Pre menstral syndrome (PMS)
What is premenstrual syndrome (PMS)?
Up to 85% of women normally have one or more troubling physical and emotional symptoms between the time they ovulate and the first days of their menstrual period.1 These are called premenstrual symptoms. When premenstrual symptoms interfere with your relationships or responsibilities, they are called premenstrual syndrome (PMS).
While some women first have PMS in their teens or 20s, others don't until their 30s. PMS can come and go during your reproductive years; you may find that your symptoms worsen as you approach perimenopause, in your late 30s or 40s.
PMS occurs only in women who ovulate during their monthly menstrual cycle. Women who do not ovulateóbecause of pregnancy, menopause, or taking birth control pillsódo not have PMS symptoms. However, many do have similar hormone-related symptoms.
What causes PMS?
PMS is linked to changes in the endocrine system, which produces hormones that control the menstrual cycle. Because the female endocrine system is so complex, medical experts don't fully understand the chain of events that causes premenstrual symptoms to be severe in some women and not in others.
The one direct cause that is known to affect some women is genetic: Many women with PMS have a close family member with a history of PMS.1
What are typical premenstrual symptoms?
PMS consists of a wide variety of physical, emotional, and behavioral symptoms. Symptoms vary greatly from woman to woman and can range from mild to severe.
Common physical symptoms include breast swelling and tenderness, bloating, water retention, weight gain, acne, food cravings, sleep changes, lack of energy, lessened sexual desire, and pain, such as headaches, migraines, aching joints or muscles, cramps, and low back pain.
Common emotional symptoms include depression, sadness, hopelessness, anger, irritability, anxiety, and mood swings. Many women also notice that they feel less alert and less able to concentrate.
Common behavioral symptoms include withdrawal from family and friends, and physical or verbal aggression.
If you have severe emotional and/or behavioral symptoms (with or without physical symptoms) between ovulation and the first days of your period, you may have premenstrual dysphoric disorder (PMDD). In contrast to PMS, PMDD affects only 3% to 8% of women.2
How is PMS diagnosed?
No single test can diagnose PMS. Diagnosis is usually based on a 2- or 3-month menstrual diary that records your daily symptoms and how severe they are, the days you menstruate, and when you ovulate (if known). However, your health professional will also consider your medical history and physical examination results. It's important to rule out other conditions that have PMS-like symptoms, such as thyroid problems.
How is it treated?
While there is no cure for PMS, most women can improve their symptoms with simple lifestyle and dietary changes. After a few cycles, you will likely notice improvement from getting enough magnesium and vitamin B6, extra calcium, and regular moderate exercise, and eating a balanced diet. It's equally important to avoid smoking, as well as too much caffeine, alcohol, chocolate, and salt. For pain, use nonsteroidal anti-inflammatory drugs (NSAIDs)óthese are effective because they block pain-producing prostaglandins, which tend to increase during the premenstrual period.
If home treatment measures don't bring enough relief, talk to your health professional about additional treatment. The first-choice medications for moderate to severe PMS are selective serotonin reuptake inhibitors (SSRIs), which improve both physical and emotional symptoms for many women. Recent research has shown that most women gain relief by taking a low dose of an SSRI either continuously or only during their premenstrual days.3
If you try an SSRI but find it ineffective, it's a good idea to try another type of SSRI before moving on to a different class of medication, such as a benzodiazepine for anxiety (which can become addictive) or birth control pills (which may help or may worsen symptoms).
If bloating is your primary symptom, ask your health professional about a diuretic, such as spironolactone.
In rare and otherwise untreatable cases, severe PMS can be treated by completely suppressing the ovaries' function. However, this creates a condition similar to menopause, with unpleasant symptoms of its own and an increased risk of osteoporosis because of low estrogen production.
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