PMS: About Premenstrual Syndrome

PMS: About Premenstrual Syndrome

PMS can drain you of energy, and make you feel sad or irritable. Learn more about the symptoms of PMS and what you can do about it.

Sometimes it is hard to know what is causing you to feel irritable, sad or tired. But in the case of PMS, timing may help pinpoint the cause. If symptoms like these appear like clockwork about five days before your period, it might be PMS.

What are the symptoms?

PMS can cause a mix of physical and emotional symptoms. Physical symptoms may include:

  • Bloating and fluid retention
  • Headache
  • Hot flushes
  • Breast pain or tenderness
  • Skin disorders, such as acne
  • Increased thirst
  • Increased appetite and food cravings
  • Trouble concentrating
  • Trouble falling asleep
  • Clumsiness
  • Bowel changes

Emotional/behavioral symptoms may include:

  • Feeling depressed
  • Feeling anxious
  • Irritability, mood swings or angry outbursts
  • Crying spells
  • Social withdrawal
  • Being impulsive
  • Feeling tired
  • Changes in libido (interest in sex)

What causes PMS?

The exact cause of PMS is not known, but because it is linked with the timing of the menstrual period, it may be tied to changes in hormone levels. It may also have something to do with the changes in the brain chemicals (neurotransmitters) that occur during the menstrual cycle.

Stress, caffeine and lack of sleep may also contribute to symptoms. There may also be a genetic component, since PMS tends to run in families.

Diagnosing PMS

One of the keys to diagnosing PMS is the pattern of when symptoms start and end. There are no lab tests to diagnose PMS, although in some cases tests may be done to rule out other conditions.

To help your doctor find out whether PMS is causing your symptoms, you may be asked to keep a symptom diary. This is a chart or calendar on which you record your symptoms and the time of your period.

It is important to distinguish between PMS and depression, anxiety, thyroid problems or another condition with similar symptoms. In PMS, a woman’s symptoms typically go away within four days of the start of the period. But, some women have PMS along with mental health conditions such as depression or anxiety. This can make diagnosis challenging.

What can I do about it?

Diet and lifestyle changes may help relieve common PMS symptoms. Your doctor may recommend that you:

  • Exercise more. Aerobic exercise, such as brisk walking, running, cycling, or swimming at least three or four times a week may help reduce mild depression and give you more energy. Exercise is also good for the heart and helps you reach or maintain a healthy weight.
  • Eat right. A diet rich in whole grains, low in fat with plenty of fruits and vegetables can help address any vitamin or mineral deficiencies that may be contributing to your symptoms. Also limit alcohol and caffeine.
  • Take vitamin supplements. A total of 1,200 mg of calcium per day may help reduce some PMS symptoms. Calcium also helps to build strong bones and prevent osteoporosis. Vitamin B-6 and magnesium may also help.
  • Relax. Stress reduction techniques such as yoga, meditation or massage might help some women ease the tension and stress of PMS. Ask your doctor for advice.
  • Get enough sleep. Getting a restful, good night’s sleep will help you deal with the symptoms of PMS.

You may also be able to treat some symptoms of PMS with over-the-counter pain relievers. This may include acetaminophen or a nonsteroidal anti-inflammatory (NSAIDs), such as ibuprofen (Motrin or Advil) or naproxen (Aleve). NSAIDs relieve both pain and inflammation. Acetaminophen works as a pain reliever. These drugs may ease headache, breast tenderness and cramps. Take these medicines only according to your doctor’s advice.

How can my doctor help?

Talk to your doctor if you have PMS symptoms that are severe or that do not respond to diet and lifestyle changes. A small number of women have a very severe form of PMS called premenstrual dysphoric disorder (PMDD). To treat more severe PMS symptoms that do not respond to the self-help steps listed above, your doctor may prescribe:

  • Diuretics, or “water pills.” A diuretic may help reduce water retention and bloating.
  • Antidepressants. One type of antidepressant, called a selective serotonin-reuptake inhibitor (SSRI), such as fluoxetine (Prozac) or sertraline (Zoloft), may help with mood symptoms related to a change in serotonin levels in the brain. Your doctor may prescribe these to be taken every day or starting two weeks before your symptoms typically appear.
  • Oral contraceptives. Birth control pills prevent ovulation and may reduce some of the physical symptoms of severe PMS.
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