One-fourth of menstruating women have no premenstrual symptoms at all. The other 75 percent have some symptoms (breast tenderness, bloating, headaches, heightened awareness of emotions), usually mild, that signal the onset of a period. For most women, such symptoms can be annoying, but they are not disabling. However, 3 to 8 percent of women have symptoms that are significant enough to be classified as premenstrual syndrome, or PMS, and about 2 percent have a more severe form of PMS referred to as premenstrual dysphoric disorder (PMDD).
PMS refers to a variety of physical and psychological symptoms that often appear one to two weeks before the start of a menstrual period, a time known as the luteal phase. For many women the discomfort evaporates in a burst of energy and feeling of well-being just before a period starts. Others find premenstrual symptoms minor nuisances that vanish after a few days. But for some women the problems remain, result in significant distress or impair the ability to function in daily activities, and may intensify over a two-week period.
Scientists first began studying PMS in earnest in 1931, when it was termed “premenstrual tension,” and there’s been no lack of research since then. Nonetheless, there’s still no widespread agreement about what causes PMS or how to treat it. Even the definition remains in dispute. One difficulty in diagnosis is that some of the more disturbing emotional symptoms (irritability, depression, fatigue) may, in some cases, not be tied to the menstrual cycle at all.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the bible of the psychiatric profession, to be diagnosed with PMDD, a woman must have at least 5 of the following symptoms during the week before the onset of the period: mood swings, anger/irritability, a sense of hopelessness/depressed mood, anxiety, problems concentrating, a decreased interest in usual activity, fatigue, feeling out of control, bloating/breast tenderness/joint or muscle aches, or sleep problems. The symptoms must have occurred during most of the menstrual cycles in the previous year and they must markedly impair a woman’s ability to function. Also, the diagnosing physician must rule out other psychiatric and medical conditions (thyroid problems or depression, for example) that might be involved.
Symptoms of PMS
PMS is associated with both physical and psychological symptoms that include the following:
- Depression or feeling of hopelessness.
- Significant mood swings.
- Irritability leading to interpersonal conflicts.
- Decreased interest in normal activity.
- Difficulty concentrating.
- Changes in appetite.
- Sleeping too much or too little.
- A feeling of being out of control.
- Physical symptoms such as breast tenderness, headache, joint and muscle pain, bloating, and weight gain.
What causes PMS?
The cause of PMS appears related to an abnormal response to fluctuations in sex hormones in susceptible women that, in turn, affects the levels of neurotransmitters, such as serotonin, that affect mood. Recent research suggests that inflammation may also play a role in PMS. Symptoms always cease when a woman experiences surgical or natural menopause. It may be that some women are more vulnerable than others to the hormonal shifts of the menstrual cycle.
What if you do nothing?
PMS symptoms should clear up within a day or two after the onset of menstrual bleeding. If symptoms are so severe that they interfere with normal life and interpersonal relationships, contact your physician.
Home remedies for PMS
Remedies and treatments for PMS abound. A study published in the 1980s reported that more than 327 treatments had been proposed. A combination of some of the following measures may help, but claims for most remedies are unproved, and few have proved worthwhile.
- Keep a diary. Since there are no specific tests for PMS, charting your daily physical and emotional symptoms may help. Keep a daily diary of your cycles for a minimum of three months, noting what the symptoms are, their severity, and exactly when they occur and disappear. Such a record will give you a sense of control, as well as assist in the diagnosis and treatment of the disorder if you decide to seek medical advice. (If these symptoms do not fall within the two weeks preceding a period, they are probably not connected with your menstrual cycle.)
- Try exercise. As with menstrual cramps, no specific exercise will relieve PMS. Nevertheless, regular aerobic exercise like walking, running, swimming, bicycling, and aerobic dancing can help elevate mood, reduce fluid retention, and relieve stress. Try to exercise several times a week for at least 20 to 30 minutes.
- Reduce stress. Learn specific relaxation techniques such as yoga, meditation, biofeedback, or progressive muscle relaxation.
- Eliminate caffeine. Some people have found this helpful.
- Don’t count on vitamins and minerals. Many dietary supplements have been promoted to curb PMS symptoms, including vitamin B6, vitamin E, calcium, and magnesium. But there’s no evidence that any vitamin or mineral helps.
- Think twice about PMS herbal products. Many herbal remedies and “formulas” that promise to relieve PMS are promoted in health food stores, supplement catalogs, and on the Internet. Typically, part of their pitch is that they contain only “natural substances.” Some products are composed of 15 or more herbs and vitamins, including dong quai, wild yam, chasteberry, borage oil, and alfalfa. There is no good evidence that any of these remedies work. Nor can you even be sure they contain what they say they do, since their contents aren’t standardized or monitored by the FDA or any other regulatory agency.
A Note on PMS Clinics
Some clinics advertise that they treat premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). If you decide to try one, be careful when making your choice.
Can PMS be prevented?
There is no known way to prevent PMS.
When to call your doctor
Contact your physician if PMS symptoms are severe or worsen and prevent you from carrying out daily activities.
What your doctor will do
No specific laboratory test is available for detecting PMS. Your doctor should thoroughly review your symptoms and may ask you to keep a daily “symptoms diary” for several months if you have not already done so. Based on this information, you and your doctor can determine if your symptoms are due to PMS or if some other disorder is involved.
Your doctor may first recommend lifestyle changes if you haven’t tried them. If these don't prove helpful, or if your symptoms are especially severe, medications will probably be prescribed. These may include oral contraceptives as well as selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac) or sertraline (Zoloft), which may help with mood changes. There is another version of fluoxetine, Sarafem, which is the exact same drug but approved specifically for treating premenstrual dysphoric disorder (PMDD).
A diuretic called spironolactone (Aldactone) may be prescribed if severe bloating due to fluid retention is a primary symptom. It’s been suggested that PMS might best be treated via a multi-disciplinary approach with a family physician working with your gynecologist, a mental health professional, and a nutritionist.
For more information
Also see Perimenopause: A Time for Change.
Published January 20, 2017