Premenstrual syndrome (PMS)
Mood swings, tender breasts, a swollen abdomen, food cravings, fatigue, irritability and depression. If you experience some or all of these problems in the days before your monthly period, you may have premenstrual syndrome (PMS).
An estimated 70 percent to 90 percent of menstruating women experience some form of PMS. These problems are more likely to trouble women in their 20s and 30s, and they tend to recur in a predictable pattern. Yet the physical and emotional changes you experience may be more or less intense with each menstrual cycle.
Still, you don't have to let these problems control your life. In recent years, much has been learned about PMS. Treatments and lifestyle adjustments can help you reduce or manage your signs and symptoms.
Signs and symptoms
For many women the signs and symptoms of PMS are an uncomfortable and unwelcome part of their monthly menstrual cycle. The most common physical and emotional signs and symptoms associated with PMS include:
Although the list of potential signs and symptoms is long, most women with PMS experience only a few of these problems.
For an estimated 30 percent to 40 percent of women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, symptoms disappear as the menstrual period begins.
But for some women with PMS, symptoms are so severe they're considered disabling. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. As many as 50 percent to 60 percent of women with severe PMS may have an underlying psychiatric disorder.
No one knows the exact cause of PMS, but several factors may contribute to the condition. Cyclic changes in hormones seem to be an important cause, because signs and symptoms of PMS change with hormonal fluctuations and also disappear with pregnancy and menopause.
Chemical changes in the brain also may be involved. One clue to the cause may be traced to fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, especially depression. Insufficient amounts of serotonin may contribute to other symptoms of PMS, such as fatigue, food cravings and sleep problems.
Occasionally, some women with severe PMS have undiagnosed depression, though depression alone does not cause all of the symptoms associated with PMS. Stress also may aggravate some of the symptoms, but alone isn't a cause.
Some PMS symptoms have been linked to low levels of vitamins and minerals. Eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances, also have been identified as possible contributors to PMS.
When to seek medical advice
If you've tried managing your PMS with lifestyle changes, but with little or no success, and signs and symptoms of PMS are seriously affecting your health and daily activities, see your doctor.
Screening and diagnosis
There are no unique physical findings or laboratory tests to positively diagnose PMS. Your doctor may attribute a particular symptom to PMS if it's part of your predictable premenstrual pattern. To establish a pattern, your physician may ask you to keep a record of your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first noticed symptoms appear and disappear. Also be sure to mark the day your period started.
Your doctor may prescribe one or more medications for PMS. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for PMS include:
Treatment for PMDD is similar to that of PMS, but may be more intense.
You can manage or sometimes reduce the symptoms of PMS by making changes in the way you eat, exercise and approach daily life. Try these steps:
Modify your diet
Incorporate exercise into your regular routine
Record your symptoms for a few months
Complementary and alternative medicine
Here's what's currently known about the effectiveness of some of the more common complementary products and remedies used to soothe the symptoms of PMS: