Premenstrual Syndrome

What is premenstrual syndrome?

Premenstrual (pree-MEN-stroo-al) syndrome is also known as PMS. It covers a group of symptoms that may begin one or two weeks before menstruation (your monthly period). PMS may be worse some months and better others. It can affect the way you act or feel. About half of all women have PMS at some time in their lives. It can happen to any woman having her period, but is most common in women ages 25 to 40.

What causes PMS?

Caregivers do not know for sure what causes PMS and why some women have worse symptoms than others. One reason PMS may happen is due to monthly changes in hormone levels. Hormones are chemicals in the body that help to control how your body works. Changes in brain chemicals may also cause or worsen PMS. Other things that may make PMS worse are a poor diet, lack of exercise, or eating and drinking too much caffeine. You may be more likely to have PMS if someone else in your family had it. Symptoms of PMS may be worse if you have a lot of stress, or have mental problems. PMS may be made worse by depression (long-term sadness), or it may cause depression.

What are the signs and symptoms of PMS?

• PMS symptoms may range from mild to severe (very bad). Symptoms usually start in the days leading up to your period. They usually go away within hours to days after menstrual bleeding starts. Other medical problems such as depression, anxiety, migraines, and epilepsy may get worse in the days before your period. Some emotional (mood) symptoms of PMS may include:
  
  
  • You may feel mad, tense, irritable, nervous, or sad.
    
    
  • You may feel hungry and crave foods like chocolate, sugar, or salt.
    
    
  • You may be moody, have crying spells, or want to be left alone.
    
    
  • You may have less energy, feel very tired, or have trouble sleeping.
    
    
  • You may have trouble thinking, focusing on tasks, or remembering things.
  
  
• You may also notice physical (body) changes. These changes may include the following:
  
  
  • Weight gain. You may have swelling in your abdomen (belly), ankles, hands, or face. Your breasts may swell and become tender or painful.
    
    
  • Acne (pimples).
    
    
  • Headaches or migraines.
    
    
  • Dizziness or feeling faint. You may have changes in your vision (seeing spots or having blurry vision).
    
    
  • Changes in bowel movements (BMs). You may have constipation (BMs that are hard, or difficult to pass) or diarrhea (loose, watery stools). You may not urinate as often as usual.
    
    
  • Less interest in sex, or less pleasure from it.
    
    
  • Heart palpitations (feeling like your heart is pounding).
    
    
  • Backaches and other general aches and pains.

How is PMS diagnosed?

• Your caregiver will ask many questions about your symptoms. Use a diary or calendar to keep a record of your menstrual cycle during each month. This record should include when your periods start and stop. Also include your symptoms, such as changing moods, behavior, and physical changes. Write down if your symptoms were mild, moderate, or severe. Record your symptoms for at least two cycles (months) so that your caregiver can check for any patterns. This record can help your caregiver focus on which of the problems are most bothersome and should be treated first.
  
  
• Your caregiver may examine you to check for other possible causes of your symptoms. You may need different tests, depending on what health problems your caregiver is checking for. For example, you may need blood tests to make sure you do not have thyroid problems. You may also need a pelvic exam. During a pelvic exam, your caregiver checks your vagina, cervix, and uterus for problems.

What may be done to treat PMS?

Your caregiver may suggest the following to help decrease your PMS symptoms.

• Activity and rest:
  
  
  • When having PMS symptoms, try to stay away from people or activities that cause you to feel upset or stressed. Stress often makes PMS symptoms worse. Yoga, relaxation exercises, or biofeedback may also help you decrease stress. Ask your caregiver for more information about any of these.
    
    
  • Exercising at least three times a week may decrease stress and PMS symptoms, and help you feel better. Try to exercise for at least 20 to 45 minutes at a time. Talk to your caregiver before you start exercising. Together, you can plan an exercise program that is right for you.
    
    
  • To help you sleep better:
    
    
    • Avoid drinks that contain alcohol or caffeine in the late afternoon or evening. Also avoid nicotine (tobacco products).
      
      
    • Do not exercise within three hours of going to bed.
      
      
    • Make your bed a place for sleep and relaxation. Try not to eat, read, work, or watch television in bed.
      
      
    • Go to bed at the same time each night and get up at the same time every day.
      
