Premenstrual Syndrome (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Premenstrual syndrome (PMS) definition and facts
- What is PMS (premenstrual syndrome)?
- How common is PMS (premenstrual syndrome)?
- PMS vs. pregnancy symptoms
- What causes PMS (premenstrual syndrome)?
- What are the signs and symptoms of PMS (premenstrual syndrome)?
- How long does PMS (premenstrual syndrome) last?
- How is PMS (premenstrual syndrome) diagnosed?
- What conditions mimic PMS (premenstrual syndrome)?
- What treatments are available for PMS (premenstrual syndrome)?
- What natural or herbal remedies help PMS (premenstrual syndrome) symptoms?
- What medications are used to treat PMS (premenstrual syndrome)?
- Can exercise help relieve some of the symptoms of PMS (premenstrual syndrome)?
- Is there a "cure" for PMS (premenstrual syndrome)?
- Find a local Obstetrician-Gynecologist in your town
What are the signs and symptoms of PMS (premenstrual syndrome)?
A great variety of symptoms have been attributed to PMS. Women can have PMS of varying duration and severity from cycle to cycle. The most frequent mood-related symptoms of PMS include:
- anger and irritability,
- oversensitivity, and
- exaggerated mood swings.
The most frequent physical signs and symptoms of PMS include:
How long does PMS (premenstrual syndrome) last?
The duration of PMS varies among women. Most women experience the symptoms for a few to several days in the week prior to the onset of their menstrual period. Some women may have symptoms for a shorter or longer time period, but symptoms of PMS typically start after ovulation (the mid-point in the monthly menstrual cycle).
How is PMS (premenstrual syndrome) diagnosed?
The most helpful diagnostic tool is the menstrual diary, which documents physical and emotional symptoms over months. If the changes occur consistently around ovulation (mid-menstrual cycle) and persist until the menstrual flow begins, then PMS is probably the accurate diagnosis. Keeping a menstrual diary not only helps the health-care professional to make the diagnosis, but also promotes a better understanding by the patient of her own body and moods. Once the diagnosis of PMS is made and understood, the patient can better cope with the symptoms.
The diagnosis of PMS can be difficult because many medical and psychological conditions can mimic or worsen symptoms of PMS. There are no blood or laboratory tests to determine if a woman has PMS. When laboratory tests are performed, they are used to exclude other conditions that can mimic PMS.
What conditions mimic PMS (premenstrual syndrome)?
Some examples of medical conditions that can mimic PMS include:
- cyclic water retention (idiopathic edema),
- chronic fatigue,
- hypothyroidism, and
- irritable bowel syndrome (IBS).
The hallmark of the diagnosis of PMS is that symptom-free interval after the menstrual flow and prior to the next ovulation. If there is no such interval and the symptoms persist throughout the cycle, then PMS may not be the proper diagnosis. PMS can still be present and aggravate symptoms related to the other conditions, but it cannot be the sole cause of constant or non-cyclic symptoms. Blood or other tests may be ordered to help rule out other potential causes of symptoms.
Another way to help make the diagnosis of PMS is to prescribe drugs that stop all ovarian function. If these medications produce relief of the troublesome symptoms, then PMS is most likely the diagnosis.
What treatments are available for PMS (premenstrual syndrome)?
The treatment of PMS can sometimes be as challenging as making the diagnosis of PMS. Various treatment approaches have been used to treat this condition. Some measures lack a solid scientific basis but seem to help some women. Other treatments with a sound scientific basis may not help all patients.
General management includes a healthy lifestyle including:
- emotional support during the premenstrual period;
- salt restriction before the menstrual period;
- decreased caffeine intake prior to menstruation;
- smoking cessation;
- limitation of alcohol intake; and
- reduction of refined sugar intake.
All of the above have been recommended and may help symptoms in some women. Furthermore, some studies suggest that calcium and magnesium supplements may provide some benefit.
What natural or herbal remedies help PMS (premenstrual syndrome) symptoms?
The fruit of the chasteberry tree (Vitex agnus castus) was shown in limited studies to relieve some of the symptoms of PMS. However, further studies are needed to clarify this association and to determine the value of chasteberry fruit as a potential therapy for PMS. Since herbal preparations are not regulated by the US FDA, caution is warranted when taking this or any kind of over-the-counter supplement. While evening primrose oil and gingko biloba are plant extracts that have been promoted by some as remedies for PMS, there is no evidence that these products are effective, and they are not recommended.
Vitamin supplementation with calcium, magnesium have been shown in some trials to help alleviate symptoms of PMS, and may have some benefit. Taking calcium and magnesium supplements may help some women. It is always important to recommend guidelines when taking vitamin supplements, since taking excess of some supplements may be harmful.
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