Premenstrual syndrome (patient information)
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# Overview
Premenstrual syndrome (PMS) refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter.

# What are the symptoms of Premenstrual syndrome?
- PMS refers to a set of physical, behavioral, or emotional symptoms that tend to:
- Start during the second half of the menstrual cycle (14 days or more after the first day of your last menstrual period)
- Go away 4 - 7 days after a menstrual period ends (during the first half of the menstrual cycle)
- It is important to keep a daily diary or log to record the type of symptoms you have, how severe they are, and how long they last. You should keep this symptom diary for at least 3 months. It will help your doctor make an accurate PMS diagnosis and recommend appropriate treatment.
- The most common physical symptoms include:
- Abdominal fullness, feeling gaseous
- Bloating of the abdomen
- Breast tenderness
- Clumsiness
- Constipation or diarrhea
- Food cravings
- Headache
- Less tolerance for noises and lights
- Other symptoms include:
- Confusion
- Difficulty concentrating
- Fatigue
- Feelings of sadness or hopelessness
- Feelings of tension, anxiety, or edginess
- Forgetfulness
- Irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others
- Loss of sex drive (may be increased in some women)
- Mood swings
- Poor judgment
- Poor self-image, feelings of guilt, or increased fears
- Sleep problems (sleeping too much or too little)
- Slow, sluggish, lethargic movement

# What causes Premenstrual syndrome?
- The exact cause of PMS has not been identified. Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones.
- PMS may be related to social, cultural, biological, and psychological factors.
- The condition is estimated to affect up to 75% of women during their childbearing years.
- It occurs more often in women:
- Between their late 20s and early 40s
- Who have at least one child
- With a personal or family history of major depression
- With a history of postpartum depression or an affective mood disorder
- The symptoms typically get worse in a woman's late 30s and 40s as she approaches the transition to menopause.
- As many as 50% - 60% of women with severe PMS have a premenstrual dysphoric disorder.

# When to seek urgent medical care?
Call for an appointment with your health care provider if:
- PMS does not go away with self-treatment
- Your symptoms are so severe that they limit your ability to function

# Diagnosis
- There are no physical examination findings or lab tests specific to the diagnosis of PMS.
- To rule out other potential causes of symptoms, it is important to have a:
- Complete medical history
- Physical examination (including pelvic exam)
- Psychiatric evaluation (in some cases)
- A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.

# Treatment options
- A healthy lifestyle is the first step to managing PMS. For many women with mild symptoms, lifestyle approaches are enough to control symptoms.
- Drink plenty of fluids (water or juice, not soft drinks or other beverages with caffeine) to help reduce bloating, fluid retention, and other symptoms.
- Eat frequent, small meals. Leave no more than 3 hours between snacks, and avoid overeating.
- Your health care provider may recommend that you take nutritional supplements. Vitamin B6, calcium, and magnesium are commonly used. Tryptophan, which is found in dairy products, may also be helpful.
- Your doctor may recommend that you eat a low-salt diet and avoid simple sugars, caffeine, and alcohol.
- Get regular aerobic exercise throughout the month to help reduce the severity of PMS symptoms.
- Try changing your night-time sleep habits before taking drugs for insomnia.
- Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed if you have significant pain, including headache, backache, menstrual cramping, and breast tenderness.
- Birth control pills OCPs may decrease or increase PMS symptoms.
- In severe cases, antidepressants may be helpful.
- The first options are usually antidepressants known as selective serotonin-reuptake inhibitors (SSRIs).
- Cognitive behavioral therapy may be an alternative to antidepressants.
- Light therapy may decrease the need for antidepressant medications.
- Patients who have severe anxiety are sometimes given anti-anxiety drugs.
- Diuretics may help women with severe fluid retention, which causes bloating, breast tenderness, and weight gain.
- Bromocriptine, danazol, and tamoxifen are drugs that are occasionally used for relieving breast pain.

# Where to find medical care for Premenstrual syndrome?
Directions to Hospitals Treating Premenstrual syndrome

# What to expect (Outlook/Prognosis)?
Most women who are treated for PMS symptoms get significant relief.

# Possible complications
- PMS symptoms may become severe enough to prevent women from functioning normally.
- Women with depression may have more severe symptoms during the second half of their cycle and may need to have their medication adjusted.
- The suicide rate in women with depression is much higher during the second half of the menstrual cycle.

# Prevention
- Some of the lifestyles changes often recommended for treating PMS may help prevent symptoms or keep them from getting worse.
- Getting regular exercise and eating a balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine) may prove beneficial.
- Your body may have different sleep needs at different times during your menstrual cycle, so it is important to get enough rest.

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