Premenstrual Syndrome (PMS)

What is PMS? What are the symptoms?

The causes of PMS are unclear; however, we do know that it is associated with changes in hormone levels during the menstrual cycle. PMS often worsens at times of hormonal instability, such as puberty, childbirth, or the period after a miscarriage or an abortion. Some PMS symptoms have been linked to deficiencies in calcium and vitamins A, B and E. PMS is not caused by stress or psychological problems, though these may make the symptoms of PMS worse. PMS is normal and every woman has symptoms that may vary across a range (no symptoms, mild to severe symptoms). By definition, PMS symptoms occur two weeks before menstruation and sometimes for a few days into menstruation. Occasionally, in some women, these symptoms may last almost the entire month.

PMS symptoms

Abdominal and pelvic cramps Acne
Alcohol intolerance Angry outbursts
Anxiety Asthma
Bloating (due to fluid retention) Breast swelling and pain
Confusion or fuzzy thinking Cravings, especially for salty or sweet foods
Depression Dizziness, decreased balance
Fainting Fatigue
Headaches Heart pounding (palpitation)
Hives Insomnia
Irritability Menstrual migraines
Mood swings Nausea
Overeating Oversensitivity
Sore throat Tearfulness
Urinary problems Weight gain
Sleep disturbances (sleeping too much or too little)  
Edema (visible swelling, particularly in the hands, feet and legs)  

How is PMS diagnosed?

Your doctor will ask you to keep track of your symptoms on a calendar. If your symptoms follow the same pattern each month, you may have PMS. However, there are no laboratory tests that can determine if you have PMS. Your doctor may want to examine you and do some tests to rule out other possible conditions. He or she may also want to talk about your eating habits, exercise habits, your work and your family.

Should I Get Treatment For PMS?

You should consider treatment if it begins to interfere with your daily life’s functions such as:

  • Work or school performance: Poor performance at school or at work is often the result of difficulty concentrating, irritability, or fatigue.
  • Disturbing physical symptoms: Breast tenderness, bloating, and headaches.
  • Problems in your social life: PMS may affect social relationships. This can include relationships with spouses, friends, lovers, and colleagues.
  • Suicidal thoughts: Suicidal thoughts are common in women with severe PMS.

How is PMS treated?

There is no cure for PMS, but eating a healthy diet, exercising regularly and taking medicine could reduce your symptoms. Your doctor will talk to you about whether you need to change your diet and exercise habits. He or she may also prescribe medication for you, depending on what your symptoms are and how severe they are. You may need to try more than one medicine to find the treatment that works best for you. Many medicines are available over-the-counter, but others require a doctor's prescription. Medicines that can be prescribed include diuretics, antidepressants and birth control pills. Other medicines for PMS are currently being investigated.

Non-pharmacological treatments

  • Nutrition
  • Exercise & Physical activity
  • Stress management
  • Nutritional supplements
    • Vitamins
    • Minerals
    • Herbal remedies

Healthy Eating

Eating healthy is important for general health and may help relieve PMS symptoms such as bloating, breast tenderness, weight gain, irritability, and headaches. Food cravings aside, PMS symptoms could be trying to tell you something about your eating habits. A number of common symptoms have been linked to deficiencies of certain vitamins. Try eating foods high in complex carbohydrates like whole grains and fresh fruits and vegetables, and avoiding saturated fats. Avoid salt for the last few days before your period to reduce bloating and fluid retention. Cut back on caffeine to feel less tense and irritable and to ease breast soreness. Cut out alcohol. Drinking alcohol before your period can make you feel more depressed. Also, avoid refined sugar, animal fats, and sometimes dairy products. Eating more small meals each day instead of three large meals may reduce food cravings and mood swings. A professional nutritionist or dietician can advise women on dietary changes that may relieve symptoms. Keep to a regular schedule of meals, bedtime and exercise. Talk with your physician about vitamins or supplements that may help. You may even want to ask for a referral to a registered nutritionist, who can help you make long-term changes in your eating habits.

Physical Activity & Exercise

Physical activity is helpful in relieving stress, improving mood. Women who are inactive are at greater risk of PMS symptoms. Many symptoms can be lessened or relieved with activity. Get yourself into a regular exercise routine and do not give in to the temptation to skip your activities when PMS symptoms begin. It is recommended to be physically active for at least 30 minutes on most days of the week throughout your menstrual cycle. Walking or other moderate physical activity may be enough, but some women find they need more vigorous aerobic exercise such as jogging, biking, swimming, or climbing stairs. If you have not been exercising regularly, talk with your doctor before starting any vigorous exercise program.

Managing Stress

Everyone has events, people, and circumstances in their lives that cause stress. Nevertheless, the way that we handle stressors makes a huge difference in our physical and emotional well-being. Stress can worsen your PMS symptoms; thus, engaging in stress reduction techniques such as deep breathing exercises, mediation, visualization/imagery, yoga and progressive muscle relaxation can be very beneficial.

Vitamins and other home remedies

You may have read that some vitamins and other supplements, such as vitamin B6, vitamin E, magnesium, manganese and tryptophan, can help relieve PMS. There have not been many studies about these treatments, and it is possible that they could do more harm than good. Beware of "natural" or "herbal" remedies: There is no cure for PMS and no way of preventing symptoms from occurring. Any drug or medication available for PMS relief must be approved by the Food and Drug Administration (FDA) for safety and effectiveness. However, "herbal" or "natural" products are considered food and not drugs. Therefore, they are not regulated by the FDA. Some of these products might contain ingredients that will interact with certain medications. To be safe, you should discuss any product you are considering with your physician before taking it.

Other Helpful Tips

  • Acknowledge PMS as a real condition: While others often attribute a woman's bad mood or food craving to PMS, it is important to realize that PMS is a genuine medical condition. If your symptoms are affecting your life, contact your doctor. There are a number of treatment methods available to you. If your doctor is insensitive or dismisses your concerns about PMS, shop around for another doctor who will take your symptoms seriously.
  • Start a menstrual diary: This simple tool can help you identify your most common PMS symptoms. Track your symptoms and any steps you are taking to relieve or reduce them.  A diary can also help you determine what is working and what is not so that you can refine your efforts. It can also help you talk to your physician about other treatment options when your current treatment plan is not as effective as you would like.
  • Support groups: Talking with someone who has a better understanding of what you are going through. Support groups provide women with a place to talk about their symptoms without being dismissed. You can also compare information on remedies and talk about ways you are affected by your menstrual cycle.
  • Get enough sleep: Your body may require more sleep than usual as your period approaches. Do not ignore this need. Getting adequate rest can help reduce or relieve PMS symptoms.