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Your Guide to Premenstrual Syndrome, or PMS

Premenstrual syndrome, commonly called PMS, is a medical condition that has symptoms that affect many women of childbearing age. PMS can cause a variety of physical and psychological symptoms that occur just before your menstrual period.

The American College of Obstetrics and Gynecology defines PMS as "The cyclic occurrence of symptoms that are sufficiently severe to interfere with some aspects of life, and that appear with consistent and predictable relationship to the menses [menstrual period]."

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What Causes PMS?

The exact cause of PMS is unknown, but it seems to be related to the fluctuating levels of hormones, including estrogen and progesterone, that occur in preparation for menstruation.

What Are the Symptoms of PMS?

There are many PMS symptoms. The number and severity of symptoms vary from woman to woman. In addition, the severity of the symptoms can vary from each month. Common PMS symptoms include:

 

  • Bloating
  • Breast tenderness
  • Weight gain
  • Aggression
  • Trouble concentrating
  • Headaches/backaches
  • Food cravings/overeating
  • Fatigue
  • Tearfulness
  • Irritability
  • Anxiety
  • Mood swings and/or depression

Up to 85% of menstruating women experience some of these symptoms related to their period, while only 2%-10% experience severe symptoms.

How Is PMS Diagnosed?

There is no single test to diagnose PMS. However, there are some strategies your health care provider may use to help make the diagnosis, including:

  • Thyroid test. Because thyroid disease is common in women of childbearing age, and some of the symptoms of PMS -- such as weight gain -- are similar to symptoms of thyroid disease, a test may be done to evaluate how well your thyroid is functioning. This can help to rule out a thyroid problem as a cause of your symptoms.
  • PMS symptoms diary. You may be asked to keep a diary of your PMS symptoms for two or three consecutive months, when they occur, and how long they last. By doing this, you can see if your symptoms correspond to certain times in your monthly cycle. While your symptoms may vary from month to month, a trend likely will appear after tracking them for a few months.

According to the American College of Obstetrics and Gynecology, you have PMS if:

  • Your symptoms occur during the last two weeks of your menstrual cycle (the two weeks before your period)
  • Your symptoms impair your quality of life
  • Your doctor has excluded other conditions that cause similar symptoms; these conditions include thyroid disease, depression, migraine headaches, irritable bowel syndrome, and chronic fatigue syndrome.

Can PMS Be Prevented?

PMS itself cannot be prevented, but through education and appropriate treatment of symptoms, most women can find relief. A healthy lifestyle -- including exercise, adequate rest, and a proper diet -- also can help a woman better manage PMS symptoms.

Is There a Treatment for PMS?

PMS treatment is based on relieving symptoms. Treatment begins with a thorough assessment of your symptoms and their impact on your daily life. Treatments for PMS include the following:

  • Education. You will be better able to deal with your symptoms if you can relate how you're feeling to your menstrual cycles, knowing that you will feel better once your period starts. Keeping a monthly symptom diary will help track your PMS symptoms, as well as their severity and how long they last. While symptoms may vary from month to month, this diary can give you a good idea of how your periods affect your physical health and moods. Learning how to cope with the problems in your life may help relieve the stress and irritability you feel before your period. If you experience severe anxiety, irritability, or depression, counseling and/or medication may be helpful.
  • Nutrition. A healthy diet is important to overall physical and mental wellness. Making changes in your diet -- including reducing the amount of caffeine, salt, and sugar you eat -- may help relieve PMS symptoms. In some cases, nutritional supplements may be recommended. These include vitamin B6, vitamin E, calcium, and magnesium. The American College of Obstetrics and Gynecology recommends a diet high in complex carbohydrates.
  • Exercise. Like a healthy diet, regular exercise, especially aerobic exercise like walking, can improve your overall health. It also can help relieve -- and help you cope with -- PMS symptoms.
  • Medications. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as aspirin, ibuprofen (Advil), and naproxen (Aleve) -- may help relieve symptoms such as headache, backache, cramps, and breast tenderness. Medications may be prescribed in cases of severe depression or anxiety. Certain antidepressants may be useful to treat severe PMS. Oral contraceptives have been prescribed to treat PMS and may be helpful, but there is little data to support their effectiveness. The diuretic spironolactone (available by prescription) can reduce the fluid retention of PMS.

Many small studies have looked at the use of natural progesterone, primrose oil, black cohosh, wild yam root, chaste tree fruit, dong quai, and vitamin B6 to relieve PMS symptoms. So far, these have been found to be ineffective or of limited benefit and are not recommended.

WebMD Medical Reference

Reviewed by Mikio A. Nihira, MD on August 16, 2012
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