Definition

      
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are the medical terms used for the physical and emotional symptoms that some women have before their menstrual period begins. These symptoms vary from woman to woman. They can be mild to severe. The milder form of these symptoms is called premenstrual syndrome (PMS). With PMS, symptoms occur the week prior to menstruation and resolve within a week of the onset of your menses. Premenstrual dysphoric disorder (PMDD) is a severe, disabling form of PMS.

Many menstruating women have some symptoms of PMS. About 5-10% of these women have PMDD. The causes of PMS and PMDD are not clear. Symptoms of PMS and PMDD occur in the week or two weeks before your period. Physical symptoms are the same for PMS and PMDD. With PMDD, however, the emotional symptoms are much more serious. You may feel very depressed, angry and hopeless.

Physical symptoms of PMS and PMDD may include:

• Tender, enlarged breasts
• Weight gain
• Headache
• Nausea, vomiting, diarrhea, constipation
• Appetite changes, such as food cravings
• Joint or muscle pain
• Fatigue, lack of energy
• Hot flashes
• Acne
• Swollen feet or hands
• Bloated stomach

Emotional symptoms may include:

• Irritability
• Anger
• Depression
• Anxiety
• Tension
• Concentration issues
• Confusion
• Crying spells
• Feeling overwhelmed or out of control
• Social withdrawal
• Lack or decrease in sex drive

Diagnosis is based on symptoms, when they occur and how much they affect your life. Diagnosis may take several months of careful observation and your provider may ask you to keep a diary of your activities, mood, and physical symptoms every day for two months. Symptoms that always occur 1-2 weeks before your periods may be caused by PMS or PMDD. A diagnosis of PMDD may be made if your monthly symptoms seriously interfering with work, school, or relationships.

Treatment

       
A wide range of therapeutic interventions have been tested in the treatment of PMS symptoms, from lifestyle changes to advanced hormonal treatment.

• Treatment options include lifestyle and diet changes. Exercising regularly, getting enough sleep, choosing healthy foods, not smoking, and managing stress in your life. Decreasing salt, caffeine, alcohol, chocolate and beverages containing caffeine may reduce breast tenderness and swelling. Eating more whole grain foods and taking calcium and magnesium supplements daily may help with PMS symptoms.
• Medications including anti-inflammatory drugs like ibuprofen can help with cramping and headaches. Mild diuretics (water pills) are sometimes used for bloating and swelling. Anti-depressants can help women with severe PMS or PMDD. These drugs can reduce anger and irritability. Hormone therapy such as progesterone or birth control pills may be prescribed. Progesterone can help bloating, breast tenderness, and psychological symptoms. Birth control pills may help some physical symptoms and some of the psychological symptoms caused by hormone fluctuation.
• Psychotherapy (counseling) may help deal with emotional or relationship problems.
• Natural and alternative treatments include nutritional supplements. Acupuncture may provide relief for some symptoms.

The symptoms of PMS usually start a few days before your menstrual period and continue until your period begins. For many women, the symptoms go away once their period begins. The symptoms change as you mature, go through childbearing years and enter menopause. During menopause PMS may go away, but you may have other symptoms caused by menopause.