Women's Health

Premenstrual Syndrome (PMS)

NetWellness receives many questions about Premenstrual Syndrome (PMS). In the few days before each menstrual period many women experience what is commonly called PMS. This can include a number of different physical and emotional symptoms. Some women find these symptoms predictable every month while others experience a great deal of variation from period to period.

Symptoms of PMS

Some symptoms commonly associated with PMS include:

Weight gain from fluid retention
Abdominal bloating and cramping
Breast tenderness
Tension or anxiety
Depressed mood
Crying spells
Mood swings and irritability or anger
Appetite changes and food cravings
Trouble falling asleep (insomnia)
Joint or muscle pain
Headache
Fatigue

Most women will agree that having some or even all of these symptoms is quite normal. Usually taking over the counter pain medication, getting plenty of rest, exercising, drinking enough water, eating well, and of course starting your period will lessen and eventually stop these symptoms until the next month.

Premenstrual Dysphoric Disorder (PMDD)

For some women, the symptoms of PMS can be severe and debilitating. These more extreme symptoms are called premenstrual dysphoric disorder (PMDD).

PMDD is a severe form of premenstrual syndrome with symptoms including:

Severe depression
Hopelessness
Anger
Anxiety
Low self-esteem
Difficulty concentrating
Irritability
Tension

A number of women with severe PMS may have an underlying psychiatric disorder.

What you can do

Talk to your doctor - If you suspect your symptoms are more severe than average PMS and you think you may be suffering from PMDD consult your healthcare provider.

Keep track of your period and symptoms - To establish whether your symptoms are part of your normal cycle or not try tracking your symptoms along with tracking your period on a calendar. This way you can give some helpful background information to you healthcare provider at your visit.

Treatments for PMDD

There are some treatments for PMS and PMDD that can only be prescribed by a healthcare provider. These include:

Nonsteroidal anti-inflammatory drugs (NSAIDs) - Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.

Oral contraceptives - These stop ovulation and stabilize hormonal swings, thereby offering relief from PMS symptoms.

Antidepressants - Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil) and sertraline (Zoloft), have been successful in reducing symptoms such as fatigue, food cravings and sleep problems. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.

Medroxyprogesterone acetate (Depo-Provera) - For severe PMS or PMDD, this injection can be used to temporarily stop ovulation. However, Depo-Provera may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache and depressed mood.

The success of these different medications varies from woman to woman but can be very helpful in lessening symptoms. Talk more with your healthcare provider to determine what the right treatment for you is.

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This article is a NetWellness exclusive.

Last Reviewed: May 05, 2011

Esa M Davis, MD, MPH
Adjunct Assistant Professor of Family Medicine
School of Medicine
Case Western Reserve University