What is PMS (premenstrual syndrome)?

Premenstrual syndrome (PMS) is a combination of emotional, physical, psychological, and mood disturbances that occur after a woman's ovulation, typically ending with the onset of her menstrual flow. The most common mood-related symptoms are irritability, depression, crying, oversensitivity, and mood swings. 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.

PMS vs. pregnancy symptoms

For certain women, the symptoms of PMS may be similar to those of early pregnancy, although this is highly individual. Many women do not experience symptoms in early pregnancy, while others may report breast tenderness, bloating, fatigue, and mood swings. These symptoms can be, for some women, similar to the symptoms of PMS or similar to the changes in their body they experience prior to the menstrual period. Unfortunately for women wondering whether specific symptoms are due to PMS or early pregnancy, the only definitive answer comes with the arrival of the menstrual period or a positive pregnancy test.

What causes PMS (premenstrual syndrome)?

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 signs and symptoms of PMS (premenstrual syndrome)?

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,
oversensitivity, and
exaggerated mood swings.
The most frequent physical signs and symptoms of PMS include:

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

How long does PMS (premenstrual syndrome) last?

The duration of PMS varies among women. Most women experience the symptoms for a few to several days in the week prior to the onset of their menstrual period. Some women may have symptoms for a shorter or longer time period, but symptoms of PMS typically start after ovulation (the mid-point in the monthly menstrual cycle).

What treatments are available for PMS (premenstrual syndrome)?

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:

emotional support during the premenstrual period;
salt restriction before the menstrual period;
decreased caffeine intake prior to menstruation;
smoking cessation;
limitation of alcohol intake; and
reduction of refined sugar intake.
All of the above have been recommended and may help symptoms in some women. Furthermore, some studies suggest that calcium and magnesium supplements may provide some benefit.

What medications are used to treat PMS (premenstrual syndrome)?

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

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, and either caffeine or pamabrom. Spironolactone (Aldactone) is a prescription diuretic that has been widely used to treat premenstrual swelling of the hands, feet and 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 anti-inflammatory drugs (NSAIDs). Examples include ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox), and mefenamic acid (Ponstel).

Evidence suggests that exercise can help relieve some of the symptoms of PMS in adolescents young women. 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.

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.

Source: Medicinenet

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