Premenstrual Syndrome (PMS)

What is premenstrual syndrome?

Most women experience some unpleasant or uncomfortable symptoms during their menstrual cycle. For some women, the symptoms are significant, but of short duration and not disabling. Other women, however, may have one or more of a broad range of symptoms that temporarily disturb normal functioning. These symptoms may last from a few hours to many days. The types and intensity of symptoms vary in individuals. This group of symptoms is referred to as premenstrual syndrome, or PMS. Although the symptoms usually cease with onset of the menstrual period, in some women, symptoms may last through and after their menstrual periods.

Who is affected by PMS?

According to the American College of Obstetricians and Gynecologists, nearly 85 percent of women, during their reproductive years, experience at least one of the common symptoms associated with PMS. It is estimated that 5 percent of women have symptoms so extreme that they are considered disabled by the condition.

In general, women most likely to experience PMS symptoms are between the ages of 20 and 40—and particularly women from this age group who have one child and have a history of depression in their family.

What are the symptoms of PMS?

The following are the most common symptoms of premenstrual syndrome. However, each individual may experience symptoms differently. Symptoms may include:

Psychological symptoms Irritability Nervousness Lack of control Agitation Anger Insomnia Difficulty in concentrating Lethargy Sadness Depression Severe fatigue Anxiety Confusion Forgetfulness Decreased self-image Paranoia Emotional hypersensitivity Crying spells Moodiness Sleep disturbances Fluid retention Edema (swelling of the ankles, hands, and feet) Periodic weight gain Oliguria (diminished urine formation) Breast fullness and pain Respiratory problems Allergies Infections Eye complaints Visual disturbances Conjunctivitis

Gastrointestinal symptoms Abdominal cramps Bloating Constipation Nausea Vomiting Diarrhea Pelvic heaviness or pressure Backache Skin problems Acne Neurodermatitis (skin inflammation with itching) Aggravation of other skin disorders, including cold sores Neurologic and vascular symptoms Headache Vertigo Syncope (fainting) Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs Easy bruising Heart palpitations Muscle spasms Other Decreased coordination Painful menstruation Diminished libido (sex drive) Appetite changes Food cravings Hot flashes

The symptoms of PMS may resemble other conditions or medical problems. Consult a health care provider for diagnosis.

What causes PMS?

The cause of premenstrual syndrome is unclear, but seems to be related to fluctuations in estrogen and progesterone levels in the body, and does not necessary denote disabled ovarian functioning. Social, cultural, biological, and psychological factors have been identified as possible contributors of PMS.

Preventing premenstrual syndrome symptoms

For some women, making simple lifestyle changes helps to reduce the occurrence of PMS symptoms. These changes may include:

• Regular exercise (three to five times each week)

• A well-balanced diet. It is generally recommended that women with PMS increase their intake of whole grains, vegetables, and fruit, while decreasing their intake of salt, sugar, caffeine, and alcohol.

• Adequate sleep and rest

• Not smoking

How to diagnose premenstrual syndrome

Aside from a complete medical history and physical and pelvic examination, diagnostic procedures for PMS are currently very limited. Your health care provider may consider recommending a psychiatric evaluation to, more or less, provide a differential diagnosis (to rule out other possible conditions). In addition, he or she may ask that you keep a journal or diary of your symptoms for several months to better assess the timing, severity, onset, and duration of symptoms.

Treatment for PMS

Specific treatment for PMS will be determined by your health care provider based on:

• Your age, overall health, and medical history

• Extent of the condition

• Current symptoms

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Counseling with your health care provider regarding symptoms can often increase understanding and lead to activities for stress management. Other possible treatments for managing PMS symptoms may include:

• Diuretic use prior to the time symptoms are usually noted (to reduce fluid retention)

• Prostaglandin inhibitors (i.e., nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin, ibuprofen) to reduce pain

• Oral contraceptives (ovulation inhibitors)

• GnRH agonists (used to temporarily stop ovarian production of estrogen and progesterone to relieve symptoms)

• Tranquilizers

• Changing the diet (to increase protein and decrease sugar and caffeine intake)

• Vitamin supplements (i.e., vitamin B6, calcium, and magnesium)

• Regular exercise

• Antidepressants (or other medications)