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Premenstrual syndrome (PMS)

Apr 10, 2020

What is PMS?

Is a group of symptoms that start about 2 weeks before your period and go away when bleeding starts or shortly after. You should not have symptoms the week after your period is over.

What causes PMS?

The cause for PMS is not clear. It is linked to changing hormones during the menstrual cycle. It is thought that ovulation triggers a change in brain chemistry. Stress and emotional problems do not seem to cause PMS, but they can make the symptoms worse.

What are the symptoms of PMS?

Often there both physical and emotional symptoms:

  • Acne
  • Breast swelling and tenderness
  • Feeling tired
  • Sleep disturbances
  • Upset stomach, bloating, constipation, or diarrhea
  • Headache or backache
  • Appetite changes or food cravings
  • Joint or muscle pains
  • Trouble concentrating or remembering
  • Tension, irritability, mood swings, anxiety, or depression

How common is PMS?

The American College of Obstetricians and Gynecologists (ACOG) says at least 85 out of 100 menstruating women have a least 1 symptom of PMS as part of their monthly cycle. Most symptoms are mild and do not need to be treated.

3 to 8 out of 100 women have a severe form of PMS called premenstrual dysphoric disorder (PMDD). Often, women with severe PMS or PMDD have a family history of depression.

What is premenstrual dysphoric disorder (PMDD)?

It is a form of PMS that is more severe. Symptoms impact quality of life or the ability to do activities. It happens most months before the menstrual cycle.

It is diagnosed after looking at symptoms and a menstrual diary with your provider. Talk with your provider if you think you have PMDD.

PMDD symptoms are:

  • Feelings of sadness or despair, or possible suicidal thoughts
  • Feelings of tension or anxiety
  • Panic attacks
  • Mood swings, crying
  • Lasting irritability or anger that affects other people
  • Disinterest in daily activities and relationships
  • Trouble thinking or focusing
  • Tiredness, low energy, or sleepiness
  • Food cravings or binge eating
  • Sleep disturbances, such as insomnia
  • Feeling out of control
  • Physical symptoms, such as:
    • Bloating
    • Breast tenderness
    • Headache
    • Joint or muscle pain

How do you treat PMS?

Vitamin supplementation therapy

This may help PMS. Data about effectiveness is limited though.

Vitamins that have been thought to help PMS are:

Vitamin B6
  • Can take the edge off irritability and lessen fatigue and depression
  • 100 mg/day maximum
  • Larger doses sometimes cause serious side effects
  • You can also take B-complex which has all the B vitamins. 
Vitamin E
  • Can help with breast tenderness
  • 400 IU/day maximum
Calcium
  • Can help with depression, bloating, and body aches
  • 1000 to 1,200 mg/day of elemental calcium
  • All forms of calcium should be labeled with amount of elemental calcium. 
Magnesium
  • Can help with pain, water retention, and negative mood
  • 400 mg/day
Vitamin D
  • Helps regulate and absorb calcium and phosphorus in the body
  • In adults, having the right levels of vitamin D promote bone health and prevent osteoporosis or the thinning of bones.

Health studies show vitamin D lowers the risks for cancers (such as colorectal and breast), cardiovascular (heart) disease, glucose intolerance, high blood pressure, asthma, some infectious diseases, multiple sclerosis, and type II diabetes.

Vitamin D levels in the blood lower than 10 to 15 mg/ml suggest a vitamin D deficiency. Adults are at high risk for deficiency if they have dark-skin, are obese, are elderly, or do not get sun exposure.

Women aged 51 to 70 should get 400 IU/daily. Women over 70 years of age should get 600 IU/daily. New studies show some people may benefit from 1000 to 15000 units daily. You can get vitamin D by:

  • Taking 400 IU of vitamin D in a supplement or in a daily multivitamin. 
  • Spending at least 15 minutes in the sun each day without sunscreen. 
  • Eating foods rich in vitamin D, such as:
    • Fortified milk
    • Liver
    • Tuna
    • Salmon
    • Fortified cereal

Relaxation techniques

Our minds and bodies are not separate. They clearly affect each other.

Stress is part of everyone's life. It is normal and helpful in motivating us to get things done. Severe stress is not healthy. It often has unpleasant physical symptoms, such as a hard time sleeping, upset stomach, and diarrhea.

For women with PMS, stress may make the symptoms worse. Many women with PMS find stress reduction techniques helpful. Spend 10 to 15 minutes a day relaxing. You may or may not want to do this with family. Remember, you probably need it most when you find you have the least amount of time.

Progressive relaxation

Wear loose clothing. Get into a comfortable position. Start at your head or your feet. Think about each muscle group, and consciously relax the muscles. Think of the muscle as being soft and limp. Think about the tension and stress floating away from you.

Do this for 15 minutes. Then take a few minutes to just relax, keeping your mind as blank as possible.

Deep breathing

Do this at any point in the day when you have a few minutes to yourself. Take 5 or more deep breaths. Let the air slowly fill your lungs, expanding your chest then abdomen. Think about blowing away the stresses of the day as you breathe out.

Relaxation tapes

These can be sounds of nature or a voice that guides you through a relaxation exercise.

Massage

  • Get a full body massage from a massage therapist. Techniques and fees differ.
  • Find someone you feel comfortable with to massage your back, shoulders, and legs.

Diet and exercise

  • Exercise often.
  • Eat healthy foods.
    • Foods high in salt and fat can worsen bloating.
  • Do not eat sugary foods, caffeine, and/or alcohol. These can make PMS symptoms worse.

Stop smoking

Smoking can make PMS worse. It is best to stop smoking.

Talk with friends

Write in a journal

Keep a symptoms calendar

Chart them each day. This will help to diagnosis PMS or PMDD. Bring this with you to your doctor appointments in the PMS Clinic. Period tracking apps are can also be used.

Antidepressants

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) change serotonin levels in the brain. They have also been shown to help some women with PMS and PMDD. 

The FDA has approved 3 medicines for the treatment of PMDD:

  • Sertraline (Zoloft®)
  • Fluoxetine (Serafem®)
  • Paroxetine HCI (Paxil CR®)

Ovulation suppressants

Birth control pills (BCP), the patch, and the ring can help suppress ovulation and lessen symptoms of PMS. Many women find they have further benefit when they take BCP so they do not have periods (continuous use) instead of the traditional way.

Other medicines, such as oral progesterone, Depo Provera, or Lupron Depot may also help PMS.

Counseling

Individual, group, and stress management counseling may also help.

Last reviewed March 2020