Understanding PMS

Premenstrual syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the month generally just before her menstrual period.

PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown. However, many researchers believe that a change in hormone levels at the beginning of the menstrual cycle may be to blame. Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability.

PMS symptoms affect about 75 percent of menstruating women.

Risk factors for premenstrual syndrome include:

  • a history of depression or mood disorders, such as postpartum depression or bipolar disorder
  • a family history of depression

Symptoms of PMS

The average woman’s menstrual cycle lasts 28 days. Ovulation (when an egg is released from the ovaries) occurs on day 14 of the cycle. Menstruation (bleeding) occurs on day 28 of the cycle. PMS symptoms can begin around day 14 and last until seven days after the start of menstruation.

Symptoms of PMS may be mild or moderate, and the severity of symptoms can vary by individual and by month. Symptoms of PMS include:

  • abdominal bloating and pain
  • sore breasts
  • acne
  • food cravings
  • constipation
  • diarrhea
  • headaches
  • sensitivity to light or sound
  • fatigue
  • irritability
  • changes in sleep patterns
  • forgetfulness
  • anxiety
  • depression or sadness
  • emotional outbursts

When Should You Visit the Doctor?

If physical pain, mood swings, and other symptoms start to affect your daily life, or if your symptoms do not go away, you should make a doctor’s appointment to have yourself checked for other medical conditions.

Your doctor may ask about any history of depression or mood disorders in your family to determine whether your symptoms are caused by PMS or another condition. Some conditions, such as irritable bowel syndrome, hypothyroidism, and pregnancy, have symptoms similar to PMS. Your doctor may do a thyroid hormone test to ensure that your thyroid gland is working properly, a pregnancy test, and perhaps a pelvic exam to check for any gynecological problems.

Keeping a symptom diary is another way to determine if you have PMS. Use a calendar to keep track of your symptoms and menstruation every month. If your symptoms start around the same time each month, PMS is most likely the cause.

Easing the Symptoms of PMS

You cannot cure PMS, but you can take steps to ease your symptoms. If you have a mild or moderate form of premenstrual syndrome, treatment options include:

  • drinking plenty of fluids to ease abdominal bloating
  • eating a balanced diet to improve your overall health and energy level (eat plenty of fruits and vegetables; reduce your intake of sugar, salt, caffeine, and alcohol)
  • taking supplements, such as folic acid, vitamin B-6, calcium, and magnesium to reduce cramps and mood swings
  • sleeping at least eight hours a night to improve fatigue
  • getting plenty of exercise to decrease bloating and improve your mental health

You can take pain medication, such as ibuprofen or aspirin, to alleviate muscle aches, headaches, and stomach cramping. You can also try a diuretic to stop bloating and water weight gain. Take medications and supplements only as directed and after speaking with your doctor.

Severe PMS: Premenstrual Dysphoric Disorder

Severe PMS symptoms are rare. But of the small number of women who have severe symptoms, 50 to 60 percent are diagnosed with premenstrual dysphoric disorder (PMDD). PMDD affects between three and eight percent of women.

Symptoms of this severe form of PMS may include:

  • depression or thoughts of suicide
  • panic attacks
  • extreme anxiety
  • anger
  • crying spells
  • lack of interest in daily activities
  • insomnia
  • trouble thinking or focusing
  • binge eating
  • painful cramping or bloating

Like PMS, symptoms of PMDD may result from changes in your estrogen and progesterone levels. There is also a connection between low serotonin levels and PMDD. Serotonin is a chemical found in your brain and gut that affects your moods, emotions, and thoughts.

Your doctor may do a physical exam, a gynecological exam, a complete blood count, and a liver function test to rule out other medical problems. He or she may also recommend a psychiatric evaluation. A personal or family history of major depression, substance abuse, trauma, or stress can trigger or worsen PMDD symptoms.

Treatment for PMDD varies. Your doctor may recommend:

  • daily exercise
  • vitamin supplements, such as calcium, magnesium, and vitamin B6
  • a caffeine-free diet
  • individual or group counseling
  • stress management classes
  • birth control pills (Yaz is the only birth control pill approved by the FDA to treat PMDD symptoms)

If your PMDD symptoms still do not improve, your doctor may give you an SSRI antidepressant. This medication increases serotonin levels in your brain. Your doctor may also suggest cognitive behavioral therapy. This type of counseling can help you understand your thoughts and feelings and change your behavior accordingly.

You cannot prevent PMS or PMDD, but the treatments outlined above can help reduce the severity and duration of your symptoms.

Long-Term Outlook for PMS

PMS and PMDD symptoms can recur from month-to-month, but typically go away after the start of menstruation. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate symptoms for most women.