PMS (Premenstrual Syndrome)
What is Premenstrual Syndrome?
Premenstrual syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior on certain days of the menstrual cycle, usually just before her periods.
PMS is a very common condition. Its symptoms affect more than 90% of menstruating women.
premenstrual syndrome symptoms begin 5 to 11 days before menstruation and typically subside when menstruation begins. The cause of PMS is unknown.
However, many researchers believe it is related to a change in the level of both the sex hormone and serotonin at the beginning of the menstrual cycle.
At certain times of the month, estrogen and progesterone levels increase. The increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroids also regulate activity in parts of your brain associated with premenstrual symptoms.
Serotonin levels affect the mood. Serotonin is a chemical in your brain and gut that affects your mood, emotions, and thoughts.
Risk factors for premenstrual syndrome include:
- a history of depression or mood disorder, such as postpartum depression or bipolar disorder
- family history of PMS
- Family history of depression
- domestic violence
- substance abuse
- physical trauma
- Emotional trauma
Relevant conditions include:
- major depressive disorder
- seasonal affective disorder
- generalized anxiety disorder
A woman’s menstrual cycle lasts an average of 28 days.
Ovulation occurs on day 14 of the cycle, the period in which an egg is released from the ovaries. Menstruation or bleeding occurs on the 28th day of the cycle. PMS symptoms can begin around day 14 and last up to seven days after the onset of menstruation.
PMS symptoms are usually mild or moderate. According to the American Family Physician magazine, about 80% of women report having one or more symptoms that do not greatly affect their daily functioning.
Between 20 and 32 percent of women report moderate to severe symptoms that affect some portion of life. 3 to 8 percent report PMDD. The severity of symptoms can vary by person and by month.
PMS symptoms include:
- Abdominal bloating
- Stomach ache
- sore breasts
- Cravings, especially dessert cravings
- sensitivity to light or sound
- Changes in sleep patterns
- emotional outbursts
When to See Your Doctor
See your doctor if physical pain, mood swings, and other symptoms begin to interfere with your daily life or if your symptoms do not go away.
Diagnosis is made when multiple recurrent symptoms are present in the time period, severe enough to cause deterioration, and absent between menses and ovulation. Your doctor may also:
- thyroid disease
- irritable bowel syndrome (IBS)
- chronic fatigue syndrome
- Connective tissue or rheumatological diseases
Your doctor may ask for any family history of depression or mood disorders to determine if your symptoms are the result of PMS or another condition. Some conditions, such as IBS, hypothyroidism, and pregnancy, have symptoms similar to PMS.
Your doctor may do a thyroid hormone test to make sure your thyroid gland is working properly, a pregnancy test, and possibly a pelvic exam to check for gynecological problems.
Keeping a diary of your symptoms is another way to determine if you have PMS. Use a calendar to track your symptoms and periods each month. If your symptoms start at the same time each month, PMS is a possible cause.
Alleviation of PMS Symptoms
You can’t cure PMS, but you can take steps to relieve your symptoms. If you have a mild or moderate form of premenstrual syndrome, treatment options include:
- drinking plenty of fluids to relieve abdominal bloating
- Eating a balanced diet to improve your overall health and energy levels, which means eating plenty of fruits and vegetables and reducing your intake of sugar, salt, caffeine and alcohol
- taking supplements such as folic acid, vitamin B-6, calcium, and magnesium to reduce cramps and mood swings
- Taking vitamin D to reduce symptoms
- Getting at least eight hours of sleep per night to reduce fatigue
- Exercise to reduce bloating and improve your mental health
- Reducing stress, such as exercising and reading
- Go to cognitive behavioral therapy where it’s effective
You can take pain medications such as ibuprofen or aspirin to relieve muscle aches, headaches, and abdominal cramps. You can also try a diuretic to stop bloating and water weight gain. Take medications and supplements only after talking and speaking with your doctor.
You can shop for these products on the online web pages:
- folic acid supplements
- Vitamin B-6 supplements
- calcium supplements
- magnesium supplements
- Vitamin D supplements
Severe PMS: Premenstrual Dysphoric Disorder
Severe PMS symptoms are rare. A small percentage of women with severe symptoms have premenstrual dysphoric disorder (PMDD). PMDD affects between 3% and 8% of women. This is described in the new edition of the Diagnostic and Statistical Manual of Mental Disorders.
Symptoms of PMDD can include:
- suicidal thoughts
- panic attacks
- extreme anxiety
- Anger with severe mood
- crying crises
- Lack of interest in daily activities
- insomnia disease
- Difficulty thinking or focusing
- eat too much
- painful cramp
PMDD symptoms can be caused by changes in your estrogen and progesterone levels. There is also a link between low serotonin levels and PMDD.
Your doctor may do the following to rule out other medical problems:
- Physical examination
- gynecological examination
- a complete blood count
- a liver function test
They may also recommend a psychiatric evaluation. A personal or family history of major depression, substance abuse, trauma, or stress can trigger or worsen PMDD symptoms.
Treatment for PMDD varies. Your doctor may suggest:
- daily exercise
- Vitamin supplements such as calcium, magnesium, and vitamin B-6
- a caffeine-free diet
- Individual or group consultation
- stress management classes
- drospirenone and ethinyl estradiol tablet, the only birth control pill approved by the Food and Drug Administration to treat symptoms of PMDD
If your PMDD symptoms still don’t improve, your doctor may give you a selective serotonin reuptake inhibitor (SSRI) antidepressant. This drug increases the level of serotonin in your brain and has many roles in regulating brain chemistry, not limited to depression.
Your doctor may also recommend cognitive behavioral therapy, a form of counseling that can help you understand your thoughts and feelings and change your behavior accordingly.
You cannot prevent PMS or PMDD, but the treatments mentioned above can help reduce the severity and duration of your symptoms.
Long Term PMS
PMS and PMDD symptoms may recur, but they usually go away after the onset of menstruation. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate most women’s symptoms.
How do PMS symptoms change as a woman approaches perimenopause and menopause?
As a woman approaches menopause, ovulation cycles become sporadic as ovarian sex hormone production decreases. The result is a heterogeneous and somewhat unpredictable course of symptoms. Using hormonal treatments to treat some of the symptoms of menopause, such as hot flashes, can further alter the symptoms. As menopause approaches, women should consult their doctor if symptoms change or new symptoms appear.
Biggs, WS and Demuth, RH (2011, October 15). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American Family Practice, 84 (8), 918-924
Premenstrual dysmorphic disorder (PMDD). (2014, 11 December)
Premenstrual syndrome (PMS) fact sheet. (2014, December 23)