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The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
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Obstetrics and Gynegology2026№5

Non-hormonal therapy of premenstrual syndrome: modern opportunities and prospects

DOI
https://dx.doi.org/10.18565/aig.2026.133

Yarmolinskaya M.I., Cherkashina S.A., Konopako E.A.

1) D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russia; 2) North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, St. Petersburg, Russia

Premenstrual syndrome (PMS), known for its high prevalence, has a negative impact on various aspects of patients’ lives. This necessitates timely diagnosis and the prescription of pathogenetically justified and effective therapy. 
This review provides current ideas of the etiology and pathogenesis of premenstrual disorders, which are based on the increased sensitivity of the central nervous system to physiological changes in sex hormone levels and dysfunction of the serotonergic and GABA-ergic systems. We paid particular attention to diagnostic criteria, including the obligatory maintenance of a prospective symptom diary, as well as the potential for therapy options, with an emphasis on non-hormonal approaches.
Patient's age, somatic status, reproductive plans and preferences – all these should be taken into account, providing an individual and safe strategy for the correction of premenstrual disorders.  Treatment of PMS should be personalized and include a comprehensive approach with a combination of non-drug (lifestyle modification, cognitive behavioral therapy) and drug strategies (COCs, SSRIs, progestogens, NSAIDs, spironolactone, GnRH agonists, calcium supplements). Vitex agnus-castus extract should also be considered as a first-line therapy, as it has pleiotropic positive effects, high safety and good tolerability. Complex vitamin and mineral supplements, combining Vitex agnus-castus with indole-3-carbinol, magnesium and B vitamins, provide a multi-target effect on pathogenic mechanisms, help normalize the menstrual cycle, improve emotional status and increase reproductive potential.
Conclusion. Non-hormonal methods of premenstrual syndrome therapy represent an important trend in the management of affective, vegetative and somatic symptoms, especially in patients with contraindications to hormonal drugs intake or in those who objects to taking them.

Autrhors’ contributions. Yarmolinskaya M.I. – study concept and plan; Yarmolinskaya M.I., Konopako E.A., Cherkashina S.A. – data collection and analysis, conclusion writing, manuscript processing.
Conflicts of interest. The authors declare no conflict of interests.
Funding. The article was published with the financial support of the company "Alcea".
Use of generative artificial intelligence. No AI was used for the preparation and submission of the manuscript.
For citation: Yarmolinskaya M.I., Cherkashina S.A., Konopako E.A. 
Non-hormonal therapy of premenstrual syndrome: modern opportunities and prospects.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (5): 184-192 (in Russian)
https://dx.doi.org/10.18565/aig.2026.133

Keywords

premenstrual syndrome
premenstrual dysphoric disorder
non-hormonal therapy
Vitex agnus-castus
Full text (in Russian)

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Received 22.04.2026

Accepted 05.05.2026

About the Authors

Maria I. Yarmolinskaya, Dr. Med. Sci., Professor of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Head of the Department of Gynecology and Endocrinology, Head of the Center of Diagnostics and Treatment of Endometriosis, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034, Russia, St. Petersburg, Mendeleevskaya line, 3; Professor at the Department of Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, 191015, Russia, St. Petersburg, Kirochnaya str., 41, m.yarmolinskaya@gmail.com, SPIN: 3686-3605, Researcher ID: P-2183-2014, Scopus Author ID: 7801562649, https://orcid.org/0000-0002-6551-4147
Sofya A. Cherkashina, Junior Researcher, D.O. Ott Research institute of Obstetrics, Gynecology and Reproductology, 199034, Russia, St. Petersburg, Mendeleevskaya line, 3, sonyach@list.ru, https://orcid.org/0009-0005-7208-3575
Ekaterina A. Konopako, Resident, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, 199034, Russia, St. Petersburg, Mendeleevskaya line, 3,
katerina.konopako@mail.ru
Corresponding author: Maria I. Yarmolinskaya, m.yarmolinskaya@gmail.com

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