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Premenstrual Syndrome

(PMS; Premenstrual Tension Syndrome)

Definition

Premenstrual syndrome (PMS) is a disorder marked by physical and emotional symptoms. It affects women 1-2 weeks before the beginning of their menstrual period.
The Menstrual Flow
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Causes

While the exact cause is not known, PMS may be related to certain factors (eg, environmental, metabolic, or behavioral factors) that may make a woman more vulnerable to the hormonal changes that occur during menstruation.

Risk Factors

Factors that may increase the risk of PMS include:
  • Age: 25-40
  • Going off birth control pills
  • Major life stress
  • Depression

Symptoms

Symptoms may include:
  • Irritability
  • Mood swings
  • Anxiety
  • Depression
  • Diminished self-esteem
  • Difficulty concentrating
  • Sleep problems
  • Appetite changes (eg, sugar and/or salt cravings, overeating)
  • Weight gain
  • Fatigue
  • Bloating
  • Headache
  • Breast swelling and tenderness
  • Palpitations
  • Dizziness
  • Gastrointestinal upset
  • Muscle pain
Symptoms usually improve when bleeding starts (menstrual period).

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done.
You will be asked to keep a detailed record of your monthly physical and emotional symptoms. If caused by PMS, these symptoms will likely occur 1-2 weeks before your menstrual period. You may have PMS if symptoms occur at the same phase of the menstrual cycle each month.

Treatment

Treatment options include:

Stress Management

Stress may be managed through lifestyle changes. Relaxation techniques, deep breathing, massage , music, and hot baths can also help reduce stress .

Dietary Changes

Dietary changes may be helpful. Your doctor may recommend that you decrease your intake of salt, sugar, and caffeine . Eating small, frequent meals may also help.

Vitamins and Minerals

The following vitamin and mineral supplements might reduce PMS symptoms:
  • Vitamin E (400 IU)—may reduce breast tenderness
  • Calcium (1,000 mg)—may decrease bloating, depression, and aches
  • Magnesium (400 mg)—may decrease pain, fluid retention, and improve mood
  • Manganese (6 mg)—may help control symptoms of menstrual pain
Talk to your doctor before you take any supplements.

Regular Exercise

Exercising throughout the week may help to reduce your symptoms.

Medications

Your doctor may recommend medicine, such as:
  • Diuretics to reduce bloating and fluid retention.
  • Pain reliever to relieve cramps, headaches, and muscle aches
  • Birth control pills to reduce physical symptoms
  • Selective serotonin reuptake inhibitors to reduce emotional symptoms

Psychotherapy

Women with severe PMS symptoms (called premenstrual dysphoric disorder ) may benefit from cognitive behavioral therapy . Therapy may reduce negative emotions and enhance problem-solving skills in relationships. It may also manage obstacles, frustrations, and discomfort.

Prevention

To help reduce your chance of getting PMS, take the following steps:

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org/

Women's Health.gov http://www.womenshealth.gov/

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca/

Women's Health Matters http://www.womenshealthmatters.ca/

References

Premenstrual syndrome. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/~/media/For%20Patients/faq057.pdf?dmc=1&ts=20120824T1006488269 . Accessed August 24, 2012.

Premenstrual syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated June 14, 2012. Accessed August 24, 2012.

Premenstrual syndrome (PMS) fact sheet. Women's Health.gov website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.cfm . Updated May 18, 2010. Accessed August 24, 2012.

4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Brown J, Shaughn O'Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001396.

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