Definition of Premenstrual syndrome:

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)

Causes, incidence, and risk factors:

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:

• Between their late 20s and early 40s
• Who have at least one child
• With a personal or family history of major depression
• With a history of postpartum depression or an affective mood disorder

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).

Symptoms:

PMS refers to a set of physical, behavioral, or emotional symptoms that tend to:

• Start during the second half of the menstrual cycle (14 days or more after the first day of your last menstrual period)
• Go away 4 - 7 days after a menstrual period ends (during the first half of the menstrual cycle)

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:

• Abdominal fullness, feeling gaseous
• Bloating of the abdomen
• Breast tenderness
• Clumsiness
• Constipation or diarrhea
• Food cravings
• Headache
• Less tolerance for noises and lights

Other symptoms include:

• Confusion
• Difficulty concentrating
• Fatigue
• Feelings of sadness or hopelessness (See also: Premenstrual dysphoric disorder)
• Feelings of tension, anxiety, or edginess
• Forgetfulness
• Irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others
• Loss of sex drive (may be increased in some women)
• Mood swings
• Poor judgment
• Poor self-image, feelings of guilt, or increased fears
• Sleep problems (sleeping too much or too little)
• Slow, sluggish, lethargic movement

Signs and tests:

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:

• Complete medical history
• Physical examination (including pelvic exam)
• Psychiatric evaluation (in some cases)

A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.

Treatment:

A healthy lifestyle is the first step to managing PMS. For many women with mild symptoms, lifestyle approaches are enough to control symptoms.

• Drink plenty of fluids (water or juice, not soft drinks or other beverages with caffeine) to help reduce bloating, fluid retention, and other symptoms.
• Eat frequent, small meals. Leave no more than 3 hours between snacks, and avoid overeating.
• Your health care provider may recommend that you take nutritional supplements. Vitamin B6, calcium, and magnesium are commonly used. Tryptophan, which is found in dairy products, may also be helpful.
• Your doctor may recommend that you eat a low-salt diet and avoid simple sugars, caffeine, and alcohol.
• Get regular aerobic exercise throughout the month to help reduce the severity of PMS symptoms.
• Try changing your nighttime sleep habits before taking drugs for insomnia. (See also: Sleeping difficulty)

Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed if you have significant pain, including headache, backache, menstrual cramping, and breast tenderness.

Birth control pills may decrease or increase PMS symptoms.

In severe cases, antidepressants may be helpful.

• The first options are usually antidepressants known as selective serotonin-reuptake inhibitors (SSRIs).
• Cognitive behavioral therapy may be an alternative to antidepressants.
• Light therapy may decrease the need for antidepressant medications.

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.

Expectations (prognosis):

Most women who are treated for PMS symptoms get significant relief.

Complications:

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).

Calling your health care provider:

Call for an appointment with your health care provider if:

• PMS does not go away with self-treatment
• Your symptoms are so severe that they limit your ability to function

Prevention:

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.