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have tender breasts, bloating, and muscle aches a few days before they start
menstrual periods. These are normal premenstrual
symptoms. But when they disrupt your daily life, they are called premenstrual
syndrome (PMS). PMS can affect your body, your mood, and how you act in the days leading up to your menstrual period.
Some women first get PMS in
their teens or 20s. Others don't get it until their 30s. The symptoms may get
worse in your late 30s and 40s, as you approach
PMS is tied to hormone changes
that happen during your menstrual cycle. Doctors don't fully know why
premenstrual symptoms are worse in some women than in others. They do know that
for many women, PMS runs in the family.
Not getting enough
vitamin B6, calcium, or magnesium in the foods you eat can increase your
chances of getting PMS. High stress, a lack of exercise, and too much caffeine
can make your symptoms worse.
Common physical signs include:
It is also common to:
PMS symptoms may be mild or strong and vary from month to month. When PMS symptoms are
severe, the condition is called
premenstrual dysphoric disorder (PMDD). But PMDD is
Your doctor will ask
questions about your symptoms and do a physical exam. It's important to make
sure that your symptoms aren't caused by something else, like
Your doctor will want
you to keep a written record of your symptoms for 2 to 3 months. This is called a menstrual diary. It can help you track when your
symptoms start, how bad they are, and how long they last. Your doctor can use
this diary to help diagnose PMS.
A few lifestyle changes will
probably help you feel better.
Talk to your doctor if these changes don't provide some relief from your symptoms after a few menstrual cycles. He or she can prescribe medicine for problems such as bloating or for more severe PMS symptoms. For example, selective serotonin reuptake inhibitors (SSRIs)
can relieve both physical and emotional symptoms. Low-estrogen birth control pills
may help relieve severe PMS or PMDD.
are taking medicine for PMS, talk with your doctor about birth control. Some
medicines for PMS can cause birth defects if you take them while you are
Learning about premenstrual syndrome (PMS):
Health Tools help you make wise health decisions or take action to improve your health.
Premenstrual syndrome (PMS) and the more severe form,
premenstrual dysphoric disorder (PMDD), are linked to
normal changes in the
endocrine system. The endocrine system makes hormones that control the
menstrual cycle. The female endocrine system
is very complex. Medical experts don't fully understand why normal hormone changes
cause PMS in some women and not others.
The one direct cause
that is known to affect some women is genetic: Many women
with PMS have a close family member with a history of PMS.
Premenstrual symptoms occur between
ovulation and the start of menstrual bleeding. More than 150 symptoms have been linked to PMS. They may vary greatly from cycle to cycle and be worse during times
of increased stress.
Women who have severe premenstrual
mood swings, depression, irritability, or anxiety (with or without physical
symptoms) are said to have
premenstrual dysphoric disorder (PMDD). Symptoms
generally go away within the first 3 days of menstrual bleeding. This severe
type of PMS isn't common.
Some medical conditions may get worse between ovulation
and the first day of menstrual bleeding.
The conditions most affected include:
What seems like PMS can sometimes be caused by another
condition. It's important to know what is causing your symptoms so you can get the right treatment. The best way to learn if your symptoms are PMS is to keep a
menstrual diarymenstrual diary(What is a PDF document?) for 2 or 3 months and then show it to your health professional.
Most women first get PMS in their mid-20s, but it becomes more common in women in their 30s. Women in their late 30s and early 40s may have
perimenopausal symptoms that are similar to PMS and
premenstrual dysphoric disorder (PMDD).
menopause, when hormones are low and no longer
rise and fall each month, women don't have PMS.
A risk factor is anything that increases your chances of getting sick or having a problem. Risk factors for PMS include:
Call your doctor if:
Most family doctors can
diagnose and treat PMS. So can most nurse practitioners and physician assistants.
If you have severe symptoms, you may need to see a
gynecologist to help you make a treatment plan.
If your symptoms are mainly
emotional or behavioral, a
psychologist can help you find ways to manage your
To prepare for your appointment, see the topic Making the Most of Your Appointment.
