Premenstrual Syndrome - PMS

Introduction

Premenstrual syndrome (PMS) includes a variety of symptoms that many women commonly experience in the days before their period begins.  Common symptoms include headache, abdominal pain, digestion problems, sleep difficulties, mood changes, and thought processing difficulties.  PMS is a real medical condition, and the symptoms are most often treatable.  Treatments may include lifestyle changes and medication.

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS with more severe forms of symptoms above and mood lability that can negatively impact both work/professional and personal relationships.

Anatomy

The menstrual cycle is a regular process that is regulated by hormones.  The average menstrual cycle lasts around 28 days, but it varies among individuals and may be either longer or shorter.  Each month the uterine lining thickens as it builds up extra blood and tissue in preparation for a potential fertilized egg.  An egg that is fertilized by a sperm cell may implant itself in the nourishing uterine lining and develop into a baby.  An unfertilized egg or a fertilized egg that does not implant in the uterus passes through the reproductive system.  During menstruation the uterine lining sheds and the blood leaves the body through the vagina.

Causes

The exact cause of PMS/PMDD is unknown.  Researchers suspect that it is linked to hormone changes that occur during the regulation of the menstrual cycle.  PMS symptoms stop with pregnancy and menopause.  Researchers believe that chemical changes in the brain, particularly in the brain chemical serotonin, may also be involved.  Some studies have shown that certain vitamin deficiencies may contribute to PMS symptoms.

Symptoms

PMS can cause a wide range of physical, emotional, and cognitive (thought processing) symptoms.  PMS symptoms usually occur about 5 to 11 days before a period begins and stop shortly thereafter.  You may or may not experience different symptoms or variations in symptom intensity with each period.  Your symptoms may be so severe that they interfere or limit your regular activities.

Common symptoms of PMS include headache; abdominal cramps, bloating, or pain; fluid retention; breast tenderness; acne; cold sores; appetite changes or food cravings; constipation, gas, or diarrhea; irritability, anger, tension, or anxiety; depressed mood or crying spells; sleep difficulty; feeling tired; poor coordination; and joint, back, or muscle pain. PMDD has some or all of the above complaints with dysfunction in work and home environments due to stress, pain and erratic mood.  

You may also experience problems with thinking skills, such as poor concentration, forgetfulness, confusion, and poor judgment.  You may feel very depressed, panic, fearful, paranoid, or have irrational thoughts.  You may feel very irritable, hostile, or aggressive.  You may experience decreased self-image, self-esteem, or sex-drive.

Diagnosis

You should talk to your doctor if you suspect that you experience symptoms of PMS.  Your doctor may ask you to record your symptoms for a few menstrual cycles.  There is no one specific test to diagnose PMS, but we do have a questionaire and charting to make a diagnosis after examining you and reviewing your symptoms and medical history.  In some cases, a psychiatric evaluation may be conducted to rule out other conditions that have symptoms similar to PMS.

Treatment

There are several types of treatments for PMS.  Some women find relief with self-care measures.  It may be helpful to participate in regular exercise and relaxation activities.  It may be helpful to avoid consuming salt, sugar, alcohol, and caffeine products.  Eating a balanced diet and increasing the amount of whole grains, vegetables, and fruit may help.  Ask your doctor about vitamin supplements.  Vitamin B6, Vitamin E, calcium, and magnesium are commonly recommended.  It is very important to get adequate sleep.  Let your doctor know if you have problems falling asleep or remaining asleep.  

Your doctor may recommend over-the-counter medications that contain ibuprofen or naproxen.  Your doctor may prescribe medications such as diuretics, oral contraceptives, hormones, or antidepressants.  Most women experience symptom relief with specific treatments.  Serafem is a medication FDA approved for PMS/PMDD

Prevention

It is helpful to keep a record of your periods and PMS symptoms to show your doctor.  Your doctor can recommend treatments to help prevent or provide relief from PMS symptoms.  It is important that you discuss new symptoms or symptoms that are not relieved by treatment so that your treatment plan can be adjusted.

Lifestyle changes may help prevent or decrease some symptoms of PMS.  It can be helpful to exercise regularly and participate in relaxation techniques or relaxing activities.  It is important to receive adequate sleep.  You should avoid sugar, salt, alcohol, or caffeine products and eat a well-balanced diet that is high in fiber, fruits, and vegetables.  Drink plenty of water to avoid dehydration and bloating.

Am I at Risk

PMS is very common.  About 75% of women experience symptoms of PMS.  It occurs more frequently in women during their late 20s to early 40s.  It appears that a personal or family history of major depression, postpartum depression, or affective mood disorder may increase the risk of experiencing PMS.

Complications

PMS symptoms can be severe enough to prevent women from participating in their regular activities.  Some women may experience premenstrual dysphoric disorder (PMDD), a severe form of PMS.  Additionally, the suicide rate is higher for women during the days before their menstrual cycle.  PMS is a real medical condition and it is important to receive appropriate treatment for all of your symptoms.

Advancements

Newer types of birth control pills may help reduce the symptoms of PMS.  There are new anti-depressant medications being developed all of the time.  It is important to remember that it may take a few trials to determine which medication is the most helpful for you.  Follow your doctor’s instructions carefully, and do not discontinue taking your medication without first talking to your doctor.