Premenstrual syndrome (PMS): causes and treatment

Premenstrual syndrome, widely referred to as PMS, is experienced by many women of all ages during their reproductive years.

PMS can either be simply bothersome and mild, or in more severe cases, life-altering affecting a woman's daily life.^1,2

Fast facts on PMS

Here are some key points about PMS. More detail and supporting information is in the main article.

• PMS affects 3 out of 4 menstruating women.²
• Approximately 85% of menstruating women will experience at least one symptom of PMS during their menstrual cycle.¹
• PMS fades away with either pregnancy or menopause.^1,2
• While the actual cause of PMS is unknown, hormonal and chemical changes within a woman's body are likely contributing factors.¹
• PMS is worsened by depression and other emotional problems.¹

What is premenstrual syndrome (PMS)?

It is estimated that approximately 85% of menstruating women will experience at least one symptom of PMS during their menstrual cycle.¹ In fact, as many as 3 out of 4 women will experience PMS at some point during their menstrual years.²

Those individuals that most commonly experience PMS include women:¹

Nearly all women of childbearing age have some premenstrual symptoms.

• In their late 20s through their early 40s
• Who have at least one child
• With a family history of depression
• With a history of postpartum depression or other mood disorder.

PMS is described as a compilation of symptoms associated with a woman's menstrual cycle including mood swings, tender breasts, food cravings, fatigue, irritability and depression.^1,2

PMS is generally experienced 1-2 weeks prior to a woman's period, resolving with the initiation of bleeding or subsiding within the first 4 days of bleeding onset.

What causes PMS?

The cause of PMS is not fully understood. However, it is felt that chemical and hormonal changes in a woman's body are contributing factors.^1,2

Depression and other emotional problems can make the symptoms of PMS worse. It is also thought that other possible contributing factors include low circulating levels of certain vitamins and minerals, consuming salty foods and drinking caffeine and alcohol.

Signs and symptoms of PMS

Symptoms associated with PMS vary and include:^1,2

• Tension, anxiety, depression
• Mood swings, irritability, anger, crying, depression, social withdrawal
• Food cravings, appetite changes
• Difficulty concentrating
• Joint or muscle pain
• Headache, fatigue, insomnia, abdominal bloating
• Weight gain
• Breast tenderness or swelling
• Acne
• Gastrointestinal changes such as constipation or diarrhea.

Treatment and prevention of PMS

While not every treatment is as effective for every woman, there are certain things that can be tried to alleviate the symptoms of PMS and include:^1,2

Taking regular exercise to improve your health and fitness may help manage PMS symptoms.

Lifestyle changes:

• Get regular exercise
• Include fruits, vegetables and whole grains into your diet and eat smaller, more frequent meals. Additionally try to add in foods high in calcium
• During PMS episodes, avoid salt, sugary foods, caffeine and alcohol
• Sleep at least 8 hours per night
• Avoid smoking
• Manage stress with things such as yoga, massage, relaxation therapy, journaling and talking with friends
• Keep a record of your symptoms.

Medications:

• Over-the-counter medications such as ibuprofen (Advil, Motrin, Midol Cramp), ketoprofen (Orudis KT), naproxen (Aleve) or aspirin may help relieve some of the physical symptoms associated with PMS
• Birth control pills to cause cessation of ovulation
• Diuretics.

Alternative therapies:

Taking certain vitamins, minerals or supplements, like the ones listed below, can help with PMS symptoms. However, speak with your health care provider before starting any of these therapies for guidance on the dose appropriate for you. It is important to make sure that these supplements do not interact with any current medications you may be taking.

• Folic acid
• Magnesium
• Vitamin B-6
• Vitamin E
• Calcium with vitamin D
• Black cohosh
• Chasteberry
• Evening primrose oil
• St. John's wort
• Ginko
• Ginger
• Acupuncture.

What is PMDD?

Premenstrual dysphoric disorder, referred to as PMDD, is a form of PMS in which the symptoms are severe and affect approximately 3-8% of women.^1,2 The brain chemical, serotonin, is thought to contribute to the development of PMDD.¹

The symptoms of PMDD are similar to those of PMS. However, they are generally more severe and debilitating and include at least one mood-related symptom.

Symptoms of PMDD include:

• Tension, anxiety, mood swings, frequent crying and panic attacks
• Sadness, feelings of despair and possible suicidal ideations
• Irritability, anger
• Lack of interest in normal daily activities and or relationships
• Difficulty with concentration or focusing
• Fatigue and low energy, insomnia
• Food cravings, binge eating
• Feelings of being out of control
• Bloating, breast tenderness, headaches and joint and muscle pain.

A diagnosis of PMDD is made when a woman experiences five or more of these symptoms.¹

Treatment of PMDD includes some of the lifestyle changes as in the treatment of PMS. However, medications such as antidepressants may be necessary to treat the disorder.

Medications approved to treat PMDD include selective serotonin uptake inhibitors (SSRIs) including sertraline (Zoloft), fluoxetine (Sarafem) and paroxetine HCI (Paxil CR). Additionally the birth control pill, Yaz, may be recommended to treat PMDD as well. Therapy may also be beneficial.

If you are concerned about your PMS symptoms or think you may be experiencing symptoms of PMDD, speak with your doctor or health care provider for evaluation.

References:

1.        Women's Health, Premenstrual syndrome (PMS) fact sheet, accessed 3 June 2015.
2.        Mayo Clinic, Premenstrual syndrome (PMS), accessed 3 June 2015.