No single test can diagnose
PMS. A diagnosis of PMS or premenstrual dysphoric disorder (PMDD) is usually
based on a
medical history and information from a two- or three-cycle menstrual diarymenstrual diary(What is a PDF document?) where you record your symptoms, menstruation days, and ovulation days, if
thyroid problems sometimes cause symptoms like those of PMS. So you may have a
thyroid-stimulating hormone (TSH) blood test to make
sure that your
thyroid gland is working properly.
It's important for your doctor to rule out other
conditions that cause symptoms like those of PMS, so it may take more than one visit to
diagnose your symptoms. Diagnosing PMS may be difficult if you have another condition that
gets worse during the last 2 weeks of your
There are ways to reduce your PMS symptoms and their impact on your life. But no single treatment works
for all women. You may have to try several to find the right choices for you.
The first step is to try some lifestyle changes, such as limiting caffeine and getting regular exercise. For more information, see Home Treatment.
If you still have
moderate to severe symptoms after two or three cycles of home treatment measures, talk your doctor about further treatment
options. These may include taking selective serotonin reuptake inhibitor (SSRI) antidepressants or low-estrogen birth control pills. For more information, see Medications.
A variety of herbs and other complementary treatments may help reduce or relieve PMS. For more information, see Other Treatment.
ovaries (oophorectomy) is a rarely used, controversial
treatment for the severe form of PMS, premenstrual dysphoric disorder (PMDD). For more information, see Surgery.
You can't prevent
PMS. But there are things you can do
to reduce your chances of having severe symptoms.
The first step in learning to manage PMS is to keep a menstrual diarymenstrual diary(What is a PDF document?). Write down what kind of symptoms you have, how severe they are, when you have your period, and when you ovulate. This can help you identify patterns in your cycle and plan ahead to better cope with the symptoms.
Next, use some self-care measures for PMS. They focus on practicing healthy habits, managing pain, and reducing stress. When you use these tips, it's best to:
If you have moderate to severe premenstrual symptoms even after you've tried home treatment and lifestyle changes, talk to your doctor
about using medicine. The most commonly used medicines for PMS are:
For more information about birth control pills and
progestin, see the topic
In the past, some women with
premenstrual dysphoric disorder (PMDD), the severe
PMS, had surgery to remove the
ovaries (oophorectomy) and the uterus (hysterectomy). Without ovaries, a woman no longer has a
Surgical removal of the
ovaries for PMDD is highly controversial and rarely done. It is only considered if a woman meets all of the following
Removing the ovaries
leads to early menopause, and the symptoms tend to be more severe
than those of natural menopause. Early menopause also increases the risk of
osteoporosis, because low estrogen leads to loss of bone
Surgery also has risks related to the procedure or
anesthesia. For more information, see the topic
Most of the following
complementary therapies aren't considered standard treatment for PMS. But you may
find that one or more of them helps to relieve some of your symptoms. In
general, these treatments are safe and don't cause bothersome side effects.
Other Works Consulted
Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper
gastrointestinal tract bleeding associated with selective serotonin reuptake
inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.
Berga SL, Spencer JB (2009). Premenstrual syndrome. In EG Nabel, ed., ACP Medicine, section 16, chap. 3. New
Davis AJ, Johnson SR (2000, reaffirmed 2010).
Premenstrual syndrome. ACOG Practice Bulletin No. 15,
pp. 1–9. Washington, DC: American College of Obstetricians and
Kwan I, Onwude JL (2009). Premenstrual syndrome, search date July 2009. Online version of BMJ Clinical Evidence:
Reid RL (2008). Premenstrual syndrome. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 672–681. Philadelphia: Lippincott Williams and Wilkins.
Twogood S, Israel J (2010). Premenstrual syndrome. In Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 267–270. Chichester, UK: Wiley-Blackwell.
U.S. Food and Drug Administration (2005).
FDA Public Health Advisory: Paroxetine. Available
Yonkers KA, et al. (2005). Efficacy of a new low-dose
oral contraceptive with drospirenone in premenstrual dysphoric disorder.
Obstetrics and Gynecology, 106(3): 492–501.
August 5, 2013
Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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