How effective are non-hormonal treatments for severe PMS?

Background: Premenstrual syndrome (PMS) affects 20-40% of reproductive-age women, with 3-8% experiencing severe symptoms that significantly impair daily functioning. While hormonal treatments are considered first-line therapy, many women prefer non-hormonal alternatives due to side effects, contraindications, or personal beliefs. This study evaluated the efficacy of evidence-based non-hormonal treatments for managing severe PMS. Methods: This 12-month, single-center, multi-arm, parallel-group, randomized, placebo-controlled trial enrolled 120 women (aged 18-45 years) with severe PMS. Participants were randomized to receive calcium-vitamin D supplementation (600mg+400IU twice daily), cognitive behavioral therapy (CBT, 8 weekly sessions), combined lifestyle intervention (structured exercise, dietary counseling, and stress management), or placebo. The primary outcome was reduction in Daily Record of Severity of Problems (DRSP) scores after 3 months. Secondary outcomes included proportion achieving ≥50% symptom reduction, domain-specific improvements, and quality of life measures. Results: At 3 months, mean DRSP score reductions were significantly greater in all intervention groups compared to placebo: calcium-vitamin D (63.7±7.2 vs. 14.9±5.8, p<0.001), CBT (58.2±6.9, p<0.001), and lifestyle intervention (49.6±7.4, p<0.001). The proportion of participants achieving ≥50% symptom reduction was highest with calcium-vitamin D (76.9%), followed by CBT (69.2%), lifestyle intervention (57.7%), and placebo (15.4%), p<0.001. Domain analysis showed differential effects with calcium-vitamin D more effective for physical symptoms (71.2% reduction), CBT for psychological symptoms (74.8% reduction), and lifestyle interventions showing balanced effects across domains. Treatment effects were maintained at 6-month follow-up. Conclusion: Non-hormonal treatments demonstrated significant efficacy in managing severe PMS, with calcium-vitamin D supplementation showing the greatest overall benefit. These findings provide evidence-based alternatives for women seeking non-hormonal PMS management and suggest that treatment selection should consider predominant symptom domains

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