Unproven treatments include the following:
PMS. It is a low-dose, monophasic combination oral contraceptive with 24
hormone days and only a four-day hormone-free interval. Studies show that
PMS symptoms are decreased with a shorter hormone-free time period. DRSP
is an analogue of spironolactone, which differs from other OCP progestins by
exhibiting both antimineralocorticoid and antiandrogenic effects.Progesterone therapy has a long history in the treatment of PMS, but neither
natural progesterone (vaginal suppositories) nor progestin therapy has been
shown to be any more effective than placebo. Because of both a lack of
efficacy and the possibility of inducing menstrual irregularities, these agents
should not be used.
Diuretics. Because of the common complaint of “bloating” voiced by many
patients with PMS, diuretics such as spironolactone have been advocated.
Spironolactone has been studied in double-blind, randomized trials, and the
results have been mixed. Although spironolactone may relieve some
symptoms for some patients, the lack of consistent response across the studies
in the literature suggests that other therapy is more effective.
Pyridoxine. Vitamin B6 in doses of 50–200 mg/d has been suggested as a
treatment for PMS. A number of randomized, blinded studies have been
performed, but no conclusive findings have emerged. Because of the lack of
demonstrated efficacy and the possibility of permanent sensory neuropathy
associated with high-dose vitamin B6 consumptions, the use of vitamin B6
should be discouraged.