Understanding Premenstrual syndrome

Premenstrual syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before her menses.

PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown.

However, many researchers believe that a change in hormone levels at the beginning of the menstrual cycle may be to blame. Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability.

Risk factors for premenstrual syndrome include:

• a history of depression or mood disorders, such as postpartum depression or bipolar disorder
• family history of PMS
• a family history of depression

Symptoms of PMS

The average woman’s menstrual cycle lasts 28 days. Ovulation (when an egg is released from the ovaries) occurs on day 14 of the cycle. Menstruation (bleeding) occurs on day 28 of the cycle. PMS symptoms can begin around day 14 and last until seven days after the start of menstruation.

Symptoms of PMS are usually mild or moderate. The severity of symptoms can vary by individual and by month. Symptoms of PMS include:

• abdominal bloating and pain
• sore breasts
• acne
• food cravings (especially sweets)
• constipation
• diarrhea
• headaches
• sensitivity to light or sound
• fatigue
• irritability
• changes in sleep patterns
• anxiety
• depression or sadness
• emotional outbursts

When Should You Visit the Doctor?

If physical pain, mood swings, and other symptoms start to affect your daily life, or if your symptoms don’t go away, you should make a doctor’s appointment to have yourself checked for other medical conditions.

Your doctor may ask about any history of depression or mood disorders in your family to determine whether your symptoms are the result of PMS or another condition. Some conditions, such as irritable bowel syndrome, hypothyroidism, and pregnancy, have symptoms similar to PMS. Your doctor may do a thyroid hormone test to ensure that your thyroid gland is working properly, a pregnancy test, and perhaps a pelvic exam to check for any gynecological problems.

Keeping a symptom diary is another way to determine if you have PMS. Use a calendar to keep track of your symptoms and menstruation every month. If your symptoms start around the same time each month, PMS is a likely cause.

Easing the Symptoms of PMS

You can’t cure PMS, but you can take steps to ease your symptoms. If you have a mild or moderate form of premenstrual syndrome, treatment options include:

• drinking plenty of fluids to ease abdominal bloating
• eating a balanced diet to improve your overall health and energy level (eat plenty of fruits and vegetables and reduce your intake of sugar, salt, caffeine, and alcohol)
• taking supplements, such as folic acid, vitamin B-6, calcium, and magnesium to reduce cramps and mood swings
• sleeping at least eight hours each night to improve fatigue
• getting plenty of exercise to decrease bloating and improve your mental health

You can take pain medication, such as ibuprofen or aspirin, to alleviate muscle aches, headaches, and stomach cramping. You can also try a diuretic to stop bloating and water weight gain. Take medications and supplements only as directed and after speaking with 

your doctor.

Can PMS Be Prevented?

PMS itself cannot be prevented, but through education and appropriate treatment of symptoms, most women can find relief. A healthy lifestyle -- including exercise, adequate rest, and a proper diet -- also can help a woman better manage PMS symptoms.

Is There a Treatment for PMS?

PMS treatment is based on relieving symptoms. Treatment begins with a thorough assessment of your symptoms and their impact on your daily life. Treatments for PMS include the following:

• Education. You will be better able to deal with your symptoms if you can relate how you're feeling to your menstrual cycles, knowing that you will feel better once your period starts. Keeping a monthly symptom diary will help track your PMS symptoms, as well as their severity and how long they last. While symptoms may vary from month to month, this diary can give you a good idea of how your periods affect your physical health and moods. Learning how to cope with the problems in your life may help relieve the stress and irritability you feel before your period. If you experience severe anxiety, irritability, or depression, counseling and/or medication may be helpful.
• Nutrition. A healthy diet is important to overall physical and mental wellness. Making changes in your diet -- including reducing the amount of caffeine, salt, and sugar you eat -- may help relieve PMS symptoms. In some cases, nutritional supplements may be recommended. These include vitamin B6, vitamin E, calcium, and magnesium. The American College of Obstetrics and Gynecology recommends a diet high in complex carbohydrates.
• Exercise. Like a healthy diet, regular exercise, especially aerobic exercise like walking, can improve your overall health. It also can help relieve -- and help you cope with -- PMS symptoms.
• Medications. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as aspirin, ibuprofen (Advil), and naproxen (Aleve) -- may help relieve symptoms such as headache, backache, cramps, and breast tenderness. Medications may be prescribed in cases of severe depresionor anxiety. Certain antidepressants may be useful to treat severe PMS. Oral contraceptives have been prescribed to treat PMS and may be helpful, but there is little data to support their effectiveness. The diuretic spironolactone (available by prescription) can reduce the fluid retention of PMS.

Many small studies have looked at the use of natural progesterone, primrose oil, black cohosh, wild yam root, chaste tree fruit, dong quai, and vitamin B6 to relieve PMS symptoms. So far, these have been found to be ineffective or of limited benefit and are not recommended.