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Premenstrual syndrome (PMS) refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter.
See also: Premenstrual dysphoric disorder (PMDD)
The exact cause of PMS has not been identified. Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones.
PMS may be related to social, cultural, biological, and psychological factors.
The condition is estimated to affect up to 75% of women during their childbearing years.
It occurs more often in women:
The symptoms typically get worse in a woman's late 30s and 40s as she approaches the transition to menopause.
As many as 50% - 60% of women with severe PMS have a psychiatric disorder (premenstrual dysphoric disorder).
PMS refers to a set of physical, behavioral, or emotional symptoms that tend to:
It is important to keep a daily diary or log to record the type of symptoms you have, how severe they are, and how long they last. You should keep this "symptom diary" for at least 3 months. It will help your doctor make an accurate PMS diagnosis and recommend appropriate treatment.
The most common physical symptoms include:
Other symptoms include:
There are no physical examination findings or lab tests specific to the diagnosis of PMS. To rule out other potential causes of symptoms, it is important to have a:
A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.
A healthy lifestyle is the first step to managing PMS. For many women with mild symptoms, lifestyle approaches are enough to control symptoms.
Birth control pills may decrease or increase PMS symptoms.
In severe cases, antidepressants may be helpful.
Patients who have severe anxiety are sometimes given anti-anxiety drugs.
Diuretics may help women with severe fluid retention, which causes bloating, breast tenderness, and weight gain.
Bromocriptine, danazol, and tamoxifen are drugs that are occasionally used for relieving breast pain.
Most women who are treated for PMS symptoms get significant relief.
PMS symptoms may become severe enough to prevent women from functioning normally.
Women with depression may have more severe symptoms during the second half of their cycle and may need to have their medication adjusted. The suicide rate in women with depression is much higher during the second half of the menstrual cycle.
See also premenstrual dysphoric disorder (PMDD).
Call for an appointment with your health care provider if:
Some of the lifestyles changes often recommended for treating PMS may help prevent symptoms or keep them from getting worse.
Getting regular exercise and eating a balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine) may prove beneficial.
Your body may have different sleep needs at different times during your menstrual cycle, so it is important to get enough rest.
Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap. 36
Yonkers KA, O'Brien PM. Premenstrual syndrome. Lancet. 2008:371(9619):1200-1210.
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