Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

What are premenstrual syndrome (PMS) and premenstrual dysphoric disorder?

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 starts. The symptoms vary from woman to woman. They can be mild or severe.

• PMS is the milder form of these symptoms.
• PMDD is a severe, disabling form of PMS.

As many as 85% of menstruating women have some symptoms of PMS. About 5% to 10% of these women have PMDD. The symptoms may occur at any age.

What is the cause?

The cause of PMS and PMDD is not clear. Researchers are studying the effects of a woman's hormones on her body’s chemistry. Perhaps these problems happen because some women are more sensitive than others to changing hormone levels during the menstrual cycle. Some scientists think PMDD may be caused by an imbalance of a chemical in the body called serotonin.

Stress does not seem to cause PMS or PMDD, but it may make it worse.

What are the symptoms?

The symptoms of PMS or PMDD occur 1 or 2 weeks before each menstrual period. Physical symptoms are the same for PMS and PMDD. The emotional symptoms of PMDD are much more serious than the emotional symptoms of PMS.

Physical symptoms or PMS or PMDD may include:

• bloated stomach
• swollen feet or hands
• tender, swollen breasts
• crampy pain in the lower belly
• weight gain
• headache
• nausea, vomiting, diarrhea, constipation
• appetite changes, such as a craving for particular foods
• joint or muscle pain
• tiredness or lack of energy
• hot flashes
• acne

Emotional symptoms may include:

• irritability
• anger
• depression
• anxiety
• tension
• trouble concentrating and remembering
• confusion
• crying spells
• feeling overwhelmed or out of control
• social withdrawal (not wanting to be around other people)
• lack of or decrease in sex drive

Many women have more relationship problems while they are having PMS. With PMDD, the problems may be severe and you may feel very depressed, angry, and hopeless. You may have depression or anxiety. These symptoms can seriously disrupt daily life.

How is it diagnosed?

The diagnosis is usually based on the symptoms, when you have them, when they get better, and how much they affect your life. Diagnosis can be difficult and may take several months of careful observation. Your healthcare provider may ask you to keep a diary of your activities, mood, and physical symptoms. Symptoms that you always have 1 to 2 weeks before your periods may be caused by PMS or PMDD.

A diagnosis of PMDD may be made if your monthly symptoms seriously interfere with work, school, or relationships.

How is it treated?

Many treatments have been tried for PMS. No treatment works for everyone. For mild cases of PMS, some changes in lifestyle may be all you need. In other cases, other treatments may be needed as well.

• Lifestyle and diet changes

  Exercise regularly, get enough sleep, and choose healthy foods. Don't smoke. Find ways to manage stress in your life.

  Try having less salt, caffeine, and alcohol, especially when you are having PMS or PMDD symptoms. For example, not eating chocolate or drinking beverages that have caffeine may reduce breast tenderness and swelling. You may need to cut these foods from your diet completely or you may need to avoid them only during the last half of your menstrual cycle. Eat more whole-grain foods.

• Medicine

  Anti-inflammatory drugs, such as ibuprofen and naproxen, can help most premenstrual cramping and headaches. If your cramps are usually very bad, you may need to start taking an anti-inflammatory medicine 1 to 2 days before you expect your cramps to begin. This can help keep your body from making cramp-causing chemicals. These drugs can also help prevent the nausea, vomiting, and diarrhea caused by the same chemicals. You may need prescription medicine for headaches.

  Your healthcare provider may prescribe a mild diuretic (water pill) for bloating and swelling. If you have severe breast symptoms, your provider may prescribe other medicines.

  Some types of antidepressants, such as the type of drugs called SSRIs, can help many women with severe symptoms. These drugs reduce anger and irritability.

  Hormone therapy, such as progesterone or birth control pills, may be prescribed. Progesterone may help bloating and breast tenderness. It may also help psychological symptoms. Birth control pills may also help some physical symptoms and psychological symptoms of PMS and PMDD.

• Psychotherapy

  Counseling may help you deal with emotional or relationship problems. Cognitive behavioral therapy may also help with PMDD. It helps you change how you feel by helping you change how you think and react. Joining a PMS program for group therapy may also be helpful.

• Natural remedies and alternative treatments

  Nutritional supplements are often recommended for mild to moderate PMS symptoms. Be sure that you are getting enough vitamins and minerals. Ask your healthcare provider if you should take a multivitamin every day. Other supplements that may be helpful are calcium, magnesium, vitamin B6, and vitamin E.

  Acupuncture may give relief for headaches, tiredness, depression, backache, and other symptoms.

  Aerobic exercises can help lessen the symptoms of PMS.

In very severe and extreme cases, when the problem is so bad that there is a risk that you might hurt yourself or others, surgery to remove the ovaries might be considered.

How long will the effects last?

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 starts.

The symptoms of PMS change as you mature, go through childbearing age, and enter menopause. During menopause PMS symptoms may go away, but you may have other symptoms caused by menopause.

How can I take care of myself?

• Pay attention to how and when PMS affects you. You can then change your diet, exercise, and schedule in ways that help PMS to pass as smoothly as possible.
• If you have PMDD, make sure you get medical and psychological treatment.
• Join a support group for women dealing with the challenges of PMS or PMDD.
• Call your healthcare provider if you have severe symptoms or notice that your symptoms vary from one month to the next. There may be a more serious cause of your symptoms.

How can I help prevent PMS and PMDD?

There is no sure way to prevent PMS and PMDD because the cause is not well understood.