminophen-induced liver damage
- Isoniazid (Nydrazid): may increase the risk for acetaminophen-induced liver damage
- Phenobarbital (Luminal): may increase the risk for acetaminophen-induced liver damage
- Phenytoin (Dilantin): may increase the risk for acetaminophen-induced liver damage
- Sulfinpyrazone (Anturane): may increase the risk for acetaminophen-induced liver damage
- Warfarin (Coumadin): use of high dose acetaminophen might increase the risk of bleeding
Analgesic (NSAID)
Consult a physician before using or do not use if you have:
- A seizure disorder
- Anemia
- Are allergic to any NSAID or any component
- Bleeding problems
- Diabetes
- Heart disease
- High blood pressure
- Kidney impairment
- Liver impairment
- Parkinson's disease
- Ulcers or other gastrointestinal problems
Or if you:
- Are on a low-salt diet
- Plan to have surgery; stop use three days before the procedure
- Plan to use for an extended period of time or at a higher dose
Or if you are taking:
- Digoxin (Lanoxin): may increase digoxin levels and effect when ibuprofen is also used
- Furosemide (Lasix): may decrease furosemide levels when ibuprofen or ketoprofen is also used
- Lithium (Lithobid): may increase lithium levels or effect
- Methotrexate (Folex): may increase methotrexate levels and effect
- Other NSAIDs: increases NSAID side effects
- Phenytoin (Dilantin): may increase phenytoin levels or effect when ibuprofen is also used
- Probenecid (Benemid): may increase NSAID levels and side effects
- Salicylates, such as
- Aspirin (Ecotrin): may decrease NSAID levels and increase NSAID side effects
- Choline salicylate (Arthopan): may decrease NSAID levels and increase NSAID side effects
- Warfarin (Coumadin): may increase warfarin side effects and the risk of bleeding
- Cyclosporin (Neoral, Sandimmune): may increase kidney damage
Antihistamines
Consult a physician before using or do not use if you have:
- Allergy to any antihistamines
- Chronic respiratory conditions
- Enlarged prostate
- Glaucoma
- Urinary obstruction
Or if you:
- Drive or operate machinery requiring alertness, dexterity, or quick reflexes
Or if you are taking:
- Alcohol: increases antihistamine side effects
- CNS depressants, such as:
- Diazepam (Valium): increases antihistamine side effects
- Phenobarbital (Luminal): increases antihistamine side effects
- Monoamine oxidase inhibitors (a class of antihistamines), such as:
- Phenelzine (Nardil): increases antihistamine side effects
- Tranylcypromine (Parnate): increases antihistamine side effects
- Other antihistamines: increases antihistamine effects
Diuretic (caffeine)
Consult a physician before using or do not use if you have:
- Allergy to caffeine or any component of PMS or menstrual products
- Anxiety
- Are under L-dopa treatment for Parkinson's disease
- Gastrointestinal disorders
- Heart disease
- High blood pressure
- Insomnia
- Irregular heartbeat
Or if you:
- Are drinking caffeinated beverages
- Plan to use for an extended period of time or at a higher dose; this might cause an stomach ulcer or rebound water retention
Or if you are taking:
- Beta-adrenergic agents, such as:
- Isoproterenol (Isoprel): may increase isoproterenol effects
- Cigarette smoking: may increase caffeine removal and decrease caffeine effects
- Cimetidine (Tagamet): may decrease caffeine removal and increase caffeine effects
- Clozapine (Clozaril): may decrease clozapine removal and increase clozapine effects
- Disulfiram (Antabuse): may decrease caffeine removal and increase caffeine effects
- Fluoroquinolones, such as:
- Ciprofloxacin (Cipro): may decrease caffeine removal and increase caffeine effects
- Norfloxacin (Noroxin): may decrease caffeine removal and increase caffeine effects
