Topic Overview
What is premenstrual syndrome (PMS)?
Most women
have tender breasts, bloating, and muscle aches a few days before they start
their
menstrual periods. These are normal premenstrual
symptoms. But when they disrupt your daily life, they are called premenstrual
syndrome (PMS). PMS can affect your body, your mood, and how you act in the days leading up to your menstrual period.
Some women first get PMS in
their teens or 20s. Others don't get it until their 30s. The symptoms may get
worse in your late 30s and 40s, as you approach
perimenopause.
What causes PMS?
PMS is tied to hormone changes
that happen during your menstrual cycle. Doctors don't fully know why
premenstrual symptoms are worse in some women than in others. They do know that
for many women, PMS runs in the family.
Not getting enough
vitamin B6, calcium, or magnesium in the foods you eat can increase your
chances of getting PMS. High stress, a lack of exercise, and too much caffeine
can make your symptoms worse.
What are the symptoms?
Common physical signs include:
- Bloating.
- Swollen and tender
breasts.
- Lack of energy.
- Headaches.
- Cramps and low back pain.
It is also common to:
- Feel sad, angry, irritable, or anxious.
- Be
less alert.
- Have trouble focusing on tasks.
- Withdraw from family and friends.
PMS symptoms may be mild or strong and vary from month to month. When PMS symptoms are
severe, the condition is called
premenstrual dysphoric disorder (PMDD). But PMDD is
rare.
How is PMS diagnosed?
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, like
thyroid disease.
Your doctor will 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.
How is it treated?
A few lifestyle changes will
probably help you feel better.
- Eat a variety of healthy foods, including whole grains, protein, low-fat dairy, fruits, and vegetables.
- Get plenty of exercise.
- Take vitamin B6 and extra calcium.
- Cut back on caffeine, alcohol, chocolate,
and salt.
- For pain, try aspirin, ibuprofen (such as Advil
or Motrin), or another
anti-inflammatory medicine.
Talk to your doctor if these changes don't provide some relief from your symptoms after a few menstrual cycles. He or she can prescribe medicine for problems such as bloating or for more severe PMS symptoms. For example, selective serotonin reuptake inhibitors (SSRIs)
can relieve both physical and emotional symptoms. Low-estrogen birth control pills
may help relieve severe PMS or PMDD.
If you
are taking medicine for PMS, talk with your doctor about birth control. Some
medicines for PMS can cause birth defects if you take them while you are
pregnant.
Frequently Asked Questions
Learning about premenstrual syndrome (PMS): | |
Being diagnosed: | |
Getting treatment: | |
Cause
Premenstrual syndrome (PMS) and the more severe form,
premenstrual dysphoric disorder (PMDD), are linked to
normal changes in the
endocrine system. The endocrine system makes hormones that control the
menstrual cycle. The female endocrine system
is very complex. Medical experts don't fully understand why normal hormone changes
cause PMS in some women and not others.
The one direct cause
that is known to affect some women is genetic: Many women
with PMS have a close family member with a history of PMS.
Symptoms
Premenstrual symptoms occur between
ovulation and the start of menstrual bleeding. More than 150 symptoms have been linked to PMS. They may vary greatly from cycle to cycle and be worse during times
of increased stress.
Common physical symptoms
- 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
Mood and behavior symptoms
- Sad or depressed mood
- Anger,
irritability, aggression
- Anxiety
- Mood swings
- Decreased alertness, trouble concentrating
- Withdrawal from family
and friends
Severe symptoms
Women who have severe premenstrual
mood swings, depression, irritability, or anxiety (with or without physical
symptoms) are said to have
premenstrual dysphoric disorder (PMDD). Symptoms
generally go away within the first 3 days of menstrual bleeding. This severe
type of PMS isn't common.
Premenstrual worsening of other conditions
Some medical conditions may get worse between ovulation
and the first day of menstrual bleeding.
The conditions most affected include:
- Mental health problems such as depression and anxiety disorders.
- Migraines.
- Seizure disorders.
- Irritable bowel syndrome (IBS).
- Asthma.
