Premenstrual Syndrome (PMS)

What is premenstrual syndrome?

Premenstrual syndrome, or PMS, is the common name for the collection of physical and emotional symptoms that many women experience seven to 14 days before their menstrual period begins. Most women have at least a few PMS symptoms at some point, and it's usually a minor inconvenience. However, up to 40 percent of women deal with PMS every month, and it's sometimes severe enough to disrupt daily life.

Talking with your health care provider can help you cope with minor episodes and determine if you need medical assistance.

What are the symptoms?

There is a long list of symptoms associated with PMS, both physical and mental. If you experience these discomforts, keep track of when you experience them to determine if PMS is the issue.

Physical symptoms:

  • Tiredness, fatigue, or a general lack of energy. If it occurs only during mid-cycle each month, PMS may be the cause.
  • Tender or sore breasts. There can be slight swelling -- your bra may not fit this week, even though its fine before and after.
  • Cramping in your mid-section, which can cause mild to severe pain. You may also experience a variety of digestive upsets including diarrhea and constipation.
  • Headaches can be both more common and more severe. Unfortunately for migraine sufferers, their headaches can make other PMS symptoms seem worse.
  • Changes in your appetite, especially cravings for certain foods, can hit during mid-cycle. This can lead to overeating.
  • Fluid retention, which can cause bloating, as well as swelling in your hands and feet.
  • Pain in your joints or muscles.
  • Skin problems like acne that can flare up, causing breakouts.

Mental and emotional symptoms:

  • You may feel unusually anxious or tense.
  • You may feel waves of intense sadness or experience sudden crying spells.
  • Your moods may be far more extreme than usual. That can mean mood swings, but it can also mean you feel irritable and get angry more quickly.
  • Concentrating can be a challenge. Sometimes your physical discomforts can be distracting; however some women report that they have difficulty paying attention to work or other tasks, even if they don't have a headache or other complaint.

What causes PMS?

Since you are most likely to suffer PMS symptoms after you've given birth, had a miscarriage or abortion, or experienced another event that involves major hormonal upheaval, there is plenty of evidence that hormones are involved. But the human body is a complex system, and there may actually be more than one factor that causes PMS.

Multiple causes would certainly help explain the wide variety of symptoms and the vast differences in severity. Diet could play a role, especially in women who don't get enough calcium. In some cases, the causes may be interconnected. A dietary imbalance, for example, might cause your hormone or neurotransmitter levels to get out of whack.

What are the best ways to get relief?

You may be able to help yourself by making some simple lifestyle choices. Try these steps:

  • Get moving. Studies show that physical activity helps relieve PMS symptoms, perhaps by triggering the release of brain chemicals which ease pain, relieve stress, brighten mood, and produce a sense of well-being. Exercise also relaxes muscles, which can ease aches. And it fights fluid retention, which can reduce bloating and breast tenderness.
  • Make a few dietary changes. Avoiding PMS discomfort is another good reason to choose healthy foods. You can reduce cravings by choosing complex carbohydrates such as whole grain breads, pasta, and cereal fruits and vegetables, too. Unlike refined sweets, these foods provide steady energy and are high in fiber. Try adding nuts, seeds, and soy products to your meals. These foods are rich in phytoestrogens (plant estrogens), which recent studies suggest may help level out those hormonal ups and downs.
  • Steer clear of certain foods and drinks. Highly salted snacks in the weeks leading up to your period can cause you to retain water and leave you feeling bloated. Caffeine can also be a troublemaker. Try cutting back on coffee, tea, and soda to see if your breast tenderness is reduced. You might find that you are less anxious and tense, too. Going easy on alcohol might help you feel better, too.
  • Get more sleep. Lack of sleep makes everything about PMS worse. Make sure you get plenty of sleep, and try relaxation techniques -- such as massage, meditation, or simply soaking in long hot baths -- as your period approaches. (Remember, caffeine can make you restless and jittery.) After a good nights sleep, you may find aches and pains, moodiness, and irritability are all less of a problem.
  • Take a calcium supplement for at least three months. Studies have shown that taking calcium throughout the day can reduce symptoms by 50 percent. Shoot for a total of 900-1200 mg per day, and take it it two or three doses -- not all at once. The benefits are not instant. You need to take the supplements for at least three months, but the results can be worth it.
  • Aspirin and ibuprofen can ease the aches and pains that come with PMS.

When should I see a doctor?

If your symptoms are mild and you're managing fine on your own, there's no need to see a physician. But if you're one of the 3 to 8 percent of women with severe, often disabling PMS, a condition known as premenstrual dysphoric disorder, your doctor can probably suggest treatments that will greatly ease your symptoms. Try keeping a diary of your complaints for a few months. This information can help your doctor determine the best course of treatment.

In some cases, your doctor may recommend medications such as antidepressants to ease the symptoms. Studies suggest that SSRI (selective serotonin reuptake inhibitor) antidepressants, such as Prozac, may effectively relieve both the emotional and physical symptoms of PMS in 75 percent of women. These medications work by increasing serotonin levels, possibly correcting neurotransmitter imbalances that seem to contribute to PMS.

References

American Academy of Family Physicians. PMS. http://familydoctor.org/online/famdocen/home/women/reproductive/menstrual/141.html

National Women's Health Information Center. Premenstrual Syndrome. http://www.womenshealth.gov/faq/premenstrual-syndrome.cfm

Mayo Clinic. Premenstrual syndrome (PMS). http://www.mayoclinic.com/health/premenstrual-syndrome/DS00134

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