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Premenstrual syndrome (PMS)
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Premenstrual syndrome (PMS) is a tricky condition to identify, partly because it has such a wide variety of signs and symptoms. Mood swings, tender breasts, food cravings, fatigue, irritability and depression are among the most common symptoms of PMS. What ties these seemingly unrelated problems together is that they affect you only in the days before your monthly period.
An estimated three of every four menstruating women experience some form of premenstrual syndrome. These problems are more likely to trouble women between their late 20s and early 40s, and they tend to recur in a predictable pattern. Yet the physical and emotional changes you experience with premenstrual syndrome may be particularly intense in some months and only slightly noticeable in others.
Still, you don't have to let these problems control your life. In recent years, much has been learned about premenstrual syndrome. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.
Symptoms
The most common signs and symptoms associated with premenstrual syndrome include:
Emotional and behavioral symptoms
- Tension or anxiety
- Depressed mood
- Crying spells
- Mood swings and irritability or anger
- Appetite changes and food cravings
- Trouble falling asleep (insomnia)
- Social withdrawal
- Poor concentration
Physical signs and symptoms
- Joint or muscle pain
- Headache
- Fatigue
- Weight gain from fluid retention
- Abdominal bloating
- Breast tenderness
- Acne flare-ups
- Constipation or diarrhea
Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems.
For some women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, signs and symptoms disappear as the menstrual period begins.
But a small proportion of women with premenstrual syndrome have disabling symptoms every month. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder.
Causes
Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition. Cyclic changes in hormones seem to be an important cause, because signs and symptoms of premenstrual syndrome change with hormonal fluctuations and also disappear with pregnancy and menopause.
Chemical changes in the brain also may be involved. Fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states could trigger the symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms. Stress also may aggravate some of the symptoms, but alone it isn't a cause.
Some PMS symptoms have been linked to low levels of vitamins and minerals. Other possible contributors to PMS include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances.
When to seek medical advice
If you've had no luck managing your premenstrual syndrome with lifestyle changes, and signs and symptoms of PMS are seriously affecting your health and daily activities, see your doctor.
Tests and diagnosis
There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it's part of your predictable premenstrual pattern. To establish a pattern, your physician may ask you to keep a record of your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first noticed your PMS symptoms, as well as the day they disappeared. Also be sure to mark the day your period started and ended. Alternatively, completing a questionnaire on the first day of your period describing your symptoms during the prior two weeks can help your doctor know whether you would benefit from further evaluation.
Treatments and drugs
Your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for premenstrual syndrome include:
- Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and others, have been successful in reducing symptoms such as fatigue, food cravings and sleep problems and are the first line agents for treatment of severe PMS or PMDD. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
- Diuretics. When exercise and limiting salt intake aren't enough to reduce the weight gain, swelling and bloating of PMS, taking diuretics, or water pills, can help your body shed excess water through your kidneys. Spironolactone is a diuretic that can help ease some of the symptoms of PMS.
- Oral contraceptives. These prescription medications stop ovulation and stabilize hormonal swings, thereby offering relief from PMS symptoms. Yaz, a type of birth control pill containing the progestin drospirenone, which acts similarly to the diuretic spironolactone, has been shown to be even more effective than regular birth control pills are in reducing the physical and emotional symptoms of PMS and PMDD.
- Medroxyprogesterone acetate (Depo-Provera). For severe PMS or PMDD, this injection can be used to temporarily stop ovulation. However, Depo-Provera may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache and depressed mood.
Lifestyle and home remedies
You can manage or sometimes reduce the symptoms of premenstrual syndrome by making changes in the way you eat, exercise and approach daily life. Try these approaches:
Modify your diet
- Eat smaller, more frequent meals each day to reduce bloating and the sensation of fullness.
- Limit salt and salty foods to reduce bloating and fluid retention.
- Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.
- Choose foods rich in calcium. If you can't tolerate dairy products or aren't getting adequate calcium in your diet, you may need a daily calcium supplement.
- Take a daily multivitamin supplement.
- Avoid caffeine and alcohol.
Incorporate exercise into your regular routine
Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week. Regular daily exercise can help improve your overall health and alleviate symptoms such as fatigue and a depressed mood.
Reduce stress
- Get plenty of sleep.
- Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia).
- Try yoga or massage as ways to relax and relieve stress.
Record your symptoms for a few months
Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.
Alternative medicine
Here's what's known about the effectiveness of some of the more common complementary products and remedies used to soothe the symptoms of premenstrual syndrome:
- Calcium. Consuming 1,200 milligrams (mg) of dietary and supplemental calcium daily, such as chewable calcium carbonate (Tums, Rolaids, others), may reduce the physical and psychological symptoms of PMS. Regular, long-term use of calcium carbonate also reduces your risk of osteoporosis.
- Magnesium. Taking 400 mg of supplemental magnesium daily may help to reduce fluid retention, breast tenderness and bloating in women with premenstrual syndrome.
- Vitamin B-6. A daily dose of 50 to 100 mg of vitamin B-6 may help some women with troublesome PMS symptoms.
- Vitamin E. This vitamin, taken in 400 international units daily, may ease PMS symptoms by reducing the production of prostaglandins, hormone-like substances that cause cramps and breast tenderness.
- Herbal remedies. Some women report relief of PMS symptoms with the use of herbs such as black cohosh, ginger, raspberry leaf, dandelion, chasteberry and evening primrose oil. However, few scientific studies prove the effectiveness of herbs thought to help reduce the effects of PMS. The Food and Drug Administration does not regulate herbs. That means their safety and effectiveness is not proved. You have no assurance that the product you buy contains the active ingredients on the label or that it isn't contaminated with other potentially harmful substances.
- Natural progesterone creams. These are derived from wild yams and soybeans. Some women report that these creams relieve symptoms. No scientific studies prove their effectiveness.
Check with your doctor before taking any herb or dietary supplement.
