Associated Women's Health Specialists  
     
     

Premenstrual Syndrome

Most women feel physical or mood changes during the days before menstruation. When these changes affect a woman's normal life, they are known as premenstrual syndrome (PMS).

Premenstrual syndrome can affect menstruating women of all ages and backgrounds. The cause of PMS is unclear. However, the symptoms can be managed in many women. This pamphlet explains:
  • How PMS can affect you
  • How it is diagnosed
  • What you can do for relief

Many women with PMS find relief with exercise and lifestyle changes. Others may find dietary supplements or medicines to be helpful.

The Menstrual Cycle

Menstruation is a normal, monthly process. To understand PMS, it helps to know how the menstrual cycle works. This will help you to predict and cope with the symptoms.

The average menstrual cycle lasts about 28 days. Normal cycles can range from 21–35 days. During the menstrual cycle, the ovaries produce hormones. These hormones are called estrogen and progesterone.

Day 1 of the cycle is the first day of a period. On about day 5, estrogen causes the lining of the uterus to begin to build up to prepare for a pregnancy. On about day 14, one of the ovaries releases an egg. This is called ovulation.

After ovulation, progesterone levels increase. If the egg is not fertilized by a sperm, the hormone levels decrease. This signals the uterus to shed its lining on about day 28 of the cycle. This shedding, or menstruation, marks the start of a new cycle.

Symptoms

Premenstrual symptoms are a common part of the monthly cycle. In fact, at least 85% of women who menstruate have at least one premenstrual symptom.

Common Symptoms of PMS

Emotional and Behavioral Symptoms

  • Depression
  • Angry outbursts
  • Being irritable
  • Crying spells
  • Anxiety
  • Confusion
  • Social withdrawal
  • Poor concentration
  • Sleep disturbance
  • Thirst and appetite changes (food cravings)
Physical Symptoms
  • Tender breasts
  • Bloating and weight gain
  • Headache
  • Swelling of the hands or feet
  • Aches and pains
Women with PMS experience a pattern of symptoms month after month. They also find that the symptoms interfere with some aspect of their family, social, or work lives.

Common symptoms of PMS are listed in the box. These symptoms occur during the 2 weeks before a woman's period and they get better after the period begins.

Diagnosis

To diagnose PMS, a doctor must confirm a pattern of symptoms. A woman's symptoms must:

  • Be present in the 5 days before her period for at least 3 menstrual cycles in a row
  • End within 4 days after her period starts
  • Interfere with some of her normal activities
A record of your symptoms can help your doctor decide if you have PMS (see box). Each day for at least 2–3 months, write down and rate any symptoms you feel. Record the dates of your menstrual periods as well.

This simple record can help your doctor learn if you have a pattern of symptoms. It will help your doctor diagnose PMS or perhaps some other condition.

PMS or Something Else?

Symptoms of other conditions can mimic PMS. For instance, premenstrual dysphoric disorder (PMDD) is a severe type of PMS. PMDD affects a small percentage of women with PMS (see box). Your doctor will want to rule out this and other conditions before diagnosing PMS.

Depressive and Anxiety Disorders

These disorders are the most common conditions confused with PMS. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. The symptoms of these disorders may worsen before or during a woman's period. This makes some women think they have PMS.

Keep a Symptom Record

A symptom record can help your doctor decide what treatment is best for you. Keeping a symptom record is easy. Write your symptoms on a calendar or create a chart like the one shown below.

Be sure to note the day your period begins each month. This will help your doctor decide if your symptoms are caused by PMS. Write down your symptoms every day for 2–3 months.

Rate each symptom for the day on a scale of 0–10. Write "0" if you have no symptoms or if a symptom is minor. Write "10" if a symptom is severe. Use numbers in between, depending on how the symptom feels.

Keeping a symptom record also can help you predict changes in your body or moods. Knowing when to expect changes will help you manage them better.

However, the symptoms of depressive disorders often are present all month long. With PMS, the symptoms go away after a period begins. Some women may have depression and PMS.

Menopause

Women entering menopause may have PMS-like symptoms. These symptoms include mood changes and fatigue.

You can help your doctor decide if the symptoms are caused by menopause or PMS. A record of your symptoms and changes in your monthly cycle can be used to make a diagnosis.

Other Conditions

Your doctor will want to rule out other conditions that share symptoms with PMS. These conditions include chronic fatigue syndrome, irritable bowel syndrome, and endocrine problems.

