Topic Overview
What is premenstrual syndrome (PMS)?
Most women
have tender breasts, bloating, and muscle aches a few days before they start
their
menstrual periods. These are normal premenstrual
symptoms. But when they affect your daily life, they are called premenstrual
syndrome (PMS). PMS can affect your body as well as your mood. Sometimes it can
make you change the way you act.
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
perimenopause.
What causes PMS?
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.
What seems like PMS might be caused
by something else. Your treatment will change if your symptoms are not tied to
PMS.
What are the symptoms?
PMS symptoms can affect
your body, your mood, and how you act in the days or week leading up to your
menstrual period.
Physical signs include:
- Acne.
- Bloating and tender
breasts.
- Food cravings.
- Lack of energy.
- Cramps.
- Headaches.
- Low back pain.
When you have PMS, you might also:
- Feel sad, angry, or anxious.
- Be
less alert.
- Find it hard to focus on tasks.
- Want to
withdraw from family and friends.
- Act in a forceful or hostile
way.
PMS symptoms can be mild or strong. If your symptoms are
severe, you may have
premenstrual dysphoric disorder (PMDD). But PMDD is
very rare.
How is PMS diagnosed?
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
thyroid disease.
Your doctor will want
you to track your symptoms for 2 to 3 months by keeping a written record of how
you feel. 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.
How is it treated?
A few lifestyle changes will
probably help you feel better. Eat healthy foods, get plenty of exercise, and
take vitamin B6 and extra calcium. Cut back on caffeine, alcohol, chocolate,
and salt. If you smoke, quit. For pain, try aspirin, ibuprofen (such as Advil
or Motrin), or another
anti-inflammatory medicine.
You will
likely feel some relief from your symptoms after a few menstrual cycles. If you
don't, talk to your doctor. He or she can prescribe medicine for many PMS
problems, such as bloating.
There are other drugs you can take
for more severe PMS symptoms. Selective serotonin reuptake inhibitors (SSRIs)
can relieve both physical and emotional symptoms. Most women feel better after
taking a low dose every day or only on premenstrual days.
Another treatment choice for moderate to severe symptoms is a
type of birth control pill. It is sold as YAZ and Yasmin.
If you
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
pregnant.
Frequently Asked Questions
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Cause
Premenstrual syndrome (PMS) and the more severe form,
premenstrual dysphoric disorder (PMDD), are linked to
the normal changes in the
endocrine system, which produces
hormones that control the
menstrual cycle. Because the female endocrine system
is so complex, medical experts don't fully understand the chain of events that
causes 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.
Just as your combination of PMS symptoms is
slightly different from another woman's, so is the mix of factors underlying
your symptoms. Changes in the endocrine system that cause PMS symptoms can
include:
- Increased aldosterone (a hormone from the
adrenal gland). This is normal after
ovulation. Aldosterone causes fluid retention, weight
gain, breast swelling, and headaches in some women but not others.
- Too much
prolactin (a hormone from the
pituitary gland), which can interfere with ovulation
and cause irregular cycles and breast tenderness.
- The brain's underuse of the
neurotransmitter serotonin, which is known to cause
anxiety and
depression. Women who have PMS
mood problems might be sensitive to normal premenstrual changes in
estrogen and
progesterone (from the ovaries). This sensitivity may
trigger a problem with the brain's use of serotonin.
- Decreased endorphins (hormones from the pituitary
gland), which may increase pain and depression in some women.
- Prostaglandins (chemicals made by all
body cells), which are linked to breast pain, fluid retention, cramping,
headaches, irritability, and depression.
- Sensitivity to
insulin, which is thought to be common during the
premenstrual time following ovulation. This sensitivity can lead to episodes of
low blood sugar, which may trigger premenstrual
symptoms.
Symptoms
Premenstrual symptoms are a natural part of
the
menstrual cycle, affecting most women at some
time during their lives. If your body doesn't react
strongly to its monthly hormonal changes, you probably have mild premenstrual
symptoms or none at all. But if you have one or more mild to moderate
premenstrual symptoms that disrupt your work, relationships with others, or
sense of well-being, you are said to have
premenstrual syndrome (PMS).
