A symptom or collection of symptoms that occurs regularly in relation to the menstrual cycle, with the onset of symptoms 5 to 11 days before the onset of menses and resolution of symptoms with menses or shortly thereafter.
Alternative Names
Premenstrual tension; PMS; Premenstrual dysphoria
Causes, incidence, and risk factors
An exact cause of PMS has not been identified; however, it may be related to social, cultural, biological, and psychological factors. PMS can occur with apparently normal ovarian function (regular ovulatory cycles). PMS is estimated to affect 70% to 90% of women during their childbearing years. Between 30% to 40% of women are thought to have PMS symptoms severe enough to interfere with daily living activities, and 10% are believed to have symptoms so severe they are considered disabling. The incidence is higher in women between their late 20s and early 40s, those with at least one child, those with a family history of a major depression disorder, or women with a past medical history of either post-partum depression or an affective mood disorder. As many as 50-60% of women with severe PMS have an underlying psychiatric disorder.
Signs and tests
There are no physical examination findings or lab tests specific to the diagnosis of PMS. It is important that a complete history, physical examination (including pelvic exam), and in some instances a psychiatric evaluation be conducted to rule out other potential causes for symptoms that may be attributed to PMS. A symptom calendar can help women identify the most troublesome symptoms and to confirm the diagnosis of PMS.
Treatment
Self-care methods include exercise and dietary measures mentioned above under "Prevention." It is also important to maintain a daily diary or log to record the type, severity, and duration of symptoms. A "symptom diary" should be kept for a minimum of 3 months in order to correlate symptoms with the menstrual cycle. The diary will greatly assist the health care provider not only in the accurate diagnosis of PMS, but also with the proposed treatment methods. Nutritional supplements may be recommended. Vitamin B6 , calcium, and magnesium are commonly used. Prostaglandin inhibitors (aspirin, ibuprofen, other NSAIDS) may be prescribed for women with significant pain, including headache , backache , menstrual cramping and breast tenderness . Diuretics may be prescribed for women found to have significant weight gain due to fluid retention. Psychiatric medications and or therapy may be used for women who exhibit a moderate to severe degree of anxiety , irritability, or depression . Hormonal therapy may include a trial on oral contraceptives, which may either decrease or increase PMS symptoms. The use of progesterone vaginal suppositories during the second half of the menstrual cycle is still controversial.
Expectations (prognosis)
After adequate diagnosis and symptom-specific treatment has been initiated, most women with PMS obtain significant relief.
Complications
PMS symptoms may become severe enough to prevent women from maintaining normal function. Women with depression may note increasing severity of symptoms during the second half of their cycle and may require associated medication adjustments. The incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle.
Calling your health care provider
Call for an appointment with your health care provider if PMS does not resolve to self-treatment measures, or if symptoms occur that are severe enough to limit functional ability.
Prevention
Some of the lifestyles changes often recommended for the treatment of PMS may actually be useful in preventing symptoms from developing or getting worse. Regular exercise 3 to 5 times per week and a balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine ) may prove beneficial. The body may have different sleep requirements at different times during a woman's menstrual cycle, and so it is important to obtain adequate rest.