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

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KEY POINTS

• Premenstrual syndrome (PMS) is the term used for the physical and emotional symptoms that some women have before their menstrual period. Premenstrual dysphoric disorder (PMDD) is the term used when PMS symptoms are severe and seriously interfere with work, school, or relationships.
• Treatment may include diet changes, medicines, and therapy.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

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What are premenstrual syndrome and premenstrual dysphoric disorder?

Premenstrual syndrome (PMS) is the term used for the physical and emotional symptoms that some women have before their menstrual period. Most women can usually manage their normal daily activities despite PMS symptoms. Premenstrual dysphoric disorder (PMDD) is the term used when PMS symptoms are severe and seriously interfere with work, school, or relationships.

Many menstruating women have some symptoms of PMS. About 5% to 10% of these women have PMDD. The symptoms may happen at any age.

What is the cause?

The exact cause is not known. Possible causes include:

• The changing levels of the female hormones estrogen and progesterone during the menstrual cycle
• An imbalance of chemicals in the brain. The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. Women with PMS or PMDD may have too little or too much of some of these chemicals.

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

What are the symptoms?

The symptoms start 1 or 2 weeks before each menstrual period and start to get better within a few days after your period starts.

Physical symptoms may include:

• Bloating and crampy pain in the lower belly
• Swollen feet or hands
• Tender, swollen breasts
• Weight gain
• Headache
• Nausea, vomiting, diarrhea, or constipation
• Appetite changes, such as a craving for certain foods
• Joint or muscle aches
• Feeling tired or lacking energy
• Hot flashes
• Acne

Mental and emotional symptoms may include:

• Irritability and anger
• Depression
• Anxiety
• Tension
• Trouble concentrating and remembering
• Crying spells
• Feeling overwhelmed or out of control
• Not wanting to be around other people
• Lack of or decrease in sex drive

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. 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 symptoms.

How is it treated?

Many treatments have been tried for PMS. No one treatment works for everyone.

• Diet changes

  Try having less salt and caffeine. For example, you may be able to reduce breast tenderness and swelling by not eating chocolate and not drinking beverages that have caffeine. Talk to your healthcare provider about foods you may need to avoid.

• Medicine

  Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help most premenstrual cramping and headaches. If your cramps are usually very bad, ask your healthcare provider if it might be helpful for you to take an NSAID 1 to 2 days before you expect your cramps to start. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take this medicine for more than 10 days.

  Your healthcare provider may prescribe:

  • Medicine for headaches
  • Medicine that lessens bloating and swelling by helping your body get rid of extra water
  • Medicine for pain and swelling of your breasts
  • Medicine to help with severe emotional symptoms
  • Hormone therapy, such as progesterone or birth control pills, which may help bloating, breast tenderness, and other physical and emotional symptoms
• Therapy

  Counseling may help you deal with emotional or relationship problems. Cognitive behavioral therapy may help 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.

• Other treatments

  Claims have been made that certain herbal and dietary products help control PMS symptoms. No herb or dietary supplement has been proven to relieve the symptoms consistently or completely. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe. Ask your healthcare provider if you should take a daily multivitamin or other supplements.

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

How can I take care of myself?

• Get support. Talk with family and friends. Join a support group in your area.
• Learn ways to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example, take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs. Exercise according to your healthcare provider's instructions.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take. Take all medicines as directed by your provider or therapist. Talk to your provider if you have problems taking your medicine or if the medicines don't seem to be working.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.