Premenstrual syndrome (PMS) is one of the oldest and most common afflictions known to women and, secondarily, to men. "When my wife has PMS, she's not the only one who suffers!" For most women, symptoms are usually mild -- fatigue, irritability, anxiety and bloating. But for some, PMS is not mild, it's debilitating -- causing severe depression, panic attacks, and even violent behavior.

Advice in the past has been less than helpful because of the large range of symptoms of a nonspecific nature. Physicians have prescribed progesterone to alleviate symptoms, but double-blind studies by the NIH show that the hormone is no better than a placebo. Over-the-counter drugs are also of little value.

So, what does work?

Exercise:
The one remedy that seems to help is exercise. When women do moderate exercise five times a week for at least 30 minutes a session, their symptoms are significantly reduced. Because long, steady exercise causes a release of endorphins, it makes sense to keep the level "pumped up," so to speak, during the last two weeks of the cycle. Continuous production of endorphins appears to diminish the PMS symptoms.

Eat small frequent meals:
It's been shown that occasional small sugar snacks are effective in relieving the milder symptoms. To avoid fluctuations in blood sugar levels, don't skip meals. Eat small frequent meals instead. Eat the same amount of food you normally would, but spread it out. Have three small meals and mid-morning and mid-afternoon snacks.

Limit simple sugars and include fiber:
It is better to limit simple sugars than to try to avoid them. It's okay to have some sugar, but don't have it on an empty stomach, for that could trigger a binge. Instead, have a dessert with your meal. It sounds strange, but it's better to eat dessert during the middle of a meal than at the end. Having something sweet at the end of a meal may lead you to want more sugar. If you eat the sweet mid meal, the craving is satisfied. Be sure to include fiber and protein with each meal to slow the digestion and absorption of the sugar.

Limit caffeine and alcohol:
Some women experience alcohol intolerance during the last two weeks of their cycle; they show signs of intoxication with only two drinks when it usually takes five or six to produce the same effects.

Reduce sodium:
Finally, sodium is not as big an issue as it once was, but if you're bothered by fluid retention and breast swelling or tenderness, then limit your sodium and avoid adding salt.