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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 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 perimenopause.
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 rare.
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 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.
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.
Learning about premenstrual syndrome (PMS):
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|PMS: Should I Try an SSRI Medicine for My Symptoms?|
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|Menstrual Cycle: Dealing With Cramps|
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 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).
After 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.
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 diary(What is a PDF document?) where you record your symptoms, menstruation days, and ovulation days, if possible.
Treatable 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 menstrual cycle.
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.
Surgery to remove the 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 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 Birth Control.
In the past, some women with premenstrual dysphoric disorder (PMDD), the severe form of PMS, had surgery to remove the ovaries (oophorectomy) and the uterus (hysterectomy). Without ovaries, a woman 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:
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 density.
Surgery also has risks related to the procedure or anesthesia. For more information, see the topic Hysterectomy.
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.
|American Congress of Obstetricians and Gynecologists (ACOG)|
|409 12th Street SW|
|P.O. Box 70620|
|Washington, DC 20024-9998|
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.
|Office on Women's Health|
|Department of Health and Human Services|
|200 Independence Avenue, SW Room 712E|
|Washington, DC 20201|
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of audiences, including consumers, health professionals, and researchers.
Other Works Consulted
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- Davis AJ, Johnson SR (2000, reaffirmed 2010). 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.
- 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 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.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
|Last Revised||August 5, 2013|
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