- Mexiletine (Mexitil): may decrease caffeine removal and increase caffeine effects
- Oral contraceptives: may decrease caffeine removal and increase caffeine effects
- Other caffeine products: will increase caffeine side effects
- Phenylpropanolamine: may increase caffeine effects
- Phenytoin (Dilantin): may increase caffeine removal and decrease caffeine effects
- Terbinafine (Lamisil): may decrease caffeine removal and increase caffeine effects
- Theophylline (Theo-Dur): may increase theophylline levels and effect
Diuretic (pamabrom)
Consult a physician before using or do not use if you have:
- Allergy to pamabrom or other components of PMS or menstrual products
- Anxiety
- Gastrointestinal disorders
- Heart disease
- High blood pressure
- Irregular heartbeat
- Liver impairment
Or if you:
- Plan to use for an extended period of time or at a higher dose; this might cause rebound water retention
Or if you are taking:
- Other diuretics: may increase diuretic effects
Pyridoxine
Consult a physician before using or do not use if you have:
- Allergy to pyridoxine
- Intestinal problems
- Liver disease
- Overactive thyroid function
- Parkinson's disease
Or if you:
- Plan to use for longer than one month
- Plan to use a larger dose than recommended
Or if you are taking:
- Levodopa (Dopar): may decrease levodopa levels and effect
- Phenobarbital (Luminal): may decrease phenobarbital levels and effect
- Phenytoin (Dilantin): may decrease phenytoin levels and effect
Common Side Effects
Analgesic (acetaminophen)
Analgesic (NSAID)
- Dizziness
- Fatigue
- Heartburn
- Nausea
- Rash
- Stomach cramps
Antihistamines
- Drowsiness
- Thickened mucus
Diuretics (caffeine)
Diuretics (pamabrom)
Infrequent to Rare Side Effects
Analgesic (acetaminophen)
- Bruising
- Nausea
- Rash
- Vomiting
Analgesic (NSAID)
- Confusion
- Fluid retention
- Headache
- Itching
- Nervousness
- Ringing in ears
- Stomach ulceration
- Vomiting
Antihistamines
- Diarrhea
- Dry mouth
- Headache
- Nausea
- Nervousness
- Tiredness
- Vomiting
Diuretics (caffeine)
- Insomnia
- Nervousness
- Rapid heartbeat
- Stomach upset
Diuretics (pamabrom)
- Dizziness
- Muscle cramps
- Weakness
Effects of Overdose
Analgesic (acetaminophen)
- Kidney damage
- Liver damage
Analgesic (NSAID)
- Kidney failure
- Seizures
- Severe nausea
- Vomiting
- Ringing in ears
Antihistamines
- Confusion
- Hallucinations
- Loss of consciousness
- Loss of coordination
- Seizures
- Severe agitation
- Severe drowsiness
Diuretics (caffeine)
- Agitation
- Confusion
- Difficulty breathing
- Vomiting
- Nausea
- Ringing in ears
- Seizures
Diuretics (pamabrom)
What to Do in Case of Overdose
- If you suspect that you or someone you know has taken an overdose of this medication, immediately STOP USING THE MEDICATION and SEEK MEDICAL HELP.
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Websites, Organizations & Manufacturers
Sources & Further Reading
Government Sources
- 1. Food & Drug Administration. Federal Register 11/16/88.
- 2. Food & Drug Administration. Federal Register 12/24/91.
- 3. Food & Drug Administration. Federal Register 2/2/94.
- 4. Food & Drug Administration. Federal Register 4/19/95.
- 5. Food & Drug Administration. Federal Register 6/13/96.
- 6. Food & Drug Administration. Federal Register 11/14/97.
- 7. Food & Drug Administration. Federal Register 11/16/88.
Books
- 1. Covington, TR et al. Handbook of Nonprescription Drugs, Eleventh Ed. American Pharmaceutical Assoc. Washington, DC 1996.
- 2. Kastrup EK et al. Drug Facts and Comparisons. Facts and Comparisons.
- 3. Inlander, CB and Slamans, S. The Over-the-Counter Doctor. Cader Books. New York, NY 1997.
Find more books on health and wellness at  barnesandnoble.com.
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