Premenstrual Syndrome

Premenstrual syndrome (PMS) is a condition that consists of physical, emotional, and behavioral symptoms that affect women of childbearing age. PMS occurs 5–14 days before the start of a menstrual period and often recurs in a predictable pattern. The symptoms go away a few days after the menstrual period starts. PMS can interfere in many ways with normal daily activities and can range from mild to severe. When PMS is considered severe, it may be diagnosed as premenstrual dysphoric disorder (PMDD). A small percentage of women are affected by PMS symptoms and an even smaller percentage of those women are affected by PMDD.

CAUSES

The exact cause of PMS is unknown, but it seems to be related to cyclic hormone changes that happen before menstruation. These hormones are thought to affect chemicals in the brain (serotonin) that can influence a person's mood.

SYMPTOMS

Symptoms of PMS recur consistently from month to month and go away completely after the menstrual period starts. The most common emotional or behavioral symptom is mood swings. These mood swings can be disabling and interfere with normal activities of daily living. Other common symptoms include depression and angry outbursts. Other symptoms may include:

  • Irritability.

  • Anxiety.

  • Crying spells.  

  • Food cravings or appetite changes.  

  • Changes in sexual desire.  

  • Confusion.  

  • Aggression.  

  • Social withdrawal.  

  • Poor concentration.

The most common physical symptoms include a sense of bloating, breast pain, headaches, and extreme fatigue. Other physical symptoms include:

  • Backaches.  

  • Swelling of the hands and feet.  

  • Weight gain.  

  • Hot flashes.  

DIAGNOSIS

To make a diagnosis, your caregiver will ask questions to confirm that you are having a pattern of symptoms. Symptoms must:

  • Be present 5 days before the start of your period and be present at least 3 months in a row.  

  • End within 4 days after your period starts.  

  • Interfere with some of your normal activities.  

Other conditions, such as thyroid disease, depression, and migraine headaches must be ruled out before a diagnosis of PMS is confirmed.

TREATMENT

Your caregiver may suggest ways to maintain a healthy lifestyle, such as exercise. Over-the-counter pain relievers may ease cramps, aches, pains, headaches, and breast tenderness. However, selective serotonin reuptake inhibitors (SSRIs) are medicines that are most beneficial in improving PMS if taken in the second half of the monthly cycle. They may be taken on a daily basis. The most effective oral contraceptive pill used for symptoms of PMS is one that contains the ingredient drospirenone. Taking 4 days off of the pill instead of the usual 7 days also has shown to increase effectiveness.

There are a number of drugs, dietary supplements, vitamins, and water pills (diuretics) which have been suggested to be helpful but have not shown to be of any benefit to improving PMS symptoms.

HOME CARE INSTRUCTIONS

  • For 2–3 months, write down your symptoms, their severity, and how long they last. This may help your caregiver prescribe the best treatment for your symptoms.

  • Exercise regularly as suggested by your caregiver.

  • Eat a regular, well-balanced diet.

  • Avoid caffeine, alcohol, and tobacco consumption.

  • Limit salt and salty foods to lessen bloating and fluid retention.

  • Get enough sleep. Practice relaxation techniques.

  • Drink enough fluids to keep your urine clear or pale yellow.

  • Take medicines as directed by your caregiver.

  • Limit stress.

  • Take a multivitamin as directed by your caregiver.