Definition

Premenstrual syndrome (PMS) is a disorder marked by physical and emotional symptoms. It affects women one or two weeks before the beginning of their menstrual period.

The Menstrual Flow

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Causes

The cause of PMS is unknown. It may be that a complex combination of environmental, metabolic, and behavioral factors produces a vulnerability to the hormonal changes associated with menstruation. A brain chemical, serotonin, may play a role in severe forms of PMS.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

  • Age: 25-40
  • Going off birth control pills
  • Major life stress
  • Depression

Symptoms

Symptoms can be extremely distressing and may include:

  • Irritability
  • Mood swings
  • Anxiety
  • Depression
  • Diminished self-esteem
  • Difficulty concentrating
  • Sleep problems
  • Appetite changes (sugar and/or salt cravings, overeating)
  • Weight gain
  • Fatigue
  • Bloating
  • Headache
  • Breast swelling and tenderness
  • Palpitations
  • Dizziness
  • Gastrointestinal upset
  • Diffuse muscle pain

Symptoms improve when bleeding starts (menstrual period).

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam.

It is a good idea to keep a record of your monthly physical and emotional symptoms. These symptoms will most likely occur 1-2 weeks before your menstrual period. You may have PMS when symptoms occur at the same phase of the menstrual cycle each month.

Treatment

Many treatments have been used to relieve symptoms. No one treatment has been found to be always effective for all symptoms, for all women. Treating one or two symptoms may help to improve the whole syndrome. Treatments include:

Stress Management

Stress may be managed through lifestyle changes. Relaxation techniques, deep breathing, massage, music, and hot baths can also help reduce stress.

Dietary Changes

Dietary changes may be helpful. They include decreasing intake of salt, sugar, and caffeine. Caffeine is found in coffee, tea, cola, diet sodas, and chocolate. Eating small, frequent meals may also help.

Vitamins and Minerals

The following vitamin and mineral supplements might help reduce PMS symptoms:

  • Vitamin E (400 IU)—may reduce breast tenderness
  • Calcium (1000 mg)—may decrease bloating, depression, and aches
  • Magnesium (400 mg)—may decrease pain, fluid retention, and improve mood
  • Manganese (6 mg)—may help control symptoms of menstrual pain

Regular Exercise

Research suggests that women who engage in moderate activity suffer less PMS-related symptoms than sedentary women.

Medications

Diuretics can reduce bloating and fluid retention. Prostaglandin inhibitors, such as Motrin, can effectively relieve cramps, headaches, and muscle aches.

Oral Contraceptives

Combined oral contraceptives may help physical symptoms associated with PMS. You may need to try several brands before finding one that helps. Progesterone alone may also help some women.

Antidepressants

Antidepressants, such as Zoloft and Prozac, are helpful in managing the depression associated with PMS.

Sexual Activity With Orgasm

Sexual activity (including masturbation) may help relieve aching muscles and sluggish circulation. It moves blood and fluids away from congested organs.

Psychotherapy

Women with severe PMS symptoms may benefit from cognitive (behavioral) therapy. Therapy may help reduce negative emotions and enhance problem-solving skills in relationships. It may also help manage obstacles, frustrations, and discomfort.

Prevention