Premenstrual Syndrome (PMS)

What is it?

Mood swings, tender breasts, a swollen abdomen, food cravings, fatigue, irritability and depression. Women who experience some or all of these problems in the days before their monthly periods may have the premenstrual syndrome (PMS).An estimated 70 to 90 percent of menstruating women experience some form of premenstrual syndrome. These problems trouble women in their 20s and 30s and they tend to recur in a predictable pattern. Yet the physical and emotional changes one experiences with premenstrual syndrome might be more or less intense with each menstrual cycle.

What are the causes?

No one knows the exact cause of premenstrual syndrome, but several factors may contribute to the condition. Cyclic changes in hormones seem to be an important cause, because the signs and symptoms of premenstrual syndrome change with hormonal fluctuations and also disappear with pregnancy and menopause.Chemical changes in the brain also may be involved. One clue to the cause may be traced to fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, especially depression. Insufficient amounts of serotonin may contribute to other symptoms of PMS, such as fatigue, food cravings and sleep problems.Occasionally, some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms associated with premenstrual syndrome. Stress also may aggravate some of the symptoms, but alone isn't a cause.Some PMS symptoms have been linked to low levels of vitamins and minerals. Eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances, also have been identified as possible contributors to PMS.

What are the symptoms?

The signs and symptoms of premenstrual syndrome are uncomfortable and unwelcome part of a woman’s monthly menstrual cycle. The most common physical and emotional symptoms associated with premenstrual syndrome include: Weight gain from fluid retention Abdominal bloating Breast tenderness Tension or anxiety Depressed mood Crying spells Mood swings and irritability or anger Appetite changes and food cravings Trouble falling asleep (insomnia) Joint or muscle pain Headache Fatigue For an estimated 30 to 40 percent women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. Most of these symptoms disappear as the menstrual period begins.In some women the symptoms are so severe that they are considered disabling. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. About 50 to 60 percent of women with severe PMS may have an underlying psychiatric disorder.

How is the diagnosis made?

There are no unique physical findings or laboratory tests to diagnose premenstrual syndrome. The doctor may attribute a particular symptom to PMS if it is a part of your predictable premenstrual pattern. To establish a pattern, the physician may ask you to keep a record of your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first noticed symptoms appear and disappear. Also be sure to mark the day your period started.

What is the treatment?

The doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for premenstrual syndrome include: Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of the period. NSAIDs such as ibuprofen or naproxen sodium can ease cramping and breast discomfort. Oral contraceptives. These stop ovulation and stabilize hormonal swings, thereby offering relief from PMS symptoms. Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine, paroxetine and sertraline, have been successful in reducing symptoms such as fatigue, food cravings and sleep problems. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins. Medroxyprogesterone acetate. For severe PMS or PMDD, this injection can be used to temporarily stop ovulation. However, this may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache and depressed mood. Treatment for PMDD is similar to that of premenstrual syndrome, but may be more intense.

DoctorNDTV Team

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