What is premenstrual syndrome (PMS)?

Premenstrual syndrome is the term used for the physical and emotional symptoms that some women have before their menstrual period begins.

Premenstrual syndrome is commonly called PMS. At least 75% of all menstruating women have some symptoms of PMS, but the symptoms vary from woman to woman. Symptoms range from mild to severe. Severe symptoms may seriously disrupt daily life.

How does it occur?

PMS is related to hormonal changes during the menstrual cycle. A single cause of PMS has not been identified. Current research includes looking at the effects of a woman's cyclical hormones on brain chemistry and other aspects of body metabolism. Possible deficiencies in the diet of certain minerals and vitamins (for example, vitamin B-6) are also being investigated.

What are the symptoms?

The symptoms of PMS usually occur during the second half of the menstrual cycle. Often they start just a few days before the menstrual period, but they may begin as much as 2 weeks before your period begins.

Physical symptoms may include:

• bloated stomach

• swollen feet or hands

• tender, enlarged breasts

• crampy lower-abdominal pain

• weight gain

• headache

• nausea, vomiting, diarrhea, constipation

• appetite changes

• joint or muscle pain

• acne.

Emotional symptoms may include:

• irritability

• anger

• depression

• anxiety

• tension

• fatigue, lack of energy

• difficulty concentrating

• crying spells

• feeling overwhelmed or out of control.

Additionally, many women who have PMS experience difficulties in their relationships with families and friends.

How is it diagnosed?

PMS cannot be diagnosed from any one physical finding or laboratory test. Your health care provider may ask you to record your physical and emotional symptoms and menstrual cycles in a journal or calendar. Symptoms that consistently appear during the week or two before your periods may be caused by PMS. Diagnosis can be difficult and may take several months of careful observation.

How is it treated?

No one therapy is effective for all women. However, for many women with PMS, aerobic exercise, rest, stress reduction, and less salt, caffeine, and refined sugar in the diet may help.

For severe emotional symptoms such as depression or anxiety, your health care provider may prescribe antidepressant or antianxiety medication. Also, counseling may help you deal with your emotional or relationship difficulties.

You may be able to reduce breast tenderness and swelling by not eating chocolate and especially by not drinking beverages containing caffeine. Some women omit these foods from their diet entirely. Others abstain from them only during the last half of their menstrual cycle. Ask your health care provider about drugs that might minimize severe breast symptoms.

Limiting the salt in your diet during the last half of your menstrual cycle may reduce problems of bloating and swelling. Mild diuretics, which are drugs that help the body get rid of excess fluid, also help some women.

Most premenstrual abdominal cramping and headaches can be treated effectively with anti-inflammatory drugs, such as ibuprofen and naproxen. If your cramps are severe, you may need to start taking the anti-inflammatory drugs 1 to 2 days before you expect your cramps to begin. This can prevent the production of cramp-causing chemicals by your body. The anti-inflammatory drugs can also help prevent the nausea, vomiting, and diarrhea caused by the same chemicals.

Some women require prescription medication for recurrent PMS headaches.

How long will the effects last?

The symptoms of PMS usually start a few days before the menstrual period and continue until the period begins. A few women continue to have symptoms during their periods. The symptoms of PMS change as a woman matures, goes through childbearing age, and enters menopause.

How can I take care of myself?

Know how and when PMS affects you. You can then change your diet, exercise, and schedule in ways that help PMS to pass as smoothly as possible.

Join a support group for women dealing with the challenges of PMS.

Call your health care provider if you have severe symptoms or notice that your symptoms vary from one month to the next. There may be a more serious underlying cause for your condition that needs treatment.

What can be done to help prevent premenstrual syndrome?

Because there is still uncertainty about the cause of PMS, there is no reliable way to prevent it. You may be able to lessen the symptoms by eating a healthy diet, maintaining a normal weight, exercising regularly, and taking anti- inflammatory drugs when necessary. If these measures fail, ask your health care provider about prescription treatments.