Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Premenstrual Syndrome

(PMS; Premenstrual Tension Syndrome)
by Amy Scholten, MPH
Definition

Premenstrual syndrome (PMS) is a disorder marked by physical and emotional symptoms. It affects women 1-2 weeks before the beginning of their menstrual period.

Causes

The cause is unknown. A combination of environmental, metabolic, and behavioral factors may make women vulnerable to the specific actions of hormonal changes linked to menstruation. A brain chemical, serotonin, may play a role in severe forms of PMS .

Risk Factors

These factors increase your chance of developing PMS. Tell your doctor if you have any of these risk factors:

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

If you have any of these symptoms do not automatically assume they are due to PMS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

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

Symptoms usually improve when bleeding starts (menstrual period).

Diagnosis

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

You will be asked to keep a very detailed record of your monthly physical and emotional symptoms. If caused by PMS, these symptoms will likely occur 1-2 weeks before your menstrual period. You may have PMS if 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 always be effective for all symptoms. Treating one or two symptoms may 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 reduce PMS symptoms:

  • Calcium (1,000 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
  • Vitamin E (400 IU)—may reduce breast tenderness
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 relieve cramps, headaches, and muscle aches.

Combined oral contraceptives (containing estrogen and progesterone) may help physical symptoms linked to PMS. You may need to try several brands before finding one that helps. Progesterone alone (without estrogen) may also help some women.

Selective serotonin reuptake inhibitors are a type of antidepressant medication that affect the level of serotonin in the brain. Women who have severe PMS may find relief with SSRIs. Examples of this type of medication include:

  • Citalopram (Celexa)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
Sexual Activity With Orgasm

Sexual activity (including masturbation) may 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 reduce negative emotions and enhance problem-solving skills in relationships. It may also manage obstacles, frustrations, and discomfort.

Prevention

To help reduce your chance of getting PMS, take the following steps:

Last reviewed: August 2010 by Ganson Purcell Jr., MD, FACOG, FACPE .

RESOURCES:
CANADIAN RESOURCES:
References:
  • American College of Obstetricians and Gynecologists. Practice bulletin: premenstrual syndrome. ACOG. No. 15. April 2000.
  • Brown J, O'Brien P, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2008;CD001396,
  • Department of Obstetrics and Gynecology. US Department of Health and Human Services website. Available at: http://www.hhs.gov/ . Accessed June 15, 2008.
  • Frye GM, Silverman SD. Is it premenstrual syndrome? Keys to focused diagnosis, therapies for multiple symptoms. Postgrad Med . 2000;107(5).
  • Premenstrual syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed October 14, 2005.
  • Premenstrual syndrome. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/premenstrualsyndrome.html . Accessed October 14, 2005.
  • 4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Brown J, Shaughn O'Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001396.