PMS
symptoms vary greatly from woman to woman and cycle to cycle, and they can range
from mild to severe. Some women note that their symptoms are worse during times
of increased emotional or physical stress. Of the more than 150 symptoms that
have been linked to PMS, the most common are listed below.
Physical symptoms
- Breast swelling and
tenderness.
- Bloating, water retention, weight
gain.
- Changes in bowel habits.
- Acne.
- Nipple discharge when nipples or breasts are pressed. (Any leakage that
spontaneously happens when you aren't pressing on the nipple should be checked
by a health professional.)
- Food cravings, especially for sweet or salty
foods.
- Sleep pattern changes.
- Fatigue, lack of
energy.
- Decreased sexual desire.
- Pain. Common complaints
include headaches or migraines, breast tenderness, aching muscles and joints,
or cramps and low back pain prior to menstrual bleeding.
Behavioral symptoms
- Aggression.
- Withdrawal from family
and friends.
Emotional and cognitive symptoms
- Depression, sadness,
hopelessness.
- Anger,
irritability.
- Anxiety.
- Mood swings.
- Decreased alertness, inability to concentrate.
By definition, premenstrual symptoms only occur during the
luteal phase, between
ovulation and the start of menstrual bleeding, or soon
after. Premenstrual symptoms can occur during the entire luteal phase or can
appear briefly during ovulation, in the days leading up to menstrual bleeding,
or both. You may notice that the severity and pattern of your PMS symptoms
varies from month to month. You may also stop or start having PMS symptoms for
no clear reason.
Severe symptoms
If you have severe premenstrual
mood swings, depression, irritability, or anxiety (with or without physical
symptoms), you are said to have
premenstrual dysphoric disorder (PMDD). Symptoms
generally subside within the first 3 days of menstrual bleeding. This severe
type of PMS is not a common problem. It happens in only about 5 out of 100 women.1 Women with
PMDD symptoms tend to report that they:
- Have negative behavior and feelings of
hopelessness.
- Feel guilt and shame.
- Feel they have lost
control over their lives.
- Believe they are mentally ill and fear
the stigma of mental illness.
- Have poor job performance or missed
workdays during the premenstrual period.
- Feel distanced from
family and friends.
Premenstrual worsening of other conditions
You may
notice that symptoms of other medical conditions get worse between ovulation
and the first day of menstrual bleeding—this is called menstrual magnification.
The conditions most affected are:
Are my symptoms truly premenstrual, starting after I ovulate?
What seems like PMS can sometimes be caused by another
condition. It's important to know, because your treatment options will be
different if your symptoms aren't actually linked to premenstrual hormone
changes. The best way to learn whether your symptoms are premenstrual is to
know when you ovulate (the day you ovulate is the start of your premenstrual
phase). Keep track of ovulation days, a daily record of your symptoms, and
menstrual bleeding days in a
menstrual diary(What is a PDF document?). There are many ways to record symptoms so you can find one that works for you.
You can most
accurately pinpoint your ovulation day by monitoring
your cervical mucus, your
basal body temperature (BBT), and your
luteinizing hormone (LH) changes with an ovulation
test. Traditionally, ovulation was thought to happen
14 days before the next menstrual period, or on day 15 of a 28-day cycle. But
ovulation dates often vary from woman to woman and from month to month.
What Happens
Premenstrual syndrome (PMS) is linked to normal changes in your
endocrine system that start when you
ovulate, lasting up to the first days of your
menstrual period. Menstrual cycles usually last 26 to
30 days. But many women have irregular cycles that are shorter or last longer.
This means the day of ovulation can vary from woman to woman and month to
month. Women with irregular cycles have an even greater range of possible
ovulation and premenstrual days.
Any number of
hormone changes can cause premenstrual symptoms—this
accounts for the many types of symptoms that women have after ovulation. As
your
hypothalamus,
pituitary gland,
thyroid gland,
adrenal glands, and
ovaries work together to produce an egg (ovum) and
prepare your body for a possible pregnancy, they send out chemical signals to
one another and the rest of your body. These signals—in the form of hormones
and brain chemicals, or
neurotransmitters—can affect your mood, energy level,
ability to think clearly, body fluid and weight, and pain perception. If one
part of the endocrine system isn't working right, the rest of the system is
affected, often causing a combination of premenstrual symptoms.
