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.
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.
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:
When you have PMS, you might also:
PMS symptoms can be mild or strong. If your symptoms are severe, you may have premenstrual dysphoric disorder (PMDD). But PMDD is very 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 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.
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.
Learning about premenstrual syndrome (PMS):
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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:
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.
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.
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:
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:
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.
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.
Although the cause of premenstrual syndrome (PMS) is poorly understood, a number of risk factors have been noted among women with PMS.
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:
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.
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.
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.
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.
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.
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:
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.
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.
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).
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.
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.
You cannot prevent premenstrual syndrome (PMS), but you can take measures to reduce your risk of having severe premenstrual symptoms by:
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.
These self-care measures can help you figure out which changes are most useful in relieving your PMS symptoms. It may be best to:
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.
For more information about birth control pills and progestin, see the topic Birth Control.
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:
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.
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.
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.
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:
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.
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.
These therapies may help relieve symptoms in some women.
These supplements are commonly recommended for PMS home treatment:
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.
|American Congress of Obstetricians and Gynecologists (ACOG)|
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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.
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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.
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|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
|Last Revised||May 17, 2011|
Last Revised: May 17, 2011
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