      
    • Get a good amount of sleep every night. Most people need six to eight hours. Ask your caregiver how many hours of sleep you should have.
  
  
• Diet and nutrition: Eat a variety of healthy foods every day. These should include fruits, vegetables, breads, dairy products, and protein (meat, beans, and fish). Eating healthy foods may help you feel better and have more energy. Other ways to improve your diet and decrease PMS symptoms include the following.
  
  
  • Do not eat foods that have a lot of salt. Eating less salt may help decrease body swelling. Read labels on food or drink packages to find out how much salt (sodium) is in the food or drink. Do not eat or drink more than 3000 mg (milligrams) of sodium a day.
    
    
  • Avoid foods and drinks have caffeine in them, such as chocolate, coffee, some teas, and soda. Too much caffeine can make you feel more nervous or moody.
    
    
  • Eat more fiber. Fiber is found in fruits, vegetables, and whole-grain breads.
    
    
  • Decrease the amount of fat in your diet. Avoid snack foods, processed foods, and fast foods. Try to eat lean meats, which are meats that have little or no fat in them.
    
    
  • Eat less sugary food. Read package labels to find out how much carbohydrates (sugars) are in the foods you eat. Sugar may be called "sucrose," "fructose," "corn syrup," or "high fructose corn syrup." If you feel the need to eat sweets, try foods high in healthier complex carbohydrates instead. Examples of foods rich in complex carbohydrates include pasta, whole wheat breads, cereal, and potatoes.
    
    
  • Increase your intake of calcium-containing foods. Some foods that contain calcium are dairy (milk) products, broccoli, salmon, and some types of nuts (almonds and brazil nuts).
    
    
  • Avoid drinks that contain alcohol for one week before your period.
    
    
  • Your caregiver may want you to take calcium, magnesium, or certain vitamins. Taking these supplements may help your PMS. Ask your caregiver for advice before taking herbal supplements for PMS. Some supplements may interact with your other medicines. They may also worsen your PMS if they are taken the wrong way.
  
  
• Medicines: Your caregiver may suggest one or more of the following medicines.
  
  
  • Pain medicine: You may use over-the-counter (OTC) medicines, such as ibuprofen, naproxen, or acetaminophen for aches and pains. Some of these medicines may also decrease swelling. These medicines may be bought without a caregiver's order. These medicines are safe for most people to use. However, they can cause serious problems when they are not used correctly. People with certain medical conditions, or using certain other medicines are at a higher risk for problems. Using too much, or using these medicines for longer than the label says can also cause problems. Follow directions on the label carefully. If you have questions, talk to your caregiver.
    
    
  • Diuretics: Diuretics are often called "water pills." This medicine helps your body get rid of extra fluid. Some OTC pain medicines and herbal supplements may also act like diuretics. Ask your caregiver before taking any of these products.
    
    
  • Antidepressants: This medicine may be given to help improve your mood or behavior. Sometimes it is given only during the last two weeks of your menstrual cycle. Some vitamins, herbal supplements, or food supplements may interact with this medicine. Ask your caregiver before taking these products.
    
    
  • Hormonal contraceptives: Caregivers may give you hormones if your PMS is very bad. This medicine helps to even out the changes in hormones that may be causing your symptoms.
  
  
• If your PMS is severe: Rarely, PMS may cause very bad symptoms that keep you from leading a normal life. If your symptoms are severe and do not go away with other treatments, you may need surgery. Surgery to remove both ovaries stops the hormonal changes of the menstrual cycle that may cause PMS. Women should choose surgery only as a last resort. You cannot become pregnant after having surgery to remove your ovaries.

Coping:

Accepting that you have PMS may be hard. Talk about how you are feeling with your caregiver. A counselor may help you learn to decrease stress and handle problems in your life. Learn as much as you can about PMS. Your caregiver can suggest books about PMS. There are also support groups for women with PMS. Call or write the following organizations for more information about PMS:

• The National Women's Health Information Center
  8270 Willow Oaks Corporate Drive
  Fairfax , VA 22031
  Phone: 1- 800 - 994-9662
  Web Address: http://www.womenshealth.gov
  

• The American College of Obstetricians and Gynecologists
  409 12th Street, SW
  Washington , DC 20090
  Phone: 1- 202 - 638-5577
  Web Address: http://www.acog.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Premenstrual Syndrome