Although most women first experience PMS in their mid-20s, PMS may become more common for women in their 30s. Among
women in their late 30s and early 40s (who have erratic periods, ovulation, and
hormone changes), unpredictable physical, emotional, and mood-related
perimenopausal symptoms can be similar to PMS and
premenstrual dysphoric disorder (PMDD). After
menopause, when hormones are low and no longer
fluctuating, women do not have PMS.
If you take
estrogen and/or
progestin for birth control or for
hormone replacement after menopause, you can also have
PMS-like symptoms.
What Increases Your Risk
Although the cause of
premenstrual syndrome (PMS) is poorly understood, a
number of risk factors have been noted among women with PMS.
Risk factors for PMS that you cannot control
- A family history of premenstrual syndrome
(PMS)
- Age. PMS becomes increasingly common as women age through
their 30s, and symptoms sometimes get worse over time.
- Previous
anxiety,
depression, or other mental health problems. This is a
significant risk factor for developing premenstrual dysphoric disorder
(PMDD).
Risk factors that you can control
- Lack of exercise
- High
stress
- Vitamin B6, calcium, or magnesium deficiency
- High caffeine intake
- Poor
diet
When To Call a Doctor
Many women have
premenstrual syndrome (PMS) either before or during
their menstrual periods. If you have severe symptoms, you may wonder whether
you need to see your health professional for symptom treatment.
Call your health professional if:
- PMS symptoms regularly disrupt your life and
keep you from doing your regular activities.
- You feel out of
control because of PMS symptoms.
- PMS symptoms do not respond to
home treatment.
- Significant PMS symptoms (such as
depression,
anxiety, irritability, crying, or mood swings) do not
end after a couple of days of your menstrual period.
Watchful waiting
If PMS symptoms consistently occur for several
months in a row, try home treatment measures. Many women find that making small
changes in their lifestyle significantly improves their symptoms.
If home treatment does not improve your symptoms and they are severely
disrupting your life, make an appointment for 3 months from now to see your
health professional. Many health professionals will want you to complete a
menstrual diary for at least two menstrual cycles before they can diagnose and
treat PMS.
If you think you have PMS, keep track of the following
in a
menstrual diary(What is a PDF document?).
- Your symptoms and their
severity
- Dates when symptoms occur
- Days that you
ovulate (if you can tell when this
happens)
- Days when you have your menstrual period
Who to see
Generally, your primary health professional can
diagnose and treat premenstrual syndrome (PMS). If your health professional is
not familiar with PMS, he or she can refer you to one who is.
Health professionals who can diagnose and treat PMS include:
If you have severe PMS, you may need to consult a
gynecologist to help develop a treatment plan. If your symptoms are mainly
emotional or behavioral, or you have been diagnosed with
premenstrual dysphoric disorder (PMDD), working with a
psychiatrist or
psychologist may help you find ways to manage your
symptoms.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
No single test can diagnose
premenstrual syndrome (PMS). A diagnosis of PMS or the
more severe form,
premenstrual dysphoric disorder (PMDD), is usually
based on a
medical history and information from a two- or three-cycle menstrual diary(What is a PDF document?) or symptom diary where you record daily symptoms, menstruation days, and ovulation days, if
possible. Because it's important for your health professional to rule out other
conditions that cause PMS-like symptoms, it may take more than one visit to
diagnose your symptoms.
Because treatable
thyroid problems sometimes cause PMS-like symptoms,
you may have a
thyroid-stimulating hormone (TSH) blood test to make
sure that your
thyroid gland is working properly.
Diagnosing PMS may be difficult when a woman has another condition that
is made worse during the last 2 weeks of her
menstrual cycle.
- Although there are clear-cut criteria for
diagnosing premenstrual syndrome, PMS symptoms often blend in with those
of other conditions.
- All symptoms need to be evaluated and
treated.
Knowing whether your symptoms are premenstrual helps you
and your health professional decide on the best treatment for you. By
definition, PMS and PMDD occur only during the phase between
ovulation and the start of menstrual bleeding.
Traditionally, ovulation was thought to happen 14 days before the next
menstrual period, or on day 15 of a 28-day cycle. But
ovulation dates often vary from woman to woman and from month to month. Women
with irregular cycles have a wide range of possible ovulation days.
You can most
accurately pinpoint your ovulation day by monitoring
your cervical mucus, your
basal body temperature, and your
luteinizing hormone (LH) changes.
Treatment Overview
Most women normally have
one or more troubling physical and emotional symptoms between the time they
ovulate and the first days of their
menstrual period. These are
called premenstrual symptoms. When premenstrual symptoms interfere with your
relationships or responsibilities, they are called
premenstrual syndrome (PMS) or
premenstrual dysphoric disorder (PMDD), a severe form
of PMS.
Although PMS cannot be cured, you do have a number of
lifestyle and medication choices that can reduce your symptoms and improve your
quality of life.
Basic PMS treatment
If you have PMS, keep a menstrual diary(What is a PDF document?), make lifestyle changes,
and use home treatment measures. After a few
menstrual cycles, you should notice some improvement in symptoms. Whether or
not you then decide to add medication treatment, the following home treatment may help you:
- Take daily
calcium and vitamin B6 (50 mg to 100 mg). Both of these
nutrients affect the
hormone-producing
endocrine system. Calcium may help relieve PMS
symptoms. Daily vitamin B6 may improve PMS depression and
physical symptoms.
- Reduce your
caffeine, refined sugar, and sodium intake, at least during the premenstrual
phase of your cycle. These substances are linked to emotional and physical PMS
symptoms, such as insomnia, tension and anxiety, food cravings, pain, and
bloating.
- Get regular exercise.
Exercise helps reduce depression. Women often
report that exercise helps relieve tension, pain, and mood-related PMS
symptoms.
- Reduce stress. While stress is not a cause of PMS, it
may make your symptoms worse. In turn, coping with stress can be more difficult
during the premenstrual period.
- Use
nonprescription medicines, such as
nonsteroidal anti-inflammatory drugs (NSAIDs), for
headache, joint or muscle pain, or cramps. NSAIDs work best when taken before
and continued at regular dosage intervals throughout the premenstrual pain
period. For some women, this continues into the first days of menstrual
bleeding, to relieve painful cramps.
Additional treatments for PMS
If you still have
moderate to severe symptoms after two or three cycles of healthy lifestyle and
home treatment measures, talk your health professional about further treatment
options. Consider the following for specific symptoms.
All physical and mood-related symptoms
The
selective serotonin reuptake inhibitor (SSRI) class of
antidepressants is often the first-choice medicine for moderate to severe
premenstrual symptoms, including aggression, depression, anxiety, and physical
symptoms. Most women gain relief by taking an SSRI either continuously or only
during their premenstrual days. If you try an SSRI but find it ineffective,
it's a good idea to try another type of SSRI before moving on to another class
of medicine.
PMS: Should I Try an SSRI Medicine for My Symptoms?
The
birth control pill with estrogen and drospirenone may help relieve symptoms in women with severe PMS or PMDD. This pill is sold as YAZ (very
low-estrogen) or Yasmin (low-estrogen).
Bloating or breast tenderness
- Spironolactone. Taken during the premenstrual phase,
this diuretic can relieve bloating and breast tenderness.
- Drospirenone, in the birth control pill called
YAZ or Yasmin, acts like spironolactone. It relieves bloating, breast
tenderness.
- Daily vitamin E (400 IU),
taken during the premenstrual phase, may help with breast tenderness.
- Evening primrose oil
contains essential fatty acids that may offer mild relief of some PMS symptoms for some women.
Other hormonal, sedative, or surgical treatments for severe PMS
The goal of hormonal and surgical treatments is to stop a
part of the hormonal (endocrine) system that is linked to premenstrual
symptoms. These treatments are not commonly used to treat PMS symptoms, either
because they are now known to be ineffective or because they have severe side
effects.
