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Premenstrual Syndrome (PMS)
What is premenstrual syndrome (PMS)?
Premenstrual syndrome (PMS) is a combination of symptoms that can affect your body, your mood, and how you act in the days before your menstrual period. Most women have tender breasts, bloating, and muscle aches a few days before their periods. These are normal premenstrual symptoms. But when symptoms disrupt your daily life, they are called PMS.
Some women first get PMS in their teens or 20s. Others don't get it until their 30s. The symptoms may get worse in your late 30s and 40s, as you approach perimenopause.
What causes it?
PMS is tied to hormone changes that happen during your menstrual cycle. Doctors aren't sure why premenstrual symptoms are worse in some women than others. Not getting enough vitamin B6, calcium, or magnesium in the foods you eat can increase your chances of getting PMS. For many women, PMS runs in the family.
What are the symptoms?
Common physical signs of PMS include bloating, swollen and tender breasts, lack of energy, headaches, cramps, and low back pain. It's also common to feel sad, angry, grouchy, or anxious. You may feel less alert, have trouble focusing, or withdraw from others. Symptoms occur between ovulation and the start of menstrual bleeding.
How is it diagnosed?
No single test can diagnose PMS. Your doctor will ask questions about your symptoms and will do a physical exam. Your doctor will want you to keep a written record of your symptoms for 2 to 3 months. This is called a menstrual diary. Your doctor can use it to help diagnose PMS.
How is PMS treated?
No single treatment works for all women. Lifestyle changes, such as healthy eating, regular exercise, and cutting back on alcohol and caffeine may help. If these changes don't help to relieve your symptoms after a few menstrual cycles, your doctor can prescribe medicine for problems like bloating or for more severe PMS symptoms.
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Premenstrual symptoms occur between ovulation and the start of menstrual bleeding. More than 150 symptoms have been linked to PMS. They may vary greatly from cycle to cycle and be worse during times of more stress.
Common physical symptoms include:
- Bloating, weight gain.
- Fatigue, lack of energy.
- Cramps, aching muscles and joints, low back pain.
- Breast swelling and tenderness.
- Food cravings, especially for sweet or salty foods.
- Sleeping too much or too little.
- Low sex drive.
- Constipation or diarrhea.
Other symptoms affect mood and behavior. They include:
- A sad or depressed mood.
- Anger, irritability, aggression.
- Mood swings.
- Decreased alertness, trouble concentrating.
- Withdrawal from family and friends.
Some medical problems may get worse between ovulation and the first day of menstrual bleeding. The conditions most affected include:
- Mental health problems such as depression and anxiety disorders.
- Seizure disorders.
- Irritable bowel syndrome (IBS).
- Myalgic encephalomyelitis/chronic fatigue syndrome.
Most women first get PMS in their mid-20s, but it becomes more common in their 30s. Women in their late 30s and early 40s may have perimenopausal symptoms that are like PMS and premenstrual dysphoric disorder (PMDD). After menopause, when hormones are low and don't rise and fall each month, women don't have PMS.
When to Call a Doctor
Call your doctor if:
- PMS symptoms regularly disrupt your life.
- You feel out of control because of PMS symptoms.
- Home treatments don't help.
- Severe PMS symptoms (such as depression, anxiety, irritability, crying, or mood swings) don't end a couple of days after your menstrual period starts.
Exams and Tests
No single test can diagnose PMS. Your doctor will ask questions about your symptoms and do a physical exam. It's important to make sure that your symptoms aren't caused by something else. So it may take more than one visit to diagnose your symptoms.
Your doctor will want you to keep a written record of your symptoms for 2 to 3 months. This is called a menstrual diary. It can help you track when your symptoms start, how bad they are, and how long they last. Your doctor can use this diary to help diagnose PMS.
Thyroid problems sometimes cause symptoms like those of PMS. So you may have a thyroid-stimulating hormone (TSH) blood test to make sure that your thyroid gland is working as it should.
There are ways to reduce your PMS symptoms and their impact on your life. But no single treatment works for all women. You may have to try several to find the right choices for you.
The first step is to make lifestyle changes. These are things like limiting caffeine and getting regular exercise.
If you still have moderate to severe symptoms after you try home treatment for two or three cycles, talk to your doctor. You can try other treatment options. These may include taking selective serotonin reuptake inhibitor (SSRI) antidepressants or low-estrogen birth control pills.
Self-care for PMS means practicing healthy habits, managing pain, and reducing stress. When you use these tips, it's best to try one or two at a time. This will help you find which tips are most helpful.
- Keep a menstrual diary.
Write down your symptoms, how severe they are, when you have your period, and when you ovulate. This can help you find patterns in your cycle and plan ahead to better cope with symptoms.
- Practice healthy habits.
- Get at least 2½ hours of moderate exercise a week. Exercise may help relieve tension, pain, and mood-related PMS symptoms.
- Eat a variety of healthy foods, especially foods rich in calcium. Include whole grains, protein, low-fat dairy, fruits, and vegetables.
- Limit caffeine, alcohol, chocolate, and salt.
- Quit smoking, if you smoke.
- Manage pain.
- Use a nonsteroidal anti-inflammatory drug (NSAID) such as naproxen or ibuprofen to relieve pain and reduce menstrual bleeding. Try to start taking an NSAID 1 or 2 days before you expect pain to start. NSAIDs work best when taken before and at regular intervals throughout the days you have pain.
- Wear a more supportive bra, such as a sports bra, when your breasts are tender.
- Reduce stress.
- Try some relaxation techniques, such as breathing exercises, yoga, or massage therapy.
- Practice better time management.
- Get enough sleep.
- Create a support system. Join a support group of women who are managing PMS. With your loved ones, plan ways to reduce the demands placed on you when you have PMS.
If you have moderate to severe premenstrual symptoms even after you've tried home treatment and lifestyle changes, talk to your doctor about using medicine.
Commonly used medicines include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen and naproxen relieve premenstrual pain and cramps. They also reduce menstrual bleeding. They work best when taken before and during the premenstrual pain period.
- Selective serotonin reuptake inhibitors (SSRIs). SSRIs such as citalopram, fluoxetine, and paroxetine may help relieve physical and emotional symptoms of PMS. You can take them during the premenstrual weeks only. Or you can take them continuously.
- Hormonal birth control. A low-estrogen birth control pill may help relieve symptoms of severe PMS or premenstrual dysphoric disorder (PMDD). Other types of birth control pills are widely prescribed for PMS. They may improve bloating, headache, belly pain, and breast tenderness.
- Diuretics. They may reduce bloating and breast tenderness if taken during the premenstrual weeks.
Several complementary therapies are commonly used for PMS. These include bright light therapy to help with mood. Calcium and magnesium may help with certain symptoms. Some women use vitamin E to help with breast tenderness.
Other therapies are sometimes used for PMS. Black cohosh might help relieve symptoms of PMS. Zinc may help improve PMS-related acne. Vitex might help relieve irritability, anger, breast tenderness, bloating, cramping, and headaches. Ginkgo biloba may reduce breast tenderness, bloating, and weight gain. Evening primrose oil may help relieve breast tenderness.
Most of these complementary therapies aren't considered standard treatment for PMS. But you may find that one or more of them helps relieve some of your symptoms. These treatments are generally safe and don't cause bothersome side effects.
Before you try any of these therapies, talk with your doctor or pharmacist. He or she can find out if it might interfere with medicines you are taking.
Current as of: February 11, 2021
Author: Healthwise Staff
Sarah Marshall MD - Family Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Kirtly Jones MD - Obstetrics and Gynecology
Current as of: February 11, 2021
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