(PMS; Premenstrual Tension Syndrome; Premenstrual Dysphoric Disorder; PMDD; Late Luteal Phase Dysphoric Disorder)
Premenstrual syndrome (PMS) is a disorder marked by physical and emotional symptoms. It affects women 1-2 weeks before the beginning of their menstrual period.
The Menstrual Flow
The cause is unknown. A combination of environmental, metabolic, and behavioral factors may make women vulnerable to the specific actions of hormonal changes linked to menstruation. A brain chemical, serotonin, may play a role in severe forms of PMS]]> .
These factors increase your chance of developing PMS. Tell your doctor if you have any of these risk factors:
- Age: 25-40
- Going off birth control pills
- Major life stress
If you have any of these symptoms do not automatically assume they are due to PMS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
- Mood swings
- Diminished self-esteem
- Difficulty concentrating
- Sleep problems
- Appetite changes (sugar and/or salt cravings, overeating)
- Weight gain
- Breast swelling and tenderness
- Gastrointestinal upset
- Diffuse muscle pain
Symptoms improve when bleeding starts (menstrual period).
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
You will be asked to keep a very detailed record of your monthly physical and emotional symptoms. If caused by PMS, these symptoms will likely occur 1-2 weeks before your menstrual period. You may have PMS if symptoms occur at the same phase of the menstrual cycle each month.
Many treatments have been used to relieve symptoms. No one treatment has been found to always be effective for all symptoms. Treating one or two symptoms may improve the whole syndrome. Treatments include:
Dietary changes may be helpful. They include decreasing intake of salt, sugar, and ]]>caffeine]]> . Caffeine is found in coffee, tea, cola, diet sodas, and chocolate. Eating small, frequent meals may also help.
Vitamins and Minerals
The following vitamin and mineral supplements might reduce PMS symptoms:
Research suggests that women who engage in moderate activity suffer less PMS-related symptoms than sedentary women.
Diuretics can reduce bloating and fluid retention.
Prostaglandin inhibitors, such as ]]>Motrin]]> , can relieve cramps, headaches, and muscle aches.
Combined oral contraceptives (containing estrogen and progesterone) may help physical symptoms linked to PMS. You may need to try several brands before finding one that helps. Progesterone alone (without estrogen) may also help some women.
Selective serotonin reuptake inhibitors are a type of antidepressant medication that affect the level of serotonin in the brain. Women who have severe PMS may find relief with SSRIs. ]]>*¹]]> Examples of this type of medication include:
Sexual Activity With Orgasm
Sexual activity (including masturbation) may relieve aching muscles and sluggish circulation. It moves blood and fluids away from congested organs.
Women with severe PMS symptoms may benefit from ]]>cognitive behavioral therapy]]> . Therapy may reduce negative emotions and enhance problem-solving skills in relationships. It may also manage obstacles, frustrations, and discomfort.
The American College of Obstetricians and Gynecologists
Women's Health Matters
Brown J, O'Brien P, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2008;CD001396,
Department of Obstetrics and Gynecology. US Department of Health and Human Services website. Available at: http://www.hhs.gov/ . Accessed June 15, 2008.
Frye GM, Silverman SD. Is it premenstrual syndrome? Keys to focused diagnosis, therapies for multiple symptoms. Postgrad Med . 2000;107(5).
Premenstrual syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed October 14, 2005.
Premenstrual syndrome. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/premenstrualsyndrome.html . Accessed October 14, 2005.
*¹4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Brown J, Shaughn O'Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001396.
Last reviewed February 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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