Premenstrual syndrome (PMS)

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

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. They can make the symptoms worse though.

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

The American College of Obstetricians and Gynecologists (ACOG) says at least 85 out of 100 menstruating people 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 people have a severe form of PMS. It is called Premenstrual Dysphoric Disorder (PMDD). Often, people with severe PMS or PMDD have a family history of depression.

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.

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, and joint or muscle pain.

This may help PMS. Data about effectiveness is limited though. Your care team recommends eating and drinking less fat, salt, sugar, caffeine, and alcohol. It can help to eat smaller, more frequent meals and snacks. Eating more complex carbohydrates, such as whole grains, may also help PMS.  

Vitamins that have been thought to help PMS are:
•    Vitamin B6. Can take the edge off irritability and lessen fatigue and depression. 
o    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.
o    400 IU/day maximum.
•    Calcium. Can help with depression, bloating, and body aches.  
o    1000 to1200 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.
o    400 mg/day
•    Vitamin D. Helps regulate and absorb calcium and phosphorus in the body. Adults need the right levels of vitamin D for bone health and to prevent osteoporosis (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
•    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
•    Do not get sun exposure 

People aged 51 to 70 should get 400 IU/daily. People 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:
 
o    Fortified milk
o    Liver
o    Tuna
o    Salmon
o    Fortified cereal 
 

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
•    Diarrhea 

For people with PMS, stress may make the symptoms worse. Many people 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:  
o    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.  
o    Do this for 15 minutes. Then take a few minutes to just relax. Keep your mind as blank as possible.
•    Deep Breathing:  
o    Do this any time of 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:  
o    These can be sounds of nature or voice guides to do relaxation exercise.
•    Massage:  
o    Get a full body massage from a massage therapist. Techniques and fees differ. 
o    Find someone you feel comfortable with to massage your back, shoulders, and legs.

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

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

Talk with Friends.

Write in a Journal.

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 called selective serotonin reuptake inhibitors (SSRIs) change serotonin levels in the brain. They have also been shown to help some people with PMS and PMDD.  
•    The FDA has approved 3 medicines for the treatment of PMDD:
 
o    Sertraline (Zoloft®)
o    Fluoxetine (Serafem®)
o    Paroxetine HCI (Paxil CR®)

Birth control pills (BCP), the patch, and the ring help suppress ovulation and lessen PMS. Many people find more benefit with continuous use of combined oral contraceptives (pills) so they do not have periods, instead of taking the usual way. 

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

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

Learn more at: Premenstrual Syndrome (PMS) | ACOG (acog.org/womens-health/faqs/premenstrual-syndrome)