Premenstrual Syndrome (PMS)

Premenstrual syndrome facts

  • Premenstrual syndrome (PMS) is a set of specific physical and psychological features.
  • Physical features include breast tenderness and bloating.
  • Psychological changes may include anger and depression.
  • PMS occurs in the last half of a woman’s menstrual cycle.
  • The exact cause is unknown but is believed to be related to interactions between sex hormones and brain chemicals (neurotransmitters).
  • PMS can be mimicked and must be distinguished from other disorders.
  • The most helpful diagnostic tool for PMS is a menstrual diary.
  • Treatment options for PMS include exercise, a healthy lifestyle, emotional support of family and friends, and medications.
  • Possible for PMS include diuretics, pain killers, oral contraceptives, drugs that suppress ovarian function and antidepressants.

What is premenstrual syndrome?

Premenstrual syndrome (PMS) is a combination of emotional, physical, psychological, and mood disturbances that occur after a woman’s ovulation and typically ending with the onset of her menstrual flow. The most common mood-related symptoms are irritability, depression, crying, oversensitivity, and mood swings with alternating sadness and anger. The most common physical symptoms are fatigue, bloating, breast tenderness (mastalgia), acne, and appetite changes with food cravings.

A more severe form of PMS, known as premenstrual dysphoric disorder (PMDD), also known as late luteal phase dysphoric disorder) occurs in a smaller number of women and leads to significant loss of function because of unusually severe symptoms. The American Psychiatric Association characterizes PMDD as a severe form of PMS in which anger, irritability, and anxiety or tension are especially prominent.

How common is PMS?

About 80% of women experience some premenstrual symptoms. The incidence of true PMS has often been overestimated by including all women who experience any physical or emotional symptoms prior to menstruation. It is estimated that clinically significant PMS (which is moderate to severe in intensity and affects a woman’s functioning) occurs in 20% to 30% of women. About 2% to 6% of women are believed to have the more severe variant known as PMDD.

When was PMS discovered?

The mood changes surrounding this condition have been described as early as the time of the ancient Greeks. However, it was not until 1931 that this disorder was officially recognized by the medical community. The term “premenstrual syndrome” was coined in 1953.

What causes PMS?

PMS remains an enigma because of the wide-ranging symptoms and the difficulty in making a firm diagnosis. Several theories have been advanced to explain the cause of PMS. None of these theories have been proven, and specific treatment for PMS still largely lacks a solid scientific basis. Most evidence suggests that PMS results from the alterations in or interactions between the levels of sex hormones and brain chemicals known as neurotransmitters.

PMS does not appear to be specifically associated with any personality factors or specific personality types. Likewise, a number of studies have shown that psychological stress is not related to the severity of PMS.

What are the symptoms of PMS?

A great variety of symptoms have been attributed to PMS. Women can have PMS of varying duration and severity from cycle to cycle. The most frequent mood-related symptoms of PMS include:

  • anger and irritability,
  • anxiety,
  • tension,
  • depression,
  • crying,
  • oversensitivity, and
  • exaggerated mood swings.

The most frequent physical signs and symptoms of PMS include:

  • fatigue,
  • bloating (due to fluid retention),
  • weight gain,
  • breast tenderness,
  • acne,
  • sleep disturbances with sleeping too much or too little (insomnia), and
  • appetite changes with overeating or food cravings.

How is the diagnosis of PMS made?

The most helpful diagnostic tool is the menstrual diary, which documents physical and emotional symptoms over months. If the changes occur consistently around ovulation (midcycle, or days 7-10 into the menstrual cycle) and persist until the menstrual flow begins, then PMS is probably the accurate diagnosis. Keeping a menstrual diary not only helps the healthcare provider to make the diagnosis, but it also promotes a better understanding by the patient of her own body and moods. Once the diagnosis of PMS is made and understood, the patient can better cope with the symptoms.

The diagnosis of PMS can be difficult because many medical and psychological conditions can mimic or worsen symptoms of PMS. There are no blood or laboratory tests to determine if a woman has PMS. When laboratory tests are performed, they are used to exclude other conditions that can mimic PMS.

What conditions are like PMS?

Some examples of medical conditions that can mimic PMS include:

  • depression,
  • cyclic water retention (idiopathic edema),
  • chronic fatigue,
  • hypothyroidism, and
  • irritable bowel syndrome.

How is PMS distinguished from other conditions?

The hallmark of the diagnosis of PMS is that symptom-free interval after the menstrual flow and prior to the next ovulation. If there is no such interval and the symptoms persist throughout the cycle, then PMS may not be the proper diagnosis. PMS can still be present and aggravate symptoms related to the other conditions, but it cannot be the sole cause of constant or non-cyclic symptoms. Blood or other tests may be ordered to help rule out other potential causes of symptoms.

Another way to help make the diagnosis of PMS is to prescribe drugs that stop all ovarian function. If these medications produce relief of the troublesome symptoms, then PMS is most likely the diagnosis.

What treatments are available for PMS?

The treatment of PMS can sometimes be as challenging as making the diagnosis of PMS. Various treatment approaches have been used to treat this condition. Some measures lack a solid scientific basis but seem to help some women. Other treatments with a sound scientific basis may not help all patients.

General management includes a healthy lifestyle including:

  • exercise;
  • family and friends can provide emotional support during the time of a woman’s cycle;
  • avoid salt before the menstrual period;
  • reduce caffeine intake;
  • quite smoking;
  • reduce alcohol intake; and
  • reduce intake of refined sugars.

All of the above have been recommended and may help symptoms in some women. Furthermore, some studies suggest that vitamin B6, vitamin E, calcium, and magnesium supplements may have some benefit.

What medications are used to treat PMS?

A variety of medications are used to treat the different symptoms of PMS. Medications include diuretics, pain killers, oral contraceptive pills, drugs that suppress ovarian function, and antidepressants.

  • Diuretics: Diuretics are medications that increase the rate of urine production, thereby eliminating excess fluid from the body tissues. Several nonprescription menstrual products (including Diurex PMS, Lurline PMS, Midol PMS, Pamprin Multisymptom and Premsyn PMS) contain diuretics, for example, either caffeine or pamabrom. Spironolactone (Aldactone) is a prescription diuretic that has been widely used to treat premenstrual swelling of the hands, feet or face. Unfortunately, it has not been effective in all patients.
  • Analgesics (pain killers): These are commonly given for menstrual cramps, headaches, and pelvic discomfort. The most effective group of analgesics appear to be the nonsteroidal antiinflammatory medications (NSAIDs). Examples of these are ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox) and mefenamic acid (Ponstel).
  • Benzodiazepines: The benzodiazepam alprazolam (Xanax) has been shown in some studies to relieve the depressive symptoms of PMS or PMDD. However, this drug is not considered a first-line treatment for these conditions because of its addictive potential.
  • Oral contraceptive pills (OCPs): OCPs are sometimes prescribed to even out ovarian hormone fluctuations. While older studies failed to provide evidence that OCPs can consistently provide relief for symptoms of PMS, the newer birth control pills, with their improved hormonal formulations, seem to be more beneficial
  • Ovarian suppressors: Drugs like danazol (Danocrine) have been prescribed to suppress ovarian hormone production. Unfortunately, Danocrine cannot be used over long periods because of side effects.
  • Complete suppression of ovarian function by a group of drugs called gonadotropin-releasing hormone (GnRH) analogs has been found to help some women with PMS. These GnRH analogs are not given long term (more than six months) because of their adverse effect on bone density and an increased risk of bone thinning (osteoporosis). In some cases these drugs may be prescribed along with hormone supplementation.
  • Antidepressants: These are widely used in treating the mood disturbances related to PMS. Antidepressants appear to work by increasing brain chemical (opioids, serotonin, and others) levels that are affected by the ovarian hormones. These opioids are important in the control of mood and emotions. The serotonin reuptake inhibitor group of antidepressants seem to be the most effective for symptoms of PMS. Fluoxetine (Prozac) and paroxetine (Paxil) are examples of antidepressant medications from this group that have been found to be effective in treating the mood changes associated with PMS.

It is important to know that these drugs, although useful in treating mood disturbances in some women, are not necessarily effective in treating the physical symptoms. Often, it is a combination of diet, medications and exercise that is needed to afford the maximum improvement from the many symptoms of PMS.

Are there herbal or natural remedies for PMS?

The fruit of the chasteberry tree (Vitex agnus castus) was shown in one placebo-controlled trial to relieve some of the symptoms of PMS. However, further studies are needed to clarify this association and determine the value of chasteberry fruit as a potential therapy for PMS. Since herbal preparations are not regulated by the US FDA, caution is warranted when taking this or any kind of supplement. While evening primrose oil and gingko biloba are plant extracts that have been promoted by some as remedies for PMS, there is no evidence that these products are effective, and they are not recommended.

Vitamin supplementation with vitamin B6, vitamin E, calcium, and magnesium have been shown in some trials to help alleviate symptoms of PMS and may have some benefit. To date, studies have been insufficient to prove a true benefit with these vitamin supplements in terms of PMS symptoms. It is always important to follow recommended guidelines when taking vitamin supplements, since taking excess doses of some supplements may be harmful.

Can exercise help relieve some of the symptoms of PMS?

Research studies are still needed to demonstrate whether exercise has true effects on PMS symptoms. However, evidence does suggest that exercise can help relieve some of the symptoms of PMS. Physical activity improves general health and helps relieve nervous tension and anxiety. Exercise is believed to release endorphins. Endorphins contribute to euphoric feelings such as the “runner’s high” experienced after prolonged exercise. Endorphins are chemical messengers for nerves (neurotransmitters) that affect mood, perception of pain, memory retention and learning. While it is unclear whether exercise is better than placebo for improvement of the symptoms of PMS, it has an overall health benefit and should be encouraged.

Aerobic exercise strengthens the heart and improves overall fitness by increasing the body’s ability to use oxygen. Swimming, walking, and dancing are “low-impact” aerobic activities. They avoid the muscle and joint pounding of more “high-impact” exercises like jogging and jumping rope. Benefits include cardiovascular fitness, muscle tone, weight loss or control, decrease in fluid retention, and increase in self-esteem.

 Is there a “cure” for PMS?

Widespread recognition of PMS has attracted a broad range of research interest in the treatment and management of the symptoms of PMS. Although there is no “cure” for PMS at this time, there are many options in managing its signs and symptoms. The first priority is an accurate diagnosis. Other medical or psychological conditions should be identified and treated. Proper diet, exercise and lifestyle changes can improve overall health and thereby can lead to the reduction of symptoms, and if these measures are not effective, over-the-counter or prescription medications may be indicated. Most women can control their PMS symptoms successfully so that they do not interfere with their leading healthy and productive lives.

This information is provided by MedicineNet.