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Pronunciations aldosterone amenorrhea arthritis dermatitis dysmenorrhea polycystic progesterone scratch dermatitis uterine

Premenstrual syndrome (PMS) is a group of physical and psychologic symptoms that start several days before and usually end a few hours after a menstrual period begins.

• PMS includes any combination of the following: becoming irritable, anxious, moody, or depressed or having headaches or sore, swollen breasts.
• Doctors base the diagnosis on symptoms, which are usually tracked in a monthly calendar.
• Consuming less sugar, salt, and caffeine and exercising may help relieve symptoms, as does taking certain supplements, pain relievers, birth control pills (sometimes), or antidepressants.

Because so many symptoms, such as a bad mood, irritability, bloating, and breast tenderness, have been ascribed to PMS, defining and identifying PMS can be difficult. PMS affects 20 to 50% of women. About 5% of women of reproductive age have a severe form of PMS called premenstrual dysphoric disorder.

PMS may occur partly because estrogen and progesterone Some Trade Names
CRINONEENDOMETRIN
levels fluctuate during the menstrual cycle. Some women are more sensitive to these fluctuations. Also, in some women with PMS, progesterone Some Trade Names
CRINONEENDOMETRIN
may be broken down differently. Progesterone Some Trade Names
CRINONEENDOMETRIN
is usually broken down into two components that have opposite effects on mood. Women with PMS may produce less of the component that tends to reduce anxiety and more of the component that tends to increase anxiety.

The fluctuations in estrogen and progesterone Some Trade Names
CRINONEENDOMETRIN
may affect other hormones, such as aldosterone, which helps regulate salt and water balance. Excess aldosterone can cause fluid retention and bloating.

Symptoms

The type and intensity of symptoms vary from woman to woman and from month to month in the same woman. The various physical and psychologic symptoms of PMS can temporarily upset a woman's life.

Symptoms may begin a few hours up to about 10 days before a menstrual period, and they often disappear completely a few hours after the period begins. Women who are approaching menopause may have symptoms that persist through and after the menstrual period. The symptoms of PMS are may be followed each month by a painful period (dysmenorrhea), particularly in teenagers.

Other disorders may worsen while PMS symptoms are occurring. They include the following:

• Seizure disorders, with more seizures than usual
• Connective tissue disorders (such as lupus or rheumatoid arthritis), with flare-ups
• Respiratory disorders (such as allergies and congestion of the nose and airways)

In premenstrual dysphoric disorder, premenstrual symptoms are so severe that they interfere with work, social activities, or relationships.

Symptoms That Can Occur in Premenstrual Syndrome Physical Awareness of heartbeats (palpitations) Backache Bloating Breast fullness and pain Changes in appetite and cravings for certain foods Constipation Cramps, heaviness, or pressure in the lower abdomen Dizziness, including vertigo Easy bruising Fainting Fatigue Headaches Hot flashes Insomnia, including difficulty falling or staying asleep at night Joint and muscle pain Lack of energy Nausea and vomiting Pins-and-needles sensations in the hands and feet Skin problems, such as acne and localized scratch dermatitis Swelling of hands and feet Weight gain Psychologic Agitation Anxiety Confusion Crying spells Depression Difficulty concentrating Emotional hypersensitivity Irritability Forgetfulness or memory loss Mood swings Nervousness Short temper Social withdrawal

Diagnosis

The diagnosis is based on symptoms. To identify PMS, doctors ask a woman to keep a daily record of her symptoms. This record helps the woman be aware of changes in her body and moods and helps doctors identify any regular symptoms and determine what treatment is best. Premenstrual dysphoric disorder cannot be diagnosed until a woman has recorded her symptoms for at least two menstrual cycles. Doctors can distinguish premenstrual syndrome and premenstrual dysphoric disorder from mood disorders, such as depression, because the symptoms disappear soon after the menstrual period begins.

Did You Know... Taking birth control pills sometimes relieves symptoms but may make them worse.

Treatment

Women can do the following to help relieve symptoms:

• Get enough rest and sleep
• Exercise regularly, which may help lessen bloating as well as irritability, anxiety, and insomnia
• Use stress reduction techniques (meditation or relaxation exercises)
• Avoid stressful activities
• Consume more protein and calcium and less sugar and caffeine (including that in chocolate)
• Consume less salt, which often reduces fluid retention and relieves bloating
• Take certain supplements: vitamin B complex (especially vitamin B₆), calcium (1,000 milligrams a day), vitamin D Some Trade Names
  See Ergocalciferol
  , and magnesium

Women should talk to their doctor before they take supplements, especially vitamin B₆, which may be harmful if taken in high doses. Nerve damage is possible with as little as 200 milligrams a day.

Doctors may prescribe diuretics (which help the kidneys eliminate salt and water from the body) to help reduce fluid retention.

Taking nonsteroidal anti-inflammatory drugs (NSAIDs—see Pain: Nonsteroidal Anti-Inflammatory Drugs) may help relieve headaches, pain due to abdominal cramps, and joint pain. Taking combination oral contraceptives (birth control pills that contain estrogen and a progestin) reduces pain, breast tenderness, and changes in appetite in some women but worsens these symptoms in a few. Taking oral contraceptives that contain only a progestin does not help.

Women who have more severe symptoms may benefit from taking fluoxetine Some Trade Names
PROZAC
, paroxetine Some Trade Names
PAXIL
, or sertraline Some Trade Names
ZOLOFT
, which are antidepressants (see Mood Disorders: Drugs Used to Treat Depression). These drugs are used to prevent symptoms, and to be effective, they should be taken before symptoms begin. Taking these drugs after symptoms begin usually does not relieve symptoms as well as taking them prior to onset. They are most effective in reducing irritability, depression, and some other symptoms of PMS. Doctors may ask a woman to continue keeping a record of her symptoms so that they can judge the effectiveness of treatment.

Women who have premenstrual dysphoric disorder may benefit from taking antidepressants such as fluoxetine Some Trade Names
PROZAC
, paroxetine Some Trade Names
PAXIL
, or sertraline Some Trade Names
ZOLOFT
. Taking a gonadotropin-releasing hormone (GnRH) analogue (such as leuprolide Some Trade Names
LUPRON
or goserelin Some Trade Names
ZOLADEX
—see Drugs Commonly Used to Treat Endometriosis), given by injection, may control symptoms. This drug is a synthetic form of a hormone produced by the body. GnRH analogues cause the body to produce less estrogen and progesterone Some Trade Names
CRINONEENDOMETRIN
. Thus, these drugs are used with estrogen plus a progestin, taken in a low dose by mouth or patch.

Last full review/revision December 2008 by JoAnn V. Pinkerton, MD