Q. Do vitamins work for premenstrual syndrome?

A. According to the American College of Physicians, the effectiveness of vitamin B6 (pyridoxine), vitamin E, magnesium, and multinutrients in treating PMS is uncertain. And extra vitamin E may even be bad for you — a meta-analysis of 19 studies in the Jan. 4 Annals of Internal Medicine found that compared with placebo (a fake pill) or no treatment, taking vitamin E in amounts above 150 IU a day may increase the risk of death. This month, Kaiser decided it will no longer sell Vitamin E in doses above 100 IU.

A woman with PMS may suffer irritability, breast tenderness and fatigue during the week or so before her period. Or she may have bloating, edema, depression, mood swings, food cravings (especially for salt and sugar), and even violence toward self and others that go away when her period starts. This can cause marital discord, difficulty maintaining friendships and difficulties with their children.

PMS sufferers may be supersensitive to the normal hormonal changes of the menstrual cycle. Serotonin, a natural brain chemical, is reduced in many with PMS. To diagnose PMS, keep a daily symptom diary for at least two months, mark when your period starts, and show this to your doctor.

What about alternative therapies like evening primrose oil and natural progesterone?

The Department of Complementary Medicine at the University of Exeter did a systematic review of 27 studies of herbs, homeopathy, dietary supplements, massage, reflexology and biofeedback, and found inadequate evidence that any of these worked.

What works? Regular aerobic exercise — and high intensity — appears to be better than low. Individual or group cognitive therapy, which corrects dysfunctional attitudes and improves coping strategies, can lead to almost complete disappearance of psychological and physical symptoms.

Take calcium supplements. A large randomized study showed that 600 milligrams of elemental calcium twice a day improves PMS after two months. They used calcium carbonate as two TUMS E-X (Extra Strength) tablets twice daily.

If these aren't enough, I then add a serotonin-increasing drug like fluoxetine, sertraline, citalopram or paroxetine, starting on either day 15 of the cycle or on the first day of symptoms, and stopping on the first day of the period. The water pill spironolactone may reduce irritability, breast tenderness and bloating. Anti-inflammatories like mefenamic acid or Naproxen may also help. With the above, most of my patients show a gratifying improvement in distressing mood symptoms and social functioning.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com.