One-fourth of menstruating women have no premenstrual symptoms at all. The rest 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, 5 to 10 percent of women have severe, disabling symptoms known as premenstrual syndrome, or PMS.
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 tension 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 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.
In an effort to help doctors in dealing with this potentially perplexing ailment, the American College of Obstetricians and Gynecologists issued guidelines on diagnosing and treating PMS. Another set of guidelines is provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the bible of the psychiatric profession, which calls severe PMS premenstrual dysphoric disorder, or PMDD, to distinguish it from nondisabling PMS.
To be diagnosed with PMDD, a woman must have 5 or more symptoms during the week between ovulation and the onset of menstruation. The symptoms must decrease and begin to disappear shortly after menstruation begins; they must not be present before ovulation. They must markedly impair a woman’s ability to function and must persist for at least two cycles. 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, or premenstrual syndrome, is associated with both physical and psychological symptoms that include the following.
- Feeling tired
- Swelling and tenderness of the breasts
- Depression or feeling of hopelessness
- Hot flashes
- Significant mood swings
- Rapid pumping of the heart
- Irritability leading to interpersonal conflicts
- Loss of sex drive
- Cravings for certain foods
- Decreased interest in normal activity
- Difficulty concentrating
- Changes in appetite
- Crying spells
- Joint pain
- Sleeping too much or too little
- A feeling of being out of control
- Acne outbreaks or skin eruptions
- Physical symptoms such as breast tenderness, headache, joint and muscle pain, bloating and weight gain
What Causes PMS?
The cause of PMS is unknown, according to the statement from the American College of Obstetricians and Gynecologists (ACOG). One theory is that the brain chemical serotonin (which regulates mood) is somehow adversely affected by hormonal activity in women with PMS. About all that can be said is that it’s related to the menstrual cycle. 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, in-line skating, 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, or progressive muscle relaxation.
- Eliminate caffeine. Some people have found this helpful.
- Eat complex carbohydrates (e.g., fruits, vegetables, and whole grains).
- Drink plenty of water.
- Don’t count on vitamins and minerals (except possibly calcium). Many dietary supplements have been promoted to curb PMS symptoms. Vitamin B6 for example, has been widely touted, even though it has not been shown to have any value for PMS. But according to an article in the Journal of the American College of Nutrition, there is convincing evidence that calcium can help reduce symptoms such as breast tenderness, bloating, headaches, and mood disorders. Studies suggest you need to take 1,000 to 1,200 milligrams a day to get this benefit; don’t exceed 2,500 milligrams total from food and supplements.
- 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 convincing 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 Food and Drug Administration (FDA) or any other regulatory agency.
- Avoid drinking alcohol or caffeine because they may affect your mood and energy levels.
About PMS Clinics
These clinics have sprung up everywhere. If you decide to try one, be careful when making your choice.
Be wary of a clinic that
- Insists on expensive preliminary lab work.
- Charges high fees payable in advance.
- Pushes one treatment (such as progesterone suppositories) for all patients.
- Offers a fast diagnosis and quick fix.
Choose a clinic that
- Is run by a reputable gynecologist or primary-care physician, preferably one recommended by a physician you trust.
- Offers psychiatric counseling or can refer you, if necessary.
- Understands the psychological and medical aspects of PMS.
- Tailors the treatment to the patient.
There is no way known to prevent PMS.
Beyond Home Remedies: 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, which have been widely prescribed for PMS and which may help with physical symptoms, but may not be effective at relieving mood-related symptoms. Various antidepressant drugs may help with mood changes. A diuretic called spironolactone may be prescribed if severe bloating due to fluid retention is a primary symptom.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media