What is premenstrual syndrome?
Premenstrual syndrome (PMS) refers to a collection of physical and emotional symptoms that may occur a week or two before the start of a woman's menstrual period and disappear after the menstrual period begins. The repeated occurrence (cyclic) nature of PMS is the only way to separate PMS from other disorders. Ninety percent of all women report experiencing PMS symptoms at some time in their lives. For some women the symptoms are so severe that work and social relationships are seriously disrupted.
Though not completely understood, many theories exist for the cause of premenstrual syndrome. Although hormonal changes that occur throughout the menstrual cycle clearly influence PMS (especially those triggered by ovulation), an imbalance between estrogen and progesterone levels has not been consistently found. Some studies have reported a deficiency of serotonin (a chemical messenger in the brain) in women with PMS, which might explain a connection with behavior. Suggested theories that target deficiencies of vitamins E and B6, magnesium, or prostaglandins (a group of fatty acids, made naturally in the body, which act in a similar way to hormones) have not been confirmed.
How is it diagnosed?
There are no physical examination findings or laboratory tests specific to the diagnosis of premenstrual syndrome (PMS). However, physicians may take a number of steps to determine whether an underlying medical condition may be causing symptoms. Conditions that may mimic PMS include depression, anxiety disorders, thyroid disorders and perimenopause (the period leading up to menopause). In addition, a number of conditions may worsen before menstruation and mimic the symptoms of PMS. These include migraines, chronic fatigue syndrome and irritable bowel syndrome. If no such condition is found, PMS may be suspected.
To rule out other potential causes of symptoms, the physician will first take a complete medical history, including menstrual history, a list of current symptoms and any medications being taken. The physician will then perform a gynecological examination, including a pelvic examination and a Pap smear (to test for cancerous or precancerous tissue in the cervix). Additional tests will vary according to the type and severity of symptoms.
If a patient does not have an underlying medical condition that explains the presence of symptoms, PMS may be suspected. The physician may recommend the patient keep a menstrual diary to document both physical and emotional/behavioral symptoms over time.
The diary enables patients to identify symptoms and determine when they occur during the menstrual cycle. It is kept over several months to identify patterns in symptoms. If symptoms occur consistently around ovulation and last until the menstruation flow begins, then PMS is usually diagnosed. The presence of the symptoms during the first half of the menstrual cycle, however, often indicates that they are being caused by another condition.
How is premenstrual syndrome treated?
Treatment options for premenstrual syndrome (PMS) vary according to the type and severity of symptoms and how bothersome they are to the patient. Patients are advised to keep a menstrual diary to better understand symptoms so they can be treated more effectively.
If symptoms are mild and do not interfere with daily living, a variety of lifestyle changes are recommended to patients. These may include:
- Nutrition. Making dietary changes can relieve symptoms of PMS or reduce their severity. This includes eating a balanced diet with whole grains, fresh fruits and vegetables, and avoiding excess salt, sugar, caffeine and alcohol, particularly when experiencing PMS symptoms. Some patients benefit from eating six small meals during the day instead of three large ones.
- Vitamins. Taking a multivitamin every day may help women with PMS.
- Exercise. Engaging in brisk walking, cycling, swimming or other aerobic activity at least 30 to 60 minutes most days of the week is recommended. Regular daily exercise can help improve overall health and alleviate symptoms. Yoga may be helpful for some patients.
- Stress reduction. Performing muscle relaxation or deep-breathing exercises may help reduce symptoms such as headaches, anxiety or insomnia. Patients may also benefit from scheduling stressful events for the week after their period.
- Rest. Getting adequate rest is important. The body may have different sleep requirements at different times during a woman's menstrual cycle.
- Over-the-counter medications. These may include pain-relievers and anti-inflammatories. There are also some medicines marketed specifically for PMS symptom relief. These usually combine a pain reliever with caffeine, antihistamines and/or diuretics.
- Diuretics (medications that increase the rate of urine production). These may help minimize bloating and weight gain associated with PMS by eliminating excess fluid in the body tissue.
- Birth control pills. These may help ease some PMS symptoms by “evening out” hormone levels throughout the menstrual cycle. However, not all women are helped by the use of birth control pills.
- Antidepressants. In severe cases, particularly in women with PMDD, antidepressants may be helpful. One example is selective serotonin reuptake inhibitors (SSRIs), which work by regulating the levels of serotonin (a brain chemical linked to mood). People with depression often have low levels of serotonin. Although traditionally reserved for more severe cases, SSRIs also may help alleviate symptoms in some women with PMS. When taken in low doses two weeks before menstruation, at the start of PMS symptoms or daily during the menstrual cycle, sertraline (a type of SSRI) can be an effective and well-tolerated treatment for moderate-to-severe PMS, according to a new study.
- GnRh agonists. May be used in severe cases of PMS to induce anovulation (absence of ovulation) and create a temporary menopausal state. These medications are prescribed only for a short period of time to avoid side effects such as hot flashes and osteoporosis.
Celexa (Citalopram), Prozac (Fluoxetine), Luvox (Fluvoxamine), Tofranil (Imipramine), Aldactone (Spironolactone), BuSpar (Buspirone), Aygestin (Norethindrone), Xanax (Alprazolam)
- Calcium. Taking 1,200 milligrams daily may reduce the physical and psychological symptoms of PMS.
- Magnesium. Taking 200 milligrams daily may help reduce fluid retention, breast tenderness and bloating in women with PMS.
- Vitamin B6. Taking 50 to 100 milligrams daily of vitamin B6 and other B vitamins may help some women with PMS symptoms.
- Vitamin E. Taking 400 international units (IU) daily may ease PMS symptoms by reducing the production of prostaglandins, which are hormone-like substances that cause cramps and breast tenderness.
- Herbal remedies. Some herbs may be marketed as relieving PMS symptoms, including black cohosh, ginger, red raspberry leaf, dandelion tea, chaste tree berry and evening primrose oil. However, studies have not proven the use of herbs to be effective, and the FDA does not regulate herbs, so their safety and effectiveness have not been proven.
- Natural progesterone creams. Creams derived from wild yams and soybeans have been marketed as relieving PMS symptoms. Some women experience relief, but their effectiveness has not been proven through scientific studies.
What might complicate it?
Individuals with more severe symptoms may need additional medical intervention. Severe emotional symptoms can disrupt work and social relationships.
PMS symptoms usually subside with the onset of the monthly menstrual period. If symptoms persist longer, another diagnosis should be considered.
Gynecologist and psychiatrist or psychologist.
Last updated 3 April 2018