Premenstrual Syndrome (PMS)

Symptoms

Premenstrual symptoms occur about 1 to 2 weeks before your period starts. These symptoms go away in the first few days of your period. Many symptoms have been linked to PMS. They may vary greatly from cycle to cycle and be worse during times of more stress.

Common physical symptoms include:

• Bloating, weight gain.
• Fatigue, lack of energy.
• Headaches.
• Cramps, aching muscles and joints, low back pain.
• Breast swelling and tenderness.
• Food cravings, especially for sweet or salty foods.
• Sleeping too much or too little.
• Low sex drive.
• Constipation or diarrhea.

Other symptoms affect mood and behavior. They include:

• A sad or depressed mood.
• Anger, irritability, aggression.
• Anxiety.
• Mood swings.
• Decreased alertness, trouble concentrating.
• Withdrawal from family and friends.

What Happens

Most people first get PMS in their mid-20s. But it can start with your first period and can continue until menopause. After menopause, PMS goes away because hormones are low and don't rise and fall each month.

When to Call a Doctor

Contact your doctor if:

• PMS symptoms regularly disrupt your life.
• You feel out of control because of PMS symptoms.
• Home treatments don't help.
• Severe PMS symptoms (such as depression, anxiety, irritability, crying, or mood swings) don't end a couple of days after your menstrual period starts.

Exams and Tests

No single test can diagnose PMS. Your doctor will ask questions about your symptoms and do a physical exam. It's important to make sure that your symptoms aren't caused by something else. So it may take more than one visit to diagnose your symptoms.

Your doctor may want you to keep a written record of your symptoms for 2 to 3 months. This is called a menstrual diary. It can help you track when your symptoms start, how bad they are, and how long they last. Your doctor can use this diary to help diagnose PMS.

Thyroid problems sometimes cause symptoms like those of PMS. So you may have a thyroid-stimulating hormone (TSH) blood test to make sure that your thyroid gland is working as it should.

Treatment Overview

There are ways to reduce your PMS symptoms and their impact on your life. But no single treatment works for everyone. You may have to try several to find the right choices for you.

Lifestyle changes can help. These are things like eating healthy, limiting things that make your symptoms worse (such as caffeine or alcohol), and getting regular exercise. Your doctor may also talk to you about taking a calcium supplement.

Other treatment options include counseling with cognitive behavioral therapy and taking medicines, such as selective serotonin reuptake inhibitor (SSRI) antidepressants or hormonal birth control.

Self-Care

Self-care for PMS means practicing healthy habits, managing pain, and reducing stress. When you use these tips, it's best to try one or two at a time. This will help you find which tips are most helpful.

• Keep a menstrual diary. Write down your symptoms, how severe they are, when you have your period, and when you ovulate. This can help you find patterns in your cycle and plan ahead to better cope with symptoms.
• Practice healthy habits.
  • Be as active as you can every day. Exercise may help relieve pain and mood-related PMS symptoms.
  • Eat a variety of healthy foods. This can include vegetables, fruits, whole grains, and protein. Include plenty of foods that are high in calcium, such as dairy products, almonds, and dark leafy greens. Ask your doctor if you should take a calcium supplement.
  • Limit food and drinks that make your symptoms worse. This may include things like caffeine, alcohol, or salt.
  • If you smoke, try to quit. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.
• Manage pain.
  • Ask your doctor if you can take a nonsteroidal anti-inflammatory drug (NSAID) such as naproxen (Aleve) or ibuprofen (Advil, Motrin) to relieve pain and reduce menstrual bleeding. Try to start taking an NSAID 1 or 2 days before you expect pain to start. NSAIDs work best when taken before and at regular intervals throughout the days you have pain.
  • Wear a more supportive bra, such as a sports bra, when your breasts are tender.
• Reduce stress.
  • Try some relaxation techniques, such as breathing exercises, yoga, or massage therapy.
  • Practice better time management.
  • Get enough sleep.
  • Create a support system. Join a support group of people who are managing PMS. With your loved ones, plan ways to reduce the demands placed on you when you have PMS.

Medicines

If you have moderate to severe premenstrual symptoms even after you've tried home treatment and lifestyle changes, talk to your doctor about using medicine.

Commonly used medicines include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) relieve premenstrual pain and cramps. They also reduce menstrual bleeding. They work best when taken before and during the premenstrual pain period.
• Selective serotonin reuptake inhibitors (SSRIs). SSRIs such as citalopram, fluoxetine, and paroxetine are antidepressants that may help relieve physical and emotional symptoms of PMS. You can take them during the premenstrual weeks only. Or you can take them continuously.
• Hormonal birth control. It may help relieve physical and emotional symptoms of PMS or premenstrual dysphoric disorder (PMDD).
• Diuretics. They may reduce bloating and breast tenderness if taken during the premenstrual weeks.

Other Treatment

Most complementary therapies aren't considered standard treatment for PMS. But you may find that one or more of them helps relieve some of your symptoms. Before you try any of these therapies, talk with your doctor first.

Some complementary therapies that may help with PMS symptoms include:

• Acupuncture or acupressure.
• Bright light therapy.
• Primrose oil.
• Vitex.
• Calcium, magnesium, or vitamin E supplements.