PREMENSTRUAL SYNDROME

The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems.

Emotional and behavioral symptoms:

• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability or anger
• Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Social withdrawal
• Poor concentration

Physical signs and symptoms:

• Joint or muscle pain
• Headache
• Fatigue
• Weight gain related to fluid retention
• Abdominal bloating
• Breast tenderness
• Acne flare-ups
• Constipation or diarrhea

For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days of the start of the menstrual period for most women.

But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).

PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.

If you haven’t been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, see your doctor.

DIAGNOSIS

There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it’s part of your predictable premenstrual pattern.

To help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also be sure to mark the days your period starts and ends.

TREATMENT

For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for premenstrual syndrome include:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or PMDD. 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.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, Naprosyn, others) can ease cramping and breast discomfort.
• Diuretics. When exercise and limiting salt intake aren’t enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.
• Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms.

Lifestyle & Home Remedies

You can sometimes manage or reduce the symptoms of premenstrual syndrome by making changes in the way you eat, exercise and approach daily life. Try these approaches:

Modify your diet

• Eat smaller, more-frequent meals to reduce bloating and the sensation of fullness.
• Limit salt and salty foods to reduce bloating and fluid retention.
• Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.
• Choose foods rich in calcium. If you can’t tolerate dairy products or aren’t getting adequate calcium in your diet, a daily calcium supplement may help.
• Avoid caffeine and alcohol.

Incorporate exercise into your regular routine

Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week. Regular daily exercise can help improve your overall health and alleviate certain symptoms, such as fatigue and a depressed mood.

Reduce stress

• Get plenty of sleep.
• Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia).
• Try yoga or massage to relax and relieve stress.

Record your symptoms for a few months

Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.