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Premenstrual Syndrome

(PMS; Premenstrual Tension Syndrome)
  • Definition

    Premenstrual syndrome (PMS) is a disorder marked by physical and emotional symptoms. It affects women 1-2 weeks before the beginning of their menstrual period.
    The Menstrual Flow
    Copyright © Nucleus Medical Media, Inc.
  • Causes

    While the exact cause is not known, PMS may be related to certain factors (environmental, metabolic, or behavioral) that may make a woman more vulnerable to the hormonal changes that occur during menstruation.
  • Risk Factors

    PMS most often occurs in women aged 25-40 years. Other factors that may increase your chance of PMS include:
    • Going off birth control pills
    • Major life stress
    • Depression
  • Symptoms

    PMS may cause:
    • Irritability
    • Mood swings
    • Anxiety
    • Depression
    • Diminished self-esteem
    • Difficulty concentrating
    • Sleep problems
    • Appetite changes, such as sugar and/or salt cravings, or overeating
    • Weight gain
    • Fatigue
    • Bloating
    • Headache
    • Breast swelling and tenderness
    • Palpitations
    • Lightheadedness
    • Gastrointestinal upset
    • Muscle pain
    Symptoms usually improve when bleeding starts (menstrual period).
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will also be done.
    You will be asked to keep a detailed record of your monthly physical and emotional symptoms. If caused by PMS, these symptoms will likely occur 1-2 weeks before your menstrual period. You may have PMS if symptoms occur at the same phase of the menstrual cycle each month.
  • Treatment

    Treatment options include:
    Stress Management
    Stress may be managed through lifestyle changes. Relaxation techniques, deep breathing, massage, music, and hot baths can also help reduce stress.
    Dietary Changes
    Dietary changes may be helpful. Your doctor may recommend that you decrease your intake of salt, sugar, and caffeine. Eating small, frequent meals may also help.
    Vitamins and Minerals
    The following vitamin and mineral supplements might reduce PMS symptoms:
    • Vitamin E may reduce breast tenderness
    • Calcium may decrease bloating, depression, and aches
    • Magnesium may decrease pain, fluid retention, and improve mood
    • Manganese may help control symptoms of menstrual pain
    Talk to your doctor before you take any supplements.
    Regular Exercise
    Exercising throughout the week may help to reduce your symptoms.
    Medications to treat PMS include:
    • Diuretics to reduce bloating and fluid retention.
    • Pain relievers to relieve cramps, headaches, and muscle aches
    • Birth control pills to reduce physical symptoms
    • Antidepressants to reduce emotional symptoms
    Women with severe PMS symptoms may benefit from cognitive behavioral therapy. Therapy may reduce negative emotions and enhance problem-solving skills in relationships. It may also manage obstacles, frustrations, and discomfort.
  • Prevention

    To help reduce your chance of getting PMS, take the following steps:

    American Congress of Obstetricians and Gynecologists

    Office on Women's Health


    Health Canada

    The Society of Obstetricians and Gynaecologists of Canada


    Premenstrual syndrome. American Congress of Obstetricians and Gynecologists website. Available at: Updated May 2015. Accessed October 7, 2015.

    Premenstrual syndrome. EBSCO DynaMed website. Available at: Updated January 9, 2015. Accessed October 7, 2015.

    Premenstrual syndrome (PMS) fact sheet. Office on Women's Health website. Available at: Updated December 23, 2014. Accessed October 7, 2015.

    4/14/2009 DynaMed's Systematic Literature Surveillance Brown J, Shaughn O'Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009;(1):CD001396.

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