Premenstrual syndrome (patient information)

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Overview
Premenstrual syndrome (PMS) refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter.

What are the symptoms of Premenstrual syndrome?

 * PMS refers to a set of physical, behavioral, or emotional symptoms that tend to:
 * Start during the second half of the menstrual cycle (14 days or more after the first day of your last menstrual period)
 * Go away 4 - 7 days after a menstrual period ends (during the first half of the menstrual cycle)


 * It is important to keep a daily diary or log to record the type of symptoms you have, how severe they are, and how long they last. You should keep this symptom diary for at least 3 months. It will help your doctor make an accurate PMS diagnosis and recommend appropriate treatment.


 * The most common physical symptoms include:
 * Abdominal fullness, feeling gaseous
 * Bloating of the abdomen
 * Breast tenderness
 * Clumsiness
 * Constipation or diarrhea
 * Food cravings
 * Headache
 * Less tolerance for noises and lights


 * Other symptoms include:
 * Confusion
 * Difficulty concentrating
 * Fatigue
 * Feelings of sadness or hopelessness
 * Feelings of tension, anxiety, or edginess
 * Forgetfulness
 * Irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others
 * Loss of sex drive (may be increased in some women)
 * Mood swings
 * Poor judgment
 * Poor self-image, feelings of guilt, or increased fears
 * Sleep problems (sleeping too much or too little)
 * Slow, sluggish, lethargic movement

What causes Premenstrual syndrome?

 * The exact cause of PMS has not been identified. Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones.


 * PMS may be related to social, cultural, biological, and psychological factors.


 * The condition is estimated to affect up to 75% of women during their childbearing years.


 * It occurs more often in women:
 * Between their late 20s and early 40s
 * Who have at least one child
 * With a personal or family history of major depression
 * With a history of postpartum depression or an affective mood disorder


 * The symptoms typically get worse in a woman's late 30s and 40s as she approaches the transition to menopause.


 * As many as 50% - 60% of women with severe PMS have a premenstrual dysphoric disorder.

When to seek urgent medical care?
Call for an appointment with your health care provider if:
 * PMS does not go away with self-treatment
 * Your symptoms are so severe that they limit your ability to function

Diagnosis

 * There are no physical examination findings or lab tests specific to the diagnosis of PMS.


 * To rule out other potential causes of symptoms, it is important to have a:
 * Complete medical history
 * Physical examination (including pelvic exam)
 * Psychiatric evaluation (in some cases)


 * A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.

Treatment options

 * A healthy lifestyle is the first step to managing PMS. For many women with mild symptoms, lifestyle approaches are enough to control symptoms.
 * Drink plenty of fluids (water or juice, not soft drinks or other beverages with caffeine) to help reduce bloating, fluid retention, and other symptoms.
 * Eat frequent, small meals. Leave no more than 3 hours between snacks, and avoid overeating.
 * Your health care provider may recommend that you take nutritional supplements. Vitamin B6, calcium, and magnesium are commonly used. Tryptophan, which is found in dairy products, may also be helpful.
 * Your doctor may recommend that you eat a low-salt diet and avoid simple sugars, caffeine, and alcohol.
 * Get regular aerobic exercise throughout the month to help reduce the severity of PMS symptoms.
 * Try changing your night-time sleep habits before taking drugs for insomnia.


 * Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed if you have significant pain, including headache, backache, menstrual cramping, and breast tenderness.


 * Birth control pills OCPs may decrease or increase PMS symptoms.


 * In severe cases, antidepressants may be helpful.
 * The first options are usually antidepressants known as selective serotonin-reuptake inhibitors (SSRIs).
 * Cognitive behavioral therapy may be an alternative to antidepressants.
 * Light therapy may decrease the need for antidepressant medications.


 * Patients who have severe anxiety are sometimes given anti-anxiety drugs.


 * Diuretics may help women with severe fluid retention, which causes bloating, breast tenderness, and weight gain.


 * Bromocriptine, danazol, and tamoxifen are drugs that are occasionally used for relieving breast pain.

Where to find medical care for Premenstrual syndrome?
Directions to Hospitals Treating Premenstrual syndrome

What to expect (Outlook/Prognosis)?
Most women who are treated for PMS symptoms get significant relief.

Possible complications

 * PMS symptoms may become severe enough to prevent women from functioning normally.


 * Women with depression may have more severe symptoms during the second half of their cycle and may need to have their medication adjusted.


 * The suicide rate in women with depression is much higher during the second half of the menstrual cycle.

Prevention

 * Some of the lifestyles changes often recommended for treating PMS may help prevent symptoms or keep them from getting worse.


 * Getting regular exercise and eating a balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine) may prove beneficial.


 * Your body may have different sleep needs at different times during your menstrual cycle, so it is important to get enough rest.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/001505.htm