- Chronic fatigue syndrome.
- Allergies.
Are your symptoms really PMS?
What seems like PMS can sometimes be caused by another
condition. It's important to know what is causing your symptoms so you can get the right treatment. The best way to learn if your symptoms are PMS is to keep a
menstrual diary (What is a PDF document?) for 2 or 3 months and then show it to your health professional.
What Happens
Most women first get PMS in their mid-20s, but it becomes more common in women in their 30s. Women in their late 30s and early 40s may have
perimenopausal symptoms that are similar to PMS and
premenstrual dysphoric disorder (PMDD).
After
menopause, when hormones are low and no longer
rise and fall each month, women don't have PMS.
What Increases Your Risk
A risk factor is anything that increases your chances of getting sick or having a problem. Risk factors for PMS include:
- A family history of PMS.
- Age. PMS becomes more common as women age through
their 30s, and symptoms sometimes get worse over time.
- Anxiety,
depression, or other mental health problems. This is a
significant risk factor for premenstrual dysphoric disorder
(PMDD).
- Lack of exercise.
- High
stress.
- A diet low in vitamin B6, calcium, or magnesium.
- High caffeine intake.
When To Call a Doctor
Call 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.
Who to see
Most family doctors can
diagnose and treat PMS. So can most nurse practitioners and physician assistants.
If you have severe symptoms, you may need to see a
gynecologist to help you make a treatment plan.
If your symptoms are mainly
emotional or behavioral, a
psychiatrist or
psychologist can help you find ways to manage your
symptoms.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
No single test can diagnose
PMS. A diagnosis of PMS or premenstrual dysphoric disorder (PMDD) is usually
based on a
medical history and information from a two- or three-cycle menstrual diary (What is a PDF document?) where you record your symptoms, menstruation days, and ovulation days, if
possible.
Treatable
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 properly.
It's important for your doctor to rule out other
conditions that cause symptoms like those of PMS, so it may take more than one visit to
diagnose your symptoms. Diagnosing PMS may be difficult if you have another condition that
gets worse during the last 2 weeks of your
menstrual cycle.
Treatment Overview
There are ways to reduce your PMS symptoms and their impact on your life. But no single treatment works
for all women. You may have to try several to find the right choices for you.
The first step is to try some lifestyle changes, such as limiting caffeine and getting regular exercise. For more information, see Home Treatment.
If you still have
moderate to severe symptoms after two or three cycles of home treatment measures, talk your doctor about further treatment
options. These may include taking selective serotonin reuptake inhibitor (SSRI) antidepressants or low-estrogen birth control pills. For more information, see Medications.
A variety of herbs and other complementary treatments may help reduce or relieve PMS. For more information, see Other Treatment.
Surgery to
remove the
ovaries (oophorectomy) is a rarely used, controversial
treatment for the severe form of PMS, premenstrual dysphoric disorder (PMDD). For more information, see Surgery.
Prevention
You can't prevent
PMS. But there are things you can do
to reduce your chances of having severe symptoms.
- Take daily
calcium (up to 1200 mg) and vitamin B6 (50 mg to 100 mg).
- Get
regular exercise. It helps reduce pain and provide a feeling of
well-being.
- Eat a
balanced diet that includes whole grains, protein, low-fat dairy,
fruits, and vegetables.
- Limit caffeine, alcohol, chocolate,
and salt.
- Reduce stress by managing your time well, getting enough rest, and learning relaxation techniques.
- Quit smoking,
if you smoke.
Home Treatment
The first step in learning to manage PMS is to keep a menstrual diary (What is a PDF document?). Write down what kind of symptoms you have, how severe they are, when you have your period, and when you ovulate. This can help you identify patterns in your cycle and plan ahead to better cope with the symptoms.
Next, use some self-care measures for PMS. They focus on practicing healthy habits, managing pain, and reducing stress. When you use these tips, it's best to:
- Try one or two at a time, instead of
all of them at the same time. This will help you find which measures are most helpful.
- Try a measure for two to three menstrual cycles.
If it doesn't seem to
be helping, try something else.
