Premenstrual Syndrome (PMS)

PMS – A Definition

Premenstrual syndrome is a group of symptoms linked to the menstrual cycle.  These symptoms occur in the week or two weeks before your period (menstruation or monthly bleeding), and usually go away after your period starts.  PMS can affect menstruating women of any age, and affects every woman differently.  It’s been estimated that as many as 85% of all menstruating women have one or more of the symptoms of PMS.  It can be anything from a monthly inconvenience to a case so severe that it affects your daily routine. 

Your Menstrual Cycle

To understand PMS, you need to know how your menstrual cycle works.  The menstrual cycle prepares your body for pregnancy each month. A cycle is counted from the first day of one period to the first day of the next period. The average menstrual cycle is 28 days long, but cycles can range anywhere from 21 to 35 days in adults.  Levels of the hormones estrogen and progesterone rise and fall during the month to make the menstrual cycle happen. In the first half of the cycle, levels of estrogen begin to rise and make the lining of the uterus (womb) grow and thicken. At the same time, an egg (ovum) in one of the ovaries starts to mature.  At around the middle of the cycle, the egg leaves the ovary. This is called ovulation.

After the egg has left the ovary it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the three days before ovulation or on the day of ovulation.  If the egg is fertilized by a man’s sperm cell and attaches to the uterine wall, the woman becomes pregnant. If the egg is not fertilized, it will break apart. If pregnancy does not occur, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

Diagnosis of PMS is usually based on your symptoms, when they occur, and how much they affect your life.

The Symptoms of PMS

PMS often includes both physical and emotional symptoms.  Common symptoms are:

• breast swelling and tenderness
• swelling of the hands and feet
• upset stomach, bloating, constipation or diarrhea
• headache or backache
• appetite changes or food cravings
• joint or muscle pain
• trouble concentrating or remembering
• tension, irritability, mood swings, or crying spells
• sleep problems
• anxiety or depression

Very few women have all of these symptoms, and they can vary each month.  It’s a good idea to keep track of which symptoms you have and how severe they are for at least a few months. You can use a calendar to write down the symptoms you have each day or you can use go online and print out a form to help you at http://www.womenshealth.gov/faq/pmsymptracker45.pdf

Many times, women entering into menopause, which is the time of life when the ovaries stop functioning and menstruation stops, have symptoms of PMS.   Your physician or midwife can use the results of your tracking and other factors to diagnose your specific case.

Treatment

No treatment works for every woman, so you may need to try different ones to see what works.  In many cases, simple lifestyle changes can help you feel better.  Otherwise, some medications are available to help you manage the symptoms.  Sometimes both are needed.   Below are some lifestyle changes that may help ease your symptoms.

• Take a multivitamin every day that includes 400 micrograms of folic acid. A calcium supplement with vitamin D can help keep bones strong and may help ease some PMS symptoms.  Most women between 18 and 50 need 1000 milligrams of calcium per day.
• Exercise regularly.
• Try to eat mostly wholesome foods, including fruits, vegetables, and whole grains.
• Avoid salt, sugary foods, caffeine, and alcohol.
• Try to get 8 hours of sleep each night.
• Find ways to relax and reduce stress.  Relaxing activities such as yoga and massage may help. 

If these changes alone are not enough, talk to your health care provider.  He or she may recommend over-the-counter pain relievers such as ibuprofen, aspirin, or naproxen to ease cramps, headaches, backaches, and breast tenderness. In some cases, prescription medicines may be used to ease symptoms. One approach has been to use drugs such as antidepressants to lessen mood symptoms.  Contraceptives (birth control pills) may be prescribed to stop ovulation from occurring, which often results in lighter and shorter periods.

Premenstrual Dysphoric Disorder (PMDD)

There is some evidence that a brain chemical called serotonin plays a role in a severe form of PMS, called Premenstrual Dysphoric Disorder (PMDD). The main symptoms, which can be disabling, include:

• Depression, sadness or despair, or possibly suicidal thoughts
• Tension, anxiety, panic attacks or severe mood swings
• Undirected, lasting irritability or anger 
• Disconnection from daily life, activities and relationships
• A problem in thinking clearly or focusing
• Low energy, a desire to sleep more than usual
• Food cravings or binge eating
• Insomnia, restlessness, trouble sleeping
• Bloating, breast tenderness, headaches, and joint or muscle pain

You must have five or more of these symptoms to be diagnosed with PMDD.  Symptoms occur during the week before your period and go away after bleeding starts.
If you are diagnosed with PMDD, your physician or midwife can prescribe the best course of treatment.  These treatment options include most of the same options for treating PMS.  In addition, drugs known as SSRIs (selective serotonin reuptake inhibitors) can help some women with PMDD.

Remember

Approximately 85% of all menstruating women experience some form of PMS.  Track your symptoms and then talk to your healthcare provider for the best course of action to treat your particular needs.