Most women feel physical or mood changes during the days before menstruation. When these changes affect a woman’s normal life, they are known as premenstrual syndrome (PMS).
Premenstrual syndrome can affect menstruating women of all ages and backgrounds. The cause of PMS is unclear. However, the symptoms can be managed in many women.
The Menstrual Cycle
Menstruation is a normal, monthly process. To understand PMS, it helps to know how the menstrual cycle works. This will help you to predict and cope with the symptoms.
The average menstrual cycle lasts about 28 days. Normal cycles can range from 21–35 days. During the menstrual cycle, the ovaries produce hormones. These hormones are called estrogen and progesterone.
Day 1 of the cycle is the first day of a period. On about day 5, estrogen causes the lining of the uterus to begin to build up to prepare for a pregnancy. On about day 14, one of the ovaries releases an egg. This is called ovulation.
After ovulation, progesterone levels increase. If the egg is not fertilized by a sperm, the hormone levels decrease. This signals the uterus to shed its lining on about day 28 of the cycle. This shedding, or menstruation, marks the start of a new cycle.
Premenstrual symptoms are a common part of the monthly cycle. In fact, at least 85% of women who menstruate have at least one premenstrual symptom. Women with PMS experience a pattern of symptoms month after month. They also find that the symptoms interfere with some aspect of their family, social, or work lives.
Common Symptoms of PMS
Emotional and Behavioral Symptoms
• Angry outbursts
• Being irritable
• Crying spells
• Social withdrawal
• Poor concentration
• Sleep disturbance
• Thirst and appetite changes (food cravings)
• Tender breasts
• Bloating and weight gain
• Swelling of the hands or feet
These symptoms occur during the 2 weeks before a woman’s period and they get better after the period begins.
To diagnose PMS, a doctor must confirm a pattern of symptoms. A woman’s symptoms must:
- Be present in the 5 days before her period for at least 3 menstrual cycles in a row
- End within 4 days after her period starts
- Interfere with some of her normal activities
PMS or Something Else?
Symptoms of other conditions can mimic PMS. For instance, premenstrual dysphoric disorder (PMDD) is a severe type of PMS. PMDD affects a small percentage of women with PMS. Your doctor will want to rule out this and other conditions before diagnosing PMS.
Premenstrual Dysphoric Disorder
PMDD can cause major strain on a woman’s work and personal life. Symptoms of PMDD may include:
- Feeling hopeless or sad
- Feeling tense, anxious, or “on edge”
- Moodiness or frequent crying
- Constant irritability and anger that cause conflict with other people
- Lack of interest in things you used to enjoy
- Having problems concentrating
- Lack of energy
- Appetite changes, overeating, or cravings
- Having trouble sleeping
- Feeling overwhelmed
- Physical symptoms such as tender or swollen breasts, headaches, joint or muscle pain, bloating, and weight gain
Most of the time, symptoms begin the week before a woman’s period and end a few days after her period starts. If you’ve had at least 5 of these symptoms during most months of the past year, see your doctor. A symptom record can help your doctor decide if you have PMDD.
Depressive and Anxiety Disorders
These disorders are the most common conditions confused with PMS. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. The symptoms of these disorders may worsen before or during a woman’s period. This makes some women think they have PMS.
Women entering menopause may have PMS-like symptoms. These symptoms include mood changes and fatigue.
You can help your doctor decide if the symptoms are caused by menopause or PMS. A record of your symptoms and changes in your monthly cycle can be used to make a diagnosis.
Your doctor will want to rule out other conditions that share symptoms with PMS. These conditions include chronic fatigue syndrome, irritable bowel syndrome, and endocrine problems.
PMS also may make the symptoms of other conditions increase. These conditions include:
- Seizure disorders
The treatment of PMS depends on the severity and type of symptoms, and how bothersome they are. For example, if your symptoms are mild and do not interfere with your daily life or personal relationships, then your doctor may suggest that you try one or more of the following lifestyle changes:
· Start a program of regular exercise (three to five exercise sessions per week).
· Do not skip meals. Follow a regular meal schedule to maintain a more stable blood sugar level.
· Eat a balanced diet that is low in refined sugars.
· Try to get a good night’s sleep. Avoid staying up all night.
· If you smoke, quit.
· Cut down on caffeine, alcohol, red meat and salty foods.
· Practice stress reduction techniques. Take a nice long bath, or try meditation or biofeedback.
Your doctor also may suggest that you try taking supplements of vitamin B6, calcium or magnesium. Always follow the dosage recommended by your doctor. Do not take more than 100 milligrams per day of vitamin B6. Nerve damage has been associated with vitamin B6 at doses higher than 100 milligrams per day.
If your symptoms are moderate to severe and interfere with your normal daily activities, then your doctor probably will prescribe medications aimed at relieving specific symptoms.
For example, if you are troubled by bloating and weight gain, then your doctor may prescribe a diuretic to help your body eliminate the excess water. Oral contraceptives, especially birth control pills containing both estrogen and progestin, may be used to minimize the severity of cramps and the length of your period.
If you have symptoms of irritability, social withdrawal, angry outbursts or depression that interferes with your work or home responsibilities or your personal relationships, then your doctor may suggest that you try an antidepressant medication. The most effective antidepressants for relieving PMS are selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac, Sarafem and others), sertraline hydrochloride (Zoloft) and clomipramine (Anafranil). Other antidepressants include nefazodone (Serzone) and venlafaxine (Effexor). These can be taken for two weeks prior to each period or can be taken every day.
For very severe symptoms, or when other medications fail, your doctor may prescribe a medication that causes the ovaries to stop producing estrogen so that ovulation stops. Danocrine (Danazol) is a synthetic androgen that suppresses the hormones in the brain that trigger ovulation. Gonadotropin-releasing hormone (GRNH) agonists, such as leuprolide (Lupron), create a temporary menopausal state by suppressing hormones in the brain that control the production of ovarian hormones and ovulation. These medications can be used only for short periods of time. They commonly lead to hot flashes and other symptoms of menopause. If therapy needs to continue for more than six months, you will also have to take estrogen to prevent bone loss. Whether your symptoms are mild or severe, it always helps to have your family’s understanding and support while you are being treated for PMS. For this reason, your doctor will encourage you to speak frankly with family members about your symptoms and your PMS treatment.
When To Call A Professional
Call your doctor if your premenstrual symptoms cause you significant distress or discomfort, if they make it hard for you to function in daily life, or if they interfere with your personal relationships. If you think you are in danger of causing harm to yourself or others, call your doctor for an emergency appointment.
In most women, PMS symptoms begin to subside after age 35 and end at menopause. Women who have PMS or PMDD are at greater risk of developing depression