Dietary modifications are widely recommended to relieve premenstrual symptoms. Whether they are effective for treating the severe symptoms of PMDD is not well established. Here are some of the most common recommendations:

1. Limit intake of alcohol, caffeine, salt, tobacco and refined sugar
2. Increase intake of complex carbohydrates and protein
3. Avoid overeating and weight gain
4. Consider frequent small meals.

Nutritional supplements (vitamins and minerals) are commonly used to treat premenstrual syndrome (PMS). Pyridoxine (vitamin B6) in a daily dose of up to 100 mg may be beneficial for some PMS symptoms, but research studies of this approach have produced conflicting results. The value of pyridoxine remains unestablished. Pyridoxine doses above 100 mg per day are not advised because high doses have actually caused nerve damage in some people. Calcium carbonate containing 1200 mg of elemental calcium daily was shown in one study to improve symptoms of PMS. Magnesium (a daily supplement of 200 mg) was reported to relieve premenstrual symptoms related to fluid retention, but whether it would be of any benefit for PMDD is not known. Optivite, a multi-vitamin, multi-mineral supplement, has been used widely over the past 20 or so years to treat symptoms of PMS. Other similar but not identical products are also available. There is some research support for Optivite as a treatment for PMS, but it has not been studied specifically for PMDD.

When used in conservative amounts vitamin and mineral supplements appear safe, but their effectiveness for treating PMDD remains to be established. There is no good evidence to support the theory that PMS or PMDD is caused by a deficiency of vitamins or minerals.

Evening primrose oil, a source of gamma-linolenic acid, has been touted as a treatment for PMS. However, a recent review of the research conducted with this product concluded that there is no good clinical proof that it works (and it's expensive).

The role of herbal preparations for treating PMS and particularly PMDD is not well established. A recent study from Germany compared Vitex agnus castus (chaste tree) fruit extract to placebo (sugar pill) in 170 women with PMS and found it beneficial and well tolerated for symptoms that included mood changes, anger, irritability, and breast fullness. Whether this would be effective for the more severe symptoms of PMDD is not known.

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