Practice healthy habits
- Get at least 2½ hours of
moderate exercise a week.
Exercise may help relieve tension, pain, and mood-related PMS
symptoms.
- Eat a
balanced diet that includes whole grains, protein, low-fat dairy, fruits, and vegetables.
- Limit caffeine, alcohol, chocolate, and salt.
- Take daily
calcium (up to 1200 mg) and vitamin B6 (50 mg to 100 mg).
- Quit smoking, if you smoke.
Manage pain
- Use a
nonsteroidal anti-inflammatory drug (NSAID) such as naproxen or ibuprofen 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.
Menstrual Cycle: Dealing With Cramps
Reduce stress
- Try some relaxation techniques, such as breathing exercises,
yoga, or
massage therapy.
- Practice better time management, and get enough sleep.
- Create a support system. Join a support
group of women who are managing PMS. With your
loved ones, plan ways to reduce the demands placed on you when you have PMS.
Medications
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. The most commonly used medicines for PMS are:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.
- Selective serotonin reuptake inhibitors (SSRIs) for mood-related symptoms.
- Hormonal birth control, which may help relieve premenstrual dysphoric disorder (PMDD).
PMS: Should I Try an SSRI Medicine for My Symptoms?
Nonsteroidal anti-inflammatory drugs (NSAIDs)
- NSAIDs such as ibuprofen and naproxen relieve premenstrual pain and cramps 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 premenstrual pain period.
Selective serotonin reuptake inhibitors (SSRIs)
- PMS: Should I Try an SSRI Medicine for My Symptoms?
Hormonal birth control
- A low-estrogen
birth control pill such as YAZ or Yasmin
may help relieve symptoms of severe PMS or PMDD.
- Other types of birth control pills
(estrogen-progestin) are widely prescribed for PMS. They may improve bloating, headache, belly pain, and breast tenderness in some women. But other women may have worse symptoms or develop
mood problems.
- Estrogen alone may offer some benefit for some women. But when estrogen is taken without progestin, it increases the risk of
uterine (endometrial) cancer.
- Progestin (progesterone) has been used in the past for
PMS. But for some women, it may make physical and emotional symptoms
worse.
For more information about birth control pills and
progestin, see the topic
Birth Control.
Diuretics
- Spironolactone is a water pill (diuretic). It may reduce bloating and breast tenderness if taken during the premenstrual weeks.
- Drospirenone, which is in the certain low-estrogen
birth control pills, acts like a diuretic to
relieve bloating and breast tenderness. This medicine may also help relieve symptoms of severe PMS or PMDD.
Less commonly used medicines
- Propranolol, a beta-blocker medicine, may be used to treat migraines
or headaches related to PMS.
- Tricyclic antidepressants are not as well studied as SSRIs for PMS. They are
generally less favored because of their possible side effects. But they do
improve severe depression and insomnia for some women.
- Alprazolam, an anti-anxiety medicine, is only
recommended for a few days' use when other treatments have not worked. It
can make you sleepy, loses effectiveness over time, and can be
addictive. Long-term use may cause withdrawal or life-threatening
symptoms.
- Danazol,
a synthetic male hormone, can relieve breast pain by decreasing estrogen
production. It isn't often prescribed.
- Gonadotropin-releasing hormone agonist (GnRH-a) is a last-resort treatment for
severe PMDD. This medicine stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.
Side effects
- If you are taking medicine for PMS, talk with your doctor about birth control. Some medicines for PMS can cause birth defects if you take them while you are pregnant.
- The side effects of some medicines may be just as unpleasant as
your PMS symptoms. For example, GnRH-a and danazol have severe side effects. In other cases, the
relief from symptoms that a medicine gives may far outweigh its side effects.
Surgery
In the past, some women with
premenstrual dysphoric disorder (PMDD), the severe
form of
PMS, had surgery to remove the
ovaries (oophorectomy) and the uterus (hysterectomy). Without ovaries, a woman no longer has a
menstrual cycle.
Surgical removal of the
ovaries for PMDD is highly controversial and rarely done. It is only considered if a woman meets all of the following
criteria:
- PMS symptoms are severe and regularly disrupt
her quality of life.
