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Premenstrual syndrome (PMS)

 Premenstrual syndrome (PMS)



Overview

Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It's estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome.

Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from just slightly noticeable all the way to intense.

Still, you don't have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.

Symptoms

The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems.

Emotional and behavioral signs and 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

Change in libido

Physical signs and symptoms

Joint or muscle pain

Headache

Fatigue

Weight gain related to fluid retention

Abdominal bloating

Breast tenderness

Acne flare-ups

Constipation or diarrhea

Alcohol intolerance

For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days after the start of the menstrual period for most women.

But a small number of women with premenstrual syndrome (PMS) have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).

PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.

Causes

Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:

Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.

Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that's thought to play a crucial role in mood states, could trigger premenstrual syndrome (PMS) symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.

Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms

Diagnosis

There are no unique physical findings or lab 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 help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also be sure to mark the days your period starts and ends.

Certain conditions may mimic PMS, including chronic fatigue syndrome, thyroid disorders and mood disorders, such as depression and anxiety. Your health care provider may order tests, such as a thyroid function test or mood screening tests to help provide a clear diagnosis.

Treatment

For many women, lifestyle changes can help relieve premenstrual syndrome (PMS) symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome.

The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include:

Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or premenstrual dysphoric disorder (PMDD). These medications 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 IB, 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 water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.

Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms.

Type of Doctor Department : A general practitioner (GP) or a gynecologist

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