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Premenstrual Syndrome (PMS)

PMS occurs during the last 2 weeks of a woman's menstrual cycle. This phase starts with the release of an egg from the ovary. It ends when the woman starts her period. The exact cause of PMS is unknown, but researchers have proposed the following causes:

changes in kidney hormone levels, which cause water retention and weight gain

deficiencies of minerals, such as calcium

deficiencies of vitamins A, B6, and E

dietary changes, such as high levels of sodium and simple sugars

higher levels of estrogen, a female hormone

higher levels of prostaglandins, which produce inflammation

lower levels of endorphins, which are a part of the nervous system that produce what is called a high feeling

lower levels of progesterone, a female hormone

lower levels of serotonin, a hormone that influences mood

What are the causes and risks of the condition?

PMS is reported in 85% of women who menstruate. However, only 5% to 10% of menstruating women are severely impaired by PMS. No one knows what makes PMS so severe in some women and mild in others.

What are the signs and symptoms of the condition?

More than 150 symptoms have been attributed to PMS. The American College of Obstetricians and Gynecologists, also known as ACOG, lists these symptoms as the most common:

abdominal distress and bloating

breast swelling

fatigue

food cravings

headache

irritability

mood swings

tensionweight gain

Diagnosis of PMS begins with a medical history and physical exam. ACOG has established the following criteria for a diagnosis of PMS:

absence of other disorders that may cause similar symptoms

impairment of some part of the woman's life

symptoms consistent with PMS that are restricted to the last 2 weeks of the menstrual cycle

ACOG recommends that a woman keep a diary of her symptoms for 2 to 3 consecutive months. She can then discuss the diary with the healthcare provider. The provider may order tests to rule out other conditions.

The following recommendations may help prevent PMS or relieve some of the symptoms.

Eat a healthy diet that limits foods high in sodium, fat, caffeine, alcohol, and simple sugars

Get aerobic exercise on a regular basis.

Get enough vitamins and minerals, especially calcium and magnesium.

Use relaxation therapy and other stress management techniques.

Several herbal remedies, including chasteberry and black cohash, have been reported to relieve PMS. While these remedies are being studied, ACOG currently recommends that women discuss these options with their healthcare providers.What are the long-term effects of the condition?

There are no significant long-term effects of PMS.What are the risks to others?

PMS is not contagious. It poses no risk to others.

ACOG recommends the following lifestyle changes to relieve PMS symptoms:

a diet high in complex carbohydrates, or starches, and lower in simple sugars

nutritional supplements, such as calcium, magnesium, and vitamins E, B complex, and B6

regular aerobic exercise

stress reduction techniques, such as meditation and imagery

Medications used to treat PMS include the following:

antidepressant medicines, such as fluoxetine, that increase serotonin production

benzodiazepine medicines, such as alprazolam, that lower anxiety

danazol, a modified male hormone, which can decrease breast pain

diuretics, such as spironolactone and metolazone, which help the body excrete excess water and salts

hormones, such as nafarelin and leuprolide, which block the release of eggs from the ovaries

medicines that affect high prostaglandin levels, such as mefenamic acid, ibuprofen, and naproxen

Gonadotropin-releasing hormone, also known as GnRH, agonists can be prescribed to prevent the release of the egg from the ovary. These medicines are used only in severe PMS that can't be treated effectively with other medicines. Other medicines, