Premenstrual Syndrome (PMS) is the most common disorder experienced by women during the menstrual years. Up to 90% of women are affected to some degree.Many woman have just a few mild symptoms, while others suffer severe discomfort which adversely effects their quality of life. If the mood swings, irritability and depression are consistently severe, the disorder is called PMDD( Premenstrual Dysphoric Disorder), and is often treated by conventional physicians with fluoxetine hydrochloride ( Prozac® , Serafem®). Although drug therapies may help mask symptoms, it does little to address causative factors.
Guy Abraham, M.D. was instrumental in classifying the symptoms of PMS into 4 main categories, and in establishing the role of nutrition in PMS.
PMS-A (anxiety) mood swings, irritability, crying jags
PMS-H (hyperhydration) bloating, weight gain, water retention, breast tenderness, constipation
PMS-C (cravings) many symptoms of hypo-glycemia(low blood sugar)- fatigue, vertigo(dizziness), sweet craving , ‘binging-out’, heart palpitations, headache, migraines
PMS-D (depression) crying bouts, insomnia, confusion, depression
Acne and other skin problems are also common. The bulk of these symptoms occur 7-5 days before the period begins, although some woman begin to experience problems shortly after ovulation, and spend half of each month in discomfort. Rarely does an individual woman fit exclusively into one of the categories, but instead may experience an overlapping of imbalances.
In most cases of PMS, there are patterns of hormone imbalance that can be uncovered through testing.
Research has consistently shown that an increased ratio of estrogen to progesterone, with a mild to moderate excess of estrogen and deficiency of progesterone(estrogen dominance), is a common factor in most of the women affected PMS symptoms are usually most prevalent during the luteal phase of the menstrual cycle; the 14 days following ovulation. Insufficient activity of the corpus luteum can lead to decreased progesterone levels. If progesterone levels are lower than 10-12 ng/ml, tested 3 weeks after the start of the last menstruation, corpus luteum insufficiency may well be involved.
Other hormones that are linked to PMS include prolactin , thyroid and adrenal hormones.
Prolactin is normally produced by the pituitary gland and functions in milk production in lactating women. However, during periods of stress, lymphocytes will also produce prolactin. Some woman with PMS have elevated prolactin levels, while others appear to be over sensitive to normal levels. Symptoms associated with prolactin include abdominal tension, edema, weight gain and breast tenderness.Prolactin levels can be further elevated due to low levels of Magnesium and Vitamin B-6. These nutrients stimulates the production of dopamine, which, in turn, limits the release of prolactin. Low Zn levels also increase prolactin release.
The thyroid may test within normal limits on blood tests and still be functioning at a low level. Woman can monitor their BBT(basal body temperature) with a basal thermometer for 1-2 months. If the BBT is lower than 97.8 degrees on average, compounded with a report of several symptoms associated with low thyroid function, an under-active thyroid may be suspect. Symptoms of an under-active thyroid include cold hands and feet, thinning hair, dry skin, slightly elevated cholesterol, mild anemia and constipation. Low thyroid function, even at a subclinical level can be a factor in PMS. 
The adrenal hormones, aldosterone and cortisol, are often slightly elevated in PMS, often due to chronic stress. New research is uncovering that not only the level of these hormones, but the level of response to them can vary in women with histories of reproductive endocrine-related mood disorders. Many women with PMS display abnormal responses, such as water retention and depression, to normal levels of these hormones. 
Pharmacies can offer saliva test kits that can be used by women to determine hormone levels.
The liver is involved in a great many metabolic processes in the body, including breaking down excess estrogens. If the liver is working well, it will break down aggressive estrogen into less harmful varieties, leading to fewer PMS symptoms. As long ago as the 1940’s it was shown that the liver cannot efficiently break down excess estrogen without the presence of sufficient B vitamins. The liver can also be challenged by the presence of a wide array of toxins, such as PBBs (polybrominated biphenyls),  that lead to increased demands on its ability to efficiently breakdown excess estrogen. The inability of the liver to properly detoxify estrogen leads to the overriding factor observed in PMS- Estrogen Dominance.
There are many causes of estrogen dominance. In rare cases it can be caused by a genetic abnormality. However, it usually is influenced by lifestyle choices, which women DO have control over. One of the main reasons women have too much estrogen is due to estrogens that are coming into their bodies from inorganic food and environmental toxins. These are called xenoestrogens.
Xenoestrogens are environmental chemicals with estrogen-like activity found throughout the environment, as by-products of pesticides, herbicides and the synthetic hormones routinely fed to animals, which is stored in their fat and transferred to people who eat them. They also come from petrochemicals found in the coating inside canned food,
and other plastics; even baby bottles! Once inside the body, xenoestrogens can play havoc with the “normal” mechanisms of the reproductive cycle, leading to PMS, premature development of both girls and boys  , and serious illness such as cancer.Investigations into the binding interaction for human plasma sex-hormone binding globulin (hSHBG) have revealed that xenoestrogens can displace normal estrogen from hSHBG binding sites and disrupt hormone balance.
PMS is not caused by one single agent, but instead must be viewed as a multifactorial imbalance that requires a complete program to lesson the input of a number of causative factors. The pharmacist can act as a health counselor for PMS, and move beyond the restrictive role of dispensing drugs.The outline below suggests an integration of therapeutic interventions in order of importance.
PMS is one health condition that conventional medicine suggests has dietary causes. Some of the well known culprits include too much caffeine, sugar, artificial sweeteners, processed foods and hydrogenated fats- in essence the Standard American Diet(SAD).
One well known symptom of PMS is carbohydrate craving. Research suggests that this may be an attempt by the woman to regulate mood changes that accompany PMS. In one study, consumption of a carbohydrate-rich, protein-poor evening meal during the late luteal phase of the menstrual cycle improved depression, tension, anger, confusion, sadness, fatigue, alertness, and calmness among patients with premenstrual syndrome. Because synthesis of brain serotonin, which is known to be involved in mood and appetite, increases after carbohydrate intake, premenstrual syndrome subjects may over consume carbohydrates in an attempt to improve their dysphoric mood state. 
A vegetarian based diet, high in organic dark, green leafy vegetables, whole grains and a small amount(if any) of free range antibiotic and hormone free animal products can substantially decrease or eliminate most symptoms associated with PMS. This dietary regimen reduces intake of xenoestrogens. Results of a recent study found “ A low-fat vegetarian diet was associated with increased serum sex-hormone binding globulin concentration and reductions in body weight, dysmenorrhea duration and intensity, and premenstrual symptom duration. The symptom effects might be mediated by dietary influences on estrogen activity…” Woman should be encouraged to maintain the diet for a long period of time, since a three to four month ‘waiting period’ may be needed before the positive effects of dietary change take effect. This is a long term, lifetime commitment that will enhance overall health and well being as well as provide relief from PMS symptoms.
The effect of exercise on PMS symptoms has been the focus of several studies, which indicate that exercise is successful in the diminution of all PMS symptoms. Moreover, it appears that these benefits are can be at obtained even with low levels of exercise intensity.  Pharmacists can make exercise videos available to their clients, and suggest them as part of an overall health and wellness approach to the alleviation of PMS.
PMS symptoms are related to the way a woman deals with stress. Stress plays a role in regulating adrenal hormones, as well as neurotransmitters involved with maintaining mental wellness. Stress reduction techniques such as meditation, prayer, yoga and cognitive behavior therapy can help to ameliorate anxiety, depression, negative thoughts, and physical changes associated with PMS. 
The first intervention, after addressing the lifestyle issues of diet, exercise and stress reduction, is to work on detoxification of the liver. Several herbs are particularly useful in supporting the liver. These include Dandelion, Milk Thistle and Burdock Root.
Almost everyone can recognize a dandelion plant, used as food and medicine by cultures internationally. The inner strength of this plant is reflected by the amount of time, energy and money spent trying to eradicate it from suburban lawns! Dandelion is a storehouse of nutrients, including the following chemical constituents: caffeic acid p-hydroxyphenylacetic acid, chlorogenic acid, linoleic acid, linolenic acid, oleic acid, palmitic acid and other acids, taraxacin(bitter), terpenoids , flavonoids, vitamin A (14,000 IU/100 g leaf- one of the greens highest in Vit A), carotenoids, choline, mucilage, inulin, pectin, phytosterols, potassium.
Dandelion supports the liver, and increases its ability to break down estrogen.
Dandelion has long been used in herbal medicine for its choleretic and diuretic properties. When tested against the pharmaceutical diuretic, Lasix, dandelion (2 g/kg) exhibited a comparable diuretic effect, without the potentially adverse side effects of Lasix, such as potassium depletion.Although the mechanism of action of dandelion is not fully understood, dandelion extract was found to diminish enzymatically induced-lipid peroxidation as well as reducing cytochrome c in a concentration dependent manner. 
Dandelion is considered safe. However, due to the abundance of taraxasterol choline, a substance that hastens the movement of bile, it should be avoided in high quantities in persons with bile duct obstructions.
Dosage: 3 cups of Dandelion Tea/day
Tincture/Extract: 20 ml 3X/day
Capsules: 500mg caps- 2 caps 2X/day
Interactions: None reported for Taraxacum Officinale. However, Chinese dandelion (Taraxacum mongolicum) interferes with absorption of quinolone antibiotics.
Burdock is found throughout the temperate zones around the world. The seed stalk produces the characteristic ‘burrs’, which one entrepreneurial gentleman used to develop the idea for ‘velcro’!
Burdock is a slow acting nutritional tonic that builds strength over time. It is highly nutritious, and contains minerals such as magnesium, calcium, potassium, and silica. Other chemical constituents include: Sesquiterpene lactones; trideca-1,11-dien-3,5,7,9-tetrain; caffeic acid derivatives (including chlorogenic acid, isochlorogenic acid); 40% to 50% inulin , mucilages; volatile oils (phenylacetaldehyde, benzaldehyde, 2-alkyl-3-methoxy-pyrazines); phytosterols, tannins.
Burdock is a traditional Alterative or ‘blood cleanser’ in herbal medicine. In Chinese Medicine it is considered a ‘cooling’ herb, useful for ‘hot’ conditions, such as hot flashes, or swollen joints. It can help with frequent urinary tract infections, and has diuretic properties. Burdock root is listed as an official medicine in the Eclectic Materia Medica and the U.S. Pharmacopoeia..
Burdock extract has a high level of antioxidant activity, and produces a significant inhibitory effect on lipid peroxidation in the liver.Burdock also has shown specific hepatoprotective effects from acetaminophen induced liver damage. 
According to the German Commission E, there are no known risks associated with the use of burdock. It is not recommended for use during pregnancy.
Dosage: fresh root- 6 inches of root per day
Extract: 20 drops 3X/day
Capsules: 2, 500 caps 3X/day
Interactions: None reported
Milk Thistle( Silybum marianum)
Milk thistle grows in the wild throughout Europe and North America. It has large purple flowers surrounded by a sharp array of thorns, hence the name ‘thistle’. Milk thistle is an excellent galactogogue (increases lactation). The ripe seeds(actually tiny fruits-kenguil seeds) are gathered in late fall to extract the highly medicinal components. The fruit contains 1.5%-3% silymarin, the most active known constituent, along with flavonolignans, tyramine, histamine, essential oils, lipids, alkaloids, saponins, mucilages, flavonoids, and vitamins C, E, and K.
Milk thistle is used first and foremost for its protective and regenerative effect on the liver. In one study which examined the effect of silibinin on phase II liver enzymes, oral administration at doses of 100 and 200 mg/kg/day(in mice) showed a significant increase in glutathione, S-transferase and quinone reductase activities in liver, lung, stomach, skin and small bowel in a dose- and time-dependent manner. Scientific studies have shown that Milk thistle has at least two distinct actions on liver cells; membrane stabilization, and increasing ribosomal proteins that helps the liver regenerate new cells. Milk Thistle is a useful herb to help in all situations where liver detoxification is indicated. In relation to women’s health issues, it is especially helpful for all imbalances linked to excessive estrogen, including PMS, cystic breasts, fibroids, endometriosis and infertility. It is also useful for alcohol, drug or chemically induced liver damage, including hepatitis, cirrhosis, and acetominophen toxicity  Silymarin inhibits 5-lipoxygenase which enhances its anti-inflammatory effects. Milk’s thistle exhibits anti-tumor activity, which may be due to its inhibition of promoter-induced edema , hyperplasia and a reduction in the proliferation index.
Tea: steep one TBS. Finely ground seeds(fruit) and leaf powder in one cup hot water.
Tincture/Extract: 20 drops 2X/day
Capsules: 200 mg 3X/day
Milk thistle is often standardized to 75-80% silymarin.
Interactions: Milk thistle has no known toxic effects. Numerous studies have shown that it has protective effects on liver and kidneys when used along with prescription medications including acetaminophen, butyrophenones, and ifosfamide cyclosporine. However, due to its marked effect on the liver, there may be a potential for silymarin to influence hepatic metabolism of certain coadministered drugs.
If the lifestyle modifications and liver cleansing herbs discussed above are instituted, most women will have an amelioration of most, if not all, PMS symptoms, both in quantity and intensity. However, if further intervention is required, there are several nutritional supplements and botanical remedies that can be helpful for PMS.
Calcium comprises more of the adult body than any other mineral(approximately 2%), and is critical to a myriad of metabolic functions, such as the development and maintenance of bones and teeth, control of the heartbeat and blood pressure, transmission of nerve impulses, muscles contraction and relaxation, maintaining membrane integrity, and enzyme activation. Estrogen, which regulates calcium metabolism and intestinal calcium absorption, fluctuates throughout the menstrual cycle, which may lead to a disregulation of calcium homeostasis. In fact, there is a marked similarity in the overall symptoms of PMS and low calcium levels (hypocalcemia). Calcium supplementation has been tested in randomized, placebo controlled, double blind studies, and was found to result in a major reduction in overall symptoms associated with PMS. 
Although calcium supplementation can help PMS, dairy products often actually make PMS worse. This may be due to a sensitivity of some individuals to dairy products, or because the high protein content in milk, along with calcium, vitamin D, and phosphorus, may decrease magnesium absorption.
Calcium supplements vary in their bioavailability. When recommending Calcium supplements, be aware that dolomite can have high lead levels, calcium carbonate requires a low pH to solubilize, and often causes gastrointestinal side effects,and bone sourced Calcium may cause consumer concern due to increased awareness of Mad Cow Disease. Calcium citrate is absorbed more easily than calcium carbonate and is relatively inexpensive.Food consumption surveys conducted in the USA have indicated calcium intake for women are often below the US recommended daily allowance (1200 mg/day). “ Evidence to date indicates that women with luteal phase symptomatology have an underlying calcium dysregulation with a secondary hyperparathyroidism and vitamin D deficiency. This strongly suggests that PMS represents the clinical manifestation of a calcium deficiency state that is unmasked following the rise of ovarian steroid hormone concentrations during the menstrual cycle.”
Dosage: 1200-1500 mg/day
Magnesium is an important mineral that helps form bones, relax muscle spasms, activate cellular enzymes, and regulate nerve and muscle function(including the heart) and acid-alkaline balance. It is often referred to as the “anti-stress” mineral. Deficiency of magnesium is known to cause many symptoms usually associated with PMS, such as irritability, depression, confusion and muscle aches. However, determining if a woman is deficient in magnesium can be a challenge. Many sources of food that are thought to contain magnesium according to old nutrient charts (grains, legumes, vegetables, nuts and seeds), are actually low due to low levels in the soil and depletion due to processing and cooking. Measuring magnesium levels in the blood plasma will often fail to demonstrate low levels, although RBC magnesium levels have been shown to be low in PMS sufferers. Therefore, woman who want to have a true picture of their magnesium levels should be encouraged to have a RBC magnesium level done. Estrogen enhances the utilization of magnesium. However, if estrogen levels are high, which is often the case with PMS, and magnesium intake is less then optimal, estrogen-induced shifts of magnesium can be deleterious, leading to muscle spasms, migraine, and other PMS disorders. In one study serum levels of magnesium were inversely related to the serum level of estrogen. 
Magnesium supplementation can help alleviate many measurable parameters of PMS, including cramps, irritability, fatigue, depression and water retention.   Magnesium citrate, gluconate, and lactate are better absorbed than magnesium oxide. Magnesium glycinate is a well absorbed form, with minimum laxative effects.
Dosage: 300mg-400mg/day. Natural health care practitioners often recommend higher doses until symptoms are alleviated. Doses should be spread out throughout the day to avoid laxative effects. Supplementation with Vitamin B-6, along with magnesium, can help to increase cellular uptake of magnesium. 
Vitamin B-6 naturally occurs in three active forms: pyridoxine (PNP), pyridoxamine (PMP) and pyridoxal (PLP). Ninety percent of vitamin B6 is in the latter form. Vitamin B-6 is a coenzyme intimately involved with many vital processes such as the formation of amino acids, hormones, and neurotransmitters including serotonin and dopamine involved in mood regulation. Several studies show that supplementing with this nutrient(50 mg/day) alleviates PMS symptoms, especially those related to mood.   However, other studies contradict this finding, and conclude that Vitamin B-6 is not a proven treatment for women with PMS, and that studies on B-6 have been poorly done.  Phosphorylation of Vitamin B-6 into its active form(pyridoxal-5-phosphate) takes place in the liver. Inefficient liver function, often present in women with PMS, can lead to conversion difficulties.Vitamin B-6 is found in many foods, including fish, poultry, eggs, sunflower seeds, soybeans, lentils, avocados, kale and bananas.
Dosage: The RDI ranges from 1.3-2.0 mg/day, but a useful therapeutic dose is 25-50mg/day. Sufficient magnesium is required for utilization of B-6.
Cautions: Symptoms of sensory neuropathy have been noted due to overdose of B-6 at levels as low as 200mg/day.
Vitamin E is a fat soluble vitamin that acts as an antioxidant and free radical scavenger in cell membranes. It occurs in plant food sources, but cooking, processing and freezing destroys a high percentage of Vitamin E in foods. Supplementation with 400 IU daily has been shown to be advantages for health by favorably influencing lipid profiles, antioxidant status,  and heart health. Vitamin E has also been found to help reduce many symptoms associated with PMS. 
Dosage: RDA is 12 IU to 16 IU daily, but studies suggest 400 IU as a beneficial therapeutic dose. D-alpha tocopherol, the natural form, is often preferred over the synthetic form (dl-alpha tocopherol). Some companies offer “mixed tocopherols” with d-beta, d-gamma, d-delta tocopherols and various tocotrienols, the way vitamin E occurs naturally in food. Dry Vitamin E (succinate) is water soluble and is the best form for those who have fat absorption problems.
As we discussed above, individual nutrients have been found to directly influence PMS. Several studies have noted a marked improvement following the use of a Multi-Vitamin Mineral Supplement which contains the individual nutrients discussed along with a balanced blend of other vitamins and minerals.  The preferred supplement must contain sufficient quantities of Mg (400mg), Vitamin B-6(50mg) and Vitamin E(400IU) in the d-alpha form.
Research results on the efficacy of the use of supplemental oils for PMS vary in outcome. While fish oil has several positive outcome studies,  the popular use of Primrose oil for PMS is not well supported by study results.  Since many women with PMS do not consume a sufficient amount of Omega 3 fatty acids, it is prudent to supplement with EPH-DHA, fish oils, or flaxseed oil.
Dosage: 2000mg /day
We will discuss three herbs that are enjoying popularity for PMS: Black Cohosh, Dong quai, and Chaste Berry.
The Black Cohosh plant is a perennial bush in the buttercup family that can grow up to 9 feet high. It is found in woodlands throughout the Northeast. The root(rhizome) is used medicinally.
The plant has several common names, which reflect the many uses that have been attributed to it, including snakeroot, bugbane, rattleweed and squawroot. ‘Cohosh” is a Native American Algonquin word which refers to the ‘rough’ surface of the rhizomes. ‘Snakeroot’ reflects its use as a snakebite remedy. ‘Bugbane’ comes from the ability of the plant’s odor to repel insects. In Europe the flowers were stuffed into pillows for this purpose. When the dry seeds found on the plants in late fall are blown by the wind, they rattle, thus ‘rattleweed’. Several native cultures considered ‘rattling’ an important sound used for sacred ceremony. Black Cohosh was also called ‘Squawroot’ because it was commonly used by Native Americans to assist in all manner of women’s ailments, including scanty, heavy, painful and irregular menstrual flow, inability to conceive, and menopausal symptoms such as hot flashes and vaginal dryness.
Black Cohosh root extract was regularly recommended by the Eclectic Physicians in the mid 1800’s for all female complaints, and is among an ever growing group of herbs where modern scientific analysis reveals the chemical constituents that help to explain the long-time observations of herbalists throughout history. The extract contains glycosides and isoflavones, which may impart an estrogenic effect. One specific isoflavone, formononetin, was shown to be able to bind to estrogen receptor sites in vitro. One study demonstrated that Black Cohosh measurably lowered luteinizing hormone (LH) levels in menopausal women.  Although most current studies focus on the usefulness of Black Cohosh for menopausal complaints, Black cohosh has been approved by the German Commission E for the treatment of PMS.
Dosage: tea made from dried root- 3-4 cups/day (1 cup water to 1/2 tsp dried root)
Capsules- 40 mg 2X/ day
Extracts- 2-4 ml/day
Black Cohosh may be standardized to 1 mg deoxyactin/20 mg extract, or 2.5% triterpene glycosides
Cautions: discontinue use during pregnancy. Headaches, dizziness, nausea, visual disturbance have been reported after taking large amounts ( over 3 grams/day)
Interactions: None reported.
Dong quai is the medicinal root of a species of the Angelica plant family. The plant has the characteristic umbrella shaped flower tops of the Umbelliferae family. The medicinal part is the root, yellow to brown on the outside and white on the inside. Dong quai has been used medicinally in China, especially in formulas for women, for thousand of years. The name “ Dong quai” translates to “proper order”; it balances the entire female system, bringing things back into ‘proper order’.
Scientific research performed on extracts of Dong quai supports many of the ancient folkloric uses. Pharmacological effects include analgesic activity along with the ability to relax smooth muscle and tonify the uterus.  Dong quai can help to reduce high blood pressure,  , ease asthma and relax the coronary arteries.  Dong quai contains ferulic acid, which acts as an anticoagulant on blood cells, and ligustilide, which may explain its antispasmotic effect that aids menstrual cramps, headaches, and acts to tonify the uterus. Dong quai contains Vit A and E, folic acid, B-12, various essential oils and bioflavonoids. It relieves PMS symptoms such as bloating, mood swings, muscle aches and menstrual cramps and increases energy and vitality.
In Chinese medicine it is used as a dried root added to nutritious soups.
Root: 10 grams added to soup
Capsules: up to six 500 to 600 mg per day
Tincture/Extract: 1-2 ml 3 times per day
Cautions: do not use in pregnancy, May cause heavy bleeding. May cause photosensitivity or skin rash.
Interactions: Warfarin and other anticoagulants- may potentiate both therapeutic and adverse effects. Hormone therapies- may compete for estrogen receptor sites
The Chaste Berry Tree is indigenous to the Mediterranean area. It is an attractive bush with finger-like leaves and thin violet, blue or pink flowers. The fruit produced by this tree is a dark brown to black berry, about the size of a peppercorn, with a spicy pepper flavor.
The Chaste Berry has a long history of use as an herbal medicinal. It was first mentioned in the 4th century BC by Hippocrates, and was indicated in The King’s American Dispensary as a remedy for female problems. Its common name reflects the belief that eating the fruit decreases sex drive, and allows for increased chastity. . During ancient Greek and Roman times, the Priestess of the Temple would eat the berries to lessen the libido. Another name for the plant, Monk’s Pepper, came from the use by medieval monks towards a similar goal.
Chaste Tree Berry is the herb with the best scientific documentation for its role in being specifically useful for PMS.  Chaste Berry effects the pituitary gland, by regulating the release of prolactin.  Problems associated with high prolactin levels, or hypersensitivity to normal levels, include PMS, infertility and abnormal bleeding. Chaste Berry has been the subject of placebo controlled double blind studies, which have uncovered some of the specific mechanisms of action, such as binding to opiod receptors. It has proven to be especially useful if irregularities are due to a deficiency in the formation of the corpus luteum. Chaste berry increases the production of lutenizing hormone(LH), and decreases follicle-stimulating hormone(FSH). This enhances the ratio of progesterone to estrogen. Chaste Berries may need to be used for several months to elicit the desired effect. Please note that this herbal remedy is often called Agnus Castus or Vitex- its all the same herb.
Dosage: tea- 1 cup of boiled water poured over 1 tsp of fresh or dried berries. Steep for 10 minutes. Drink 1-2 cups per day.
Extract- 10-40 drops 2X/day
Capsules- 1 cap(40 mg) 1X/ day
Cautions: Do not use during pregnancy. If using Chaste Berry to enhance fertility, discontinue use once conception has occurred. Skin rashes, and increased menstrual flow have been reported in a small number of users.
Interactions: Do not use along with birth control pills or other prescription hormone therapies due to possible competition for binding sites. It may weaken the effect of dopamine- receptor antagonists.
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