- Birth control pills (estrogen-progestin) are
widely prescribed for PMS, but they do not always relieve PMS. Although they may improve
bloating, headache, abdominal pain, and breast tenderness for some women, other
women report that they have worse symptoms or they develop mood problems. Birth
control pills are known to be ineffective for treating mood symptoms. Estrogen alone may offer some benefit for some women,
but when taken without progestin, it increases the risk of
uterine (endometrial) cancer.
- Progestin has been used in the past for PMS, but for
some women, it may make physical and emotional symptoms worse.
- Danazol is a synthetic male hormone that can relieve breast pain by decreasing estrogen
production. It isn't often prescribed.
- Benzodiazepine
treatment with alprazolam is occasionally used for PMS-related anxiety.
It depresses the central nervous system, loses effectiveness over time, and can
be addictive. Because long-term use can be complicated by withdrawal and
life-threatening symptoms, this medicine is only recommended for a few days'
use when other treatments have been ineffective.
- Gonadotropin-releasing hormone agonists (GnRH-a) are a
last-resort treatment for severe
PMDD symptoms. This medicine stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.
- Surgery to
remove the
ovaries (oophorectomy) is a rarely used, controversial
treatment, because it irreversibly causes early
menopause. Menopause symptoms caused by surgery, such
as hot flashes, depression, and insomnia, are often more severe than those of
natural menopause.
What to think about
No single therapy is effective
for all women. You and your health professional may have to try more than one
type of treatment before finding the right choice for you.
Prevention
You cannot prevent
premenstrual syndrome (PMS), but you can take measures
to reduce your risk of having severe premenstrual symptoms by:
- Taking daily
calcium and vitamin B6 (50 mg to 100 mg). Calcium and vitamin B6 may help relieve PMS symptoms.
- Getting
regular exercise, which increases natural brain
chemicals (endorphins) that reduce pain and provide a feeling of
well-being.
- Eating a
balanced diet that helps keep your blood sugar levels
stable. Eat small meals with complex carbohydrates, whole grains, protein,
fruits, and vegetables. Avoid refined sugar, as well as excessive fats, salt,
and alcohol.
- Reducing stress with time management
practices, enough rest, and relaxation techniques.
- Limiting the
amount of
caffeine in your diet.
- Quitting smoking,
if you smoke.
Home Treatment
For as long as you have a
menstrual cycle and
ovulate, your
hormone-producing
endocrine system has powerful, cyclic effects on your
body. If you have symptoms that are or may be
premenstrual syndrome (PMS), use the following home
treatment measures as initial and ongoing treatment.
- Keep a symptom diary or menstrual diary(What is a PDF document?). By recording your
symptoms, their severity, and the days when you have your period and ovulate,
you can identify patterns in your cycle and plan the best treatment with your
health professional. You can also use your menstrual diary to plan ahead for,
prevent or reduce, and better cope with your premenstrual symptoms. Whenever
possible, plan to take extra good physical and emotional care of yourself
during your premenstrual days. It's also useful to let people close to you know
when your more trying days will be.
- Begin or maintain a
moderate exercise schedule (at least 2½ hours a week).
Exercise helps reduce depression. Women often
report that exercise helps relieve tension, pain, and mood-related PMS
symptoms.
- Take daily
calcium and vitamin B6 (50 mg to 100 mg). Calcium and vitamin B6 may help relieve PMS symptoms.
- Follow
a sensible and
balanced diet that provides the recommended levels of
vitamins and nutrients.
- Use a
nonsteroidal anti-inflammatory drug (NSAID) to reduce
PMS pain. NSAIDs relieve premenstrual and menstrual pain and reduce menstrual
bleeding. They reduce
inflammation, which is from increased
prostaglandin production during the premenstrual
period. NSAIDs work best when taken before and continued at regular dosage
intervals throughout the premenstrual pain period. For some women, this
continues into the first days of menstrual bleeding, to relieve painful cramps.
If you have regular cycles, start taking an NSAID 1 to 2 days before you expect
pain to start.
- Avoid or eliminate
unhealthy habits, such as smoking or having too much
caffeine, alcohol, chocolate, or salt.
- Reduce stress in your life.
- Create a support system. Join a support
group of women who are managing their PMS or
premenstrual dysphoric disorder (PMDD). With your
loved ones, plan ahead for ways to reduce the demands and stress placed on you,
as well as the amount of stress that your premenstrual symptoms place on
them.
- Wear a more supportive bra, such as a sports bra, if your
breasts are tender during your premenstrual days.
- If you have cramps, you can usually relieve them with over-the-counter medicine and home treatment.
Menstrual Cycle: Dealing With Cramps
These self-care measures can help you figure out which
changes are most useful in relieving your PMS symptoms. It may be best
to:
- Try one or two techniques at a time, instead of
all of them at once. This will allow you to identify the most helpful
techniques.
- Try the technique for two to three menstrual cycles.
Some techniques may require more than one cycle to be helpful.
- Stop
using a technique if you have tried it for 2 or 3 months and it doesn't seem to
be helping. (But if it is improving other parts of your life, you might want to
keep doing it even if it isn't reducing your PMS symptoms.)
Medications
Troubling physical and emotional symptoms
that occur between the time you
ovulate and the first days of your
menstrual period are called premenstrual symptoms.
When premenstrual symptoms interfere with your relationships or
responsibilities, they are called
premenstrual syndrome (PMS). When premenstrual
emotional symptoms or aggression are severe, they are called
premenstrual dysphoric disorder (PMDD).
If you have moderate to severe premenstrual symptoms that continue
despite home treatment and lifestyle changes, talk to your health professional
about using medicine. Most medicines for PMS affect some part of the
hormone-producing
endocrine system, with the goal of blocking or
increasing a certain chemical process that may be causing symptoms. There is no
known medicine that can "cure" PMS.
The most commonly used medicines for PMS are
nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and selective serotonin
reuptake inhibitors (SSRIs) for mood-related symptoms. There is also a type of birth control pill, sold as YAZ and Yasmin, that may help relieve PMDD
symptoms.
- PMS: Should I Try an SSRI Medicine for My Symptoms?
Pain relievers (nonsteroidal anti-inflammatory drugs [NSAIDs])
- Naproxen, ibuprofen, or mefenamic acid. NSAIDs
relieve premenstrual and menstrual pain and reduce menstrual bleeding. They
reduce
inflammation, which is from increased
prostaglandin production during the premenstrual
period. NSAIDs work best when taken before and continued at regular dosage
intervals throughout the premenstrual pain period. For some women, this
continues into the first days of menstrual bleeding, to relieve painful cramps.
If you have regular cycles, start taking an NSAID 1 to 2 days before you expect
pain to start.
Selective serotonin reuptake inhibitors (SSRIs) to treat mood-related and physical symptoms
Diuretic to treat water retention and weight gain
- Spironolactone. When taken
during the premenstrual weeks, this
diuretic may reduce bloating and breast tenderness by
blocking the body's use of the hormone aldosterone.
- Drospirenone, in the
birth control pill called Yasmin or YAZ, acts like a water pill (diuretic). It
relieves bloating and breast tenderness. This medicine may also help relieve symptoms of severe PMS or PMDD.
Benzodiazepine to treat anxiety
- Alprazolam is only
recommended for a few days' use when other treatments have been ineffective. It
depresses the central nervous system, loses effectiveness over time, and can be
addictive. Long-term use can be complicated by withdrawal or life-threatening
symptoms.
Hormonal treatments
- There is a
birth control pill with estrogen and drospirenone (sold as YAZ and Yasmin)
that may help relieve symptoms of severe PMS or PMDD. YAZ is very low-estrogen,
and Yasmin is low-estrogen.
- Other types of birth control pills
(estrogen-progestin) are widely prescribed for PMS, but birth control pills may not relieve PMS symptoms for everyone. Although
they may improve bloating, headache, abdominal pain, and breast tenderness for
some women, other women report that they have worse symptoms or they develop
mood problems. Birth control pills do not appear to help relieve
mood symptoms. Estrogen alone may offer some benefit for some women,
but when taken without progestin, it increases the risk of
uterine (endometrial) cancer.
- Progestin (progesterone) has been used in the past for
PMS, but for some women, it may make physical and emotional symptoms
worse.
For more information about birth control pills and
progestin, see the topic
Birth Control.
Additional hormone treatments
- Danazol,
a synthetic male hormone, can relieve breast pain by decreasing estrogen
production. It isn't often prescribed.
- Gonadotropin-releasing hormone agonist (GnRH-a). A GnRH-a is a last-resort treatment for
severe
PMDD symptoms. This medicine stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.
Other antidepressants
- Tricyclic antidepressants are not as well studied as SSRIs for PMS and are
generally less favored because of their possible side effects. But they do
improve severe depression and insomnia for some women.
Other medicines
- A beta-blocker medicine, propranolol, may be used to treat migraines
or headaches related to PMS.
What to think about
Using your menstrual diary(What is a PDF document?) or symptom diary,
show your health professional which symptoms are the most bothersome to you. He
or she can then recommend treatment that focuses on relieving your worst
symptoms.
If you are considering medication treatment, it
may be helpful to think about and discuss some of the following questions with
your health professional:
How well the medicines work
Some medicines and dietary supplements have been shown to be effective in
relieving symptoms of PMS. Other medicines used to treat PMS have been shown to
be no more effective than a "sugar pill" (placebo). Some
of these medicines, such as progesterone, may be recommended. But it is better
to use medicines, vitamins, or minerals that studies have shown to be
effective. You may also want to think about the cost of a medicine that may or
may not work.
Side effects
The side effects of some medicines may be just as unpleasant as
your PMS symptoms. For example, gonadotropin-releasing hormone agonists
(GnRH-a) and danazol have significant adverse side effects. In other cases, the
relief from symptoms that a medicine gives may far outweigh any side effects it
causes.
How often to take the medicines
Some medicines must be taken every day, but others may only be taken when
your symptoms are present. If your symptoms aren't severe and don't last
long, you may not think the benefits of medicine treatment are worth taking the
medicine every day.
Surgery
In the past, some women with
premenstrual dysphoric disorder (PMDD), the severe
form of
premenstrual syndrome, were treated with surgical
removal of the
ovaries (oophorectomy) and the uterus (hysterectomy). Without functioning ovaries, a woman's
body doesn't make eggs,
estrogen, and
progesterone and no longer has a
menstrual cycle.
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
criteria:
- PMS symptoms are severe and regularly disrupt
her quality of life.
- She has no future plans to have biological
children, and she is many years away from natural
menopause.
- Symptoms improve with the use of medicines that produce
a condition similar to
menopause (such as danazol or a gonadotropin-releasing
hormone agonist [GnRH-a]). But even if symptoms improve during danazol or a
GnRH-a treatment, it is possible that the medicine is not the reason for the
improvement.
- All other treatments have failed.
- All or most of the symptoms are directly related to PMDD. Other
problems, such as psychological or nonmedical problems in her life or
environment, do not appear to contribute to the symptoms.
Although oophorectomy ends premenstrual symptoms, it also
leads to early menopause and
perimenopausal symptoms that tend to be more severe
than those of natural menopause. Early menopause also increases the risk of
osteoporosis because low estrogen leads to bone
density loss. Because of this, women with no ovaries are advised to take
estrogen (HRT or ERT) at least until menopausal age to protect
against bone loss.
Surgery also has risks related to the procedure or
anesthesia. For more information, see the topic
Hysterectomy.
Other Treatment
Although
premenstrual syndrome (PMS) can't be cured, you do
have a number of lifestyle, medicine, and other treatment choices that can
reduce your symptoms and improve your quality of life. Although most of the
therapies listed below are not considered standard treatment for PMS, you may
find one or more of them helpful in relieving some of your symptoms. In
general, these treatments are safe and well tolerated.
Complementary or alternative therapies
These therapies may help relieve symptoms in some women.
Vitamin and mineral supplements often recommended for home treatment of PMS and PMDD
These supplements are commonly
recommended for PMS home treatment:
- Calcium. This
mineral affects the
hormone-producing
endocrine system. Calcium may help relieve PMS
symptoms. A high level of
calcium intake, broken up into three doses per day,
may improve your negative moods and reduce fluid retention and pain. Calcium
has the added advantage of reducing the risk of
osteoporosis.
- Magnesium. Some women take magnesium supplements to help with
certain symptoms of PMS. But these supplements might not help everyone.
- Vitamin B6 (pyridoxine). This vitamin
affects the endocrine system and helps the body use magnesium. Vitamin B6 might help improve
PMS depression and physical symptoms. Take no more
than 100 mg daily to avoid toxic effects on
the nervous system.
- Vitamin E. Some women
take vitamin E supplements to help with breast tenderness related to PMS. But these supplements might not help everyone.
Other mineral or herbal therapies sometimes used for PMS
- Zinc. Zinc may help
improve PMS-related acne.
- Vitex (agnus-castus, or chasteberry). Although vitex's action on the body isn't well understood,
it does seem to change hormone levels that affect
ovulation and
estrogen production. Vitex might help relieve irritability, anger, breast tenderness, bloating,
cramping, and headaches. But possible side effects
include nausea, gastrointestinal upset, and malaise.
- Ginkgo biloba. Ginkgo may reduce
breast tenderness, bloating, and weight gain. But it is not known if ginkgo helps relieve PMS symptoms.
- Black cohosh. Black cohosh is sometimes used to relieve menopause symptoms and it might help relieve symptoms of PMS. But this therapy might not work for everyone. If you plan to take black cohosh, talk to your doctor about how to take it safely.
- Evening primrose (Oenothera biennis). The oil of evening primrose is a rich
source of gamma-linolenic acid (GLA), an essential fatty acid, and may offer
mild relief of breast tenderness. But it is not known if evening primrose can relieve PMS symptoms.
What to think about
Before you start taking a vitamin, herb, or mineral supplement, talk with your doctor or pharmacist. He or she can find out if it might interfere with other medicines you are taking.
You can buy vitamin and mineral
supplements and herbal remedies in drugstores, grocery stores, or health food
stores.
When trying an alternative therapy for PMS or PMDD, first
try those that are most known to be effective. Try a therapy for two to three
menstrual cycles: to be helpful, some therapies may require use for more than
one cycle.
As with all supplements, it is important to follow the
directions on the supplement label. Do not exceed the maximum dose. If you are
trying to become pregnant but want some relief from your PMS symptoms, discuss
using nutritional supplements and herbal remedies with your health
professional. Certain supplements and remedies have side effects that should be
avoided if you are trying to become pregnant.
Other Places To Get Help
Organizations
| American Congress of Obstetricians and Gynecologists
(ACOG) |
| 409 12th Street SW |
| P.O. Box 96920 |
| Washington, DC 20090-6920 |
| Phone: |
(202) 638-5577 |
| Email: |
resources@acog.org |
| Web Address: |
www.acog.org |
| |
|
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
|
|
| National Women's Health Information
Center |
| 8270 Willow Oaks Corporate Drive |
| Fairfax, VA 22031 |
| Phone: |
1-800-994-9662
(202) 690-7650 |
| Fax: |
(202) 205-2631 |
| TDD: |
1-888-220-5446 |
| Web Address: |
www.womenshealth.gov |
| |
|
The National Women's Health Information Center (NWHIC)
is a service of the U.S. Department of Health and Human Services Office on
Women's Health. NWHIC provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.
|
|
References
Citations
- Katz VL, et al. (2007). Primary and secondary
dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder. In LO
Eckert, GM Lentz, eds., Comprehensive Gynecology, 5th
ed., pp. 901–913. Philadelphia: Mosby Elsevier.
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
York: WebMD.
- Davis AJ, Johnson SR (2000, reaffirmed 2008).
Premenstrual syndrome. ACOG Practice Bulletin No. 15,
pp. 1–9. Washington, DC: American College of Obstetricians and
Gynecologists.
- Kwan I, Onwude JL (2009). Premenstrual syndrome, search date July 2009. Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
- 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.
- U.S. Food and Drug Administration (2005).
FDA Public Health Advisory: Paroxetine. Available
online: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm051731.htm.
- 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.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer |
Kirtly Jones, MD - Obstetrics and Gynecology |
| Last Revised |
May 17, 2011 |