- She has no future plans to give birth, and she is many years away from natural
menopause.
- Symptoms improve with the use of medicines that produce
a condition similar to
menopause (such as danazol or a GnRH-a).
- All other treatments have failed.
- All or most of the symptoms are directly related to PMDD. Other
problems, such as psychological or nonmedical problems, do not appear to contribute to the symptoms.
Removing the ovaries
leads to early menopause, and the symptoms tend to be more severe
than those of natural menopause. Early menopause also increases the risk of
osteoporosis, because low estrogen leads to loss of bone
density.
Surgery also has risks related to the procedure or
anesthesia. For more information, see the topic
Hysterectomy.
Other Treatment
Most of the following
complementary therapies aren't considered standard treatment for PMS. But you may
find that one or more of them helps to relieve some of your symptoms. In
general, these treatments are safe and don't cause bothersome side effects.
- Before you take any vitamin, herb, or mineral supplement, talk with your doctor or pharmacist. He or she can find out if it might interfere with other medicines you are taking.
- Be sure to follow the
directions on the label. Don't take more than the maximum dose.
- Some supplements and remedies should be
avoided if you are trying to get pregnant.
Complementary therapies commonly used for PMS
- Bright light therapy on days when PMS
symptoms are present may help relieve mood symptoms.
- Magnesium may help with
certain symptoms of PMS.
- Vitamin E is used by some women to help with breast tenderness related to PMS.
Complementary therapies sometimes used for PMS
- Black cohosh is sometimes used to relieve menopause symptoms, and it might help relieve symptoms of PMS. If you plan to take black cohosh, talk to your doctor about how to take it safely.
- Zinc may help
improve PMS-related acne.
- Vitex (agnus-castus, or chasteberry) might help relieve irritability, anger, breast tenderness, bloating,
cramping, and headaches. But possible side effects
include nausea, gastrointestinal upset, and malaise.
- Ginkgo biloba may reduce
breast tenderness, bloating, and weight gain.
- Evening primrose oil (Oenothera biennis) may offer
mild relief of breast tenderness.
Other Places To Get Help
Organizations
| American Congress of Obstetricians and Gynecologists
(ACOG) |
| 409 12th Street SW |
| P.O. Box 70620 |
| Washington, DC 20024-9998 |
| Phone: | 1-800-673-8444 |
| Phone: | (202) 638-5577 |
| Email: | resources@acog.org |
| Web Address: | www.acog.org |
| |
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking. |
|
| Office on Women's Health |
| Department of Health and Human Services |
| 200 Independence Avenue, SW Room 712E |
| Washington, DC 20201 |
| Phone: | 1-800-994-9662
(202) 690-7650 |
| Fax: | (202) 205-2631 |
| TDD: | 1-888-220-5446 |
| Web Address: | www.womenshealth.gov |
| |
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers. |
|
References
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- Berga SL, Spencer JB (2009). Premenstrual syndrome. In EG Nabel, ed., ACP Medicine, section 16, chap. 3. New
York: WebMD.
- Davis AJ, Johnson SR (2000, reaffirmed 2010).
Premenstrual syndrome. ACOG Practice Bulletin No. 15,
pp. 1–9. Washington, DC: American College of Obstetricians and
Gynecologists.
- Kwan I, Onwude JL (2009). Premenstrual syndrome, search date July 2009. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
- Reid RL (2008). Premenstrual syndrome. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 672–681. Philadelphia: Lippincott Williams and Wilkins.
- Twogood S, Israel J (2010). Premenstrual syndrome. In Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 267–270. Chichester, UK: Wiley-Blackwell.
- U.S. Food and Drug Administration (2005).
FDA Public Health Advisory: Paroxetine. Available
online: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm051731.htm.
- Yonkers KA, et al. (2005). Efficacy of a new low-dose
oral contraceptive with drospirenone in premenstrual dysphoric disorder.
Obstetrics and Gynecology, 106(3): 492–501.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
|---|
| Last Revised | July 26, 2012 |
|---|