PMS also may make the symptoms of other conditions increase. These conditions include:

  • Seizure disorders
  • Migraines
  • Asthma
What You Can Do

Lifestyle and dietary changes often can relieve some PMS symptoms. Medicines also can help women manage the symptoms.

Talk with your doctor about your symptoms and treatment options. He or she may suggest some of the options described here. You may have to combine options to find relief.

Aerobic Exercise

For many women, aerobic exercise lessens PMS symptoms. It may reduce fatigue and depression. Exercise can include brisk walking, running, cycling, or swimming. Try to exercise at least 30 minutes most days of the week.

Aerobic exercise also improves health in other ways. For instance, it can promote heart health and help control weight.

Relaxation

Finding ways to relax and reduce stress can help women who have PMS. Your doctor might suggest relaxation therapy to help lessen PMS symptoms. Relaxing activities like yoga or massage also may help. You also should be sure to get enough sleep.

Dietary Changes

Simple changes in your diet may help relieve the symptoms of PMS. Your doctor may suggest a diet rich in fruit, vegetables, and whole grains. Reduce your intake of fat, salt, and sugar. Avoid caffeine and alcohol.

Premenstrual Dysphoric Disorder

PMDD can cause major strain on a woman's work and personal life. Symptoms of PMDD may include:

  • Feeling hopeless or sad
  • Feeling tense, anxious, or "on edge"
  • Moodiness or frequent crying
  • Constant irritability and anger that cause conflict with other people
  • Lack of interest in things you used to enjoy
  • Having problems concentrating
  • Lack of energy
  • Appetite changes, overeating, or cravings
  • Having trouble sleeping
  • Feeling overwhelmed
  • Physical symptoms such as tender or swollen breasts, headaches, joint or muscle pain, bloating, and weight gain
Most of the time, symptoms begin the week before a woman's period and end a few days after her period starts. If you've had at least 5 of these symptoms during most months of the past year, see your doctor. A symptom record can help your doctor decide if you have PMDD.

Drugs called selective serotonin reuptake inhibitors (SSRIs) can help treat PMDD in some women. These drugs are used to treat depression.

Dietary Supplements

Dietary supplements help lessen the symptoms of PMS in many women. Your doctor may suggest that you take calcium supplements. Studies have shown that taking 1,200 mg of calcium a day can help reduce the physical and mood symptoms that are part of PMS.

Your doctor also may suggest taking magnesium to reduce bloating, breast tenderness, and mood symptoms. Vitamin B6 and vitamin E also may help reduce symptoms of PMS.

Talk with your doctor before taking dietary supplements or herbal products. Many of these products have not been proved to be effective. Taking excess amounts of these products or taking these products with some medications may be harmful.

Medications

Women with severe PMS may not feel relief with lifestyle or dietary changes alone. If these changes don't reduce symptoms, your doctor may suggest medications.

Antidepressants, especially SSRIs, can be helpful in treating PMS. These drugs can help lessen mood symptoms. They can be used 2 weeks before the onset of symptoms or throughout the menstrual cycle.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain. Diuretics ("water pills") may help reduce fluid buildup.

Talk with your doctor before taking NSAIDs or diuretics. Long-term use of NSAIDs can cause stomach bleeding or ulcers. Using NSAIDs and diuretics at the same time may cause kidney problems.

Other options for severe PMS include oral contraceptives (birth control pills) and drugs that prevent ovulation. Birth control pills may lessen physical symptoms. However, they will not likely relieve the mood symptoms of PMS.

Talk With Others

Talking with others about what you are going through can help. Sharing your feelings may help your family to support you more. Being aware of your symptoms also may help prevent conflicts with others.

Finally . . .

Many women with PMS find relief with exercise and lifestyle changes. Others may find dietary supplements or medicines to be helpful.

If you have PMS, talk with your doctor about ways to find relief. Simple changes may help improve your well-being, all month long.

Glossary

Estrogen: A female hormone produced in the ovaries that stimulates the growth of the lining of the uterus.

Hormones: Substances produced by the body to control the function of various organs.

Menopause: The process in a woman's life when ovaries stop functioning and menstruation stops.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Progesterone: A female hormone that is produced in the ovaries and makes the lining of the uterus grow. When the level of progesterone decreases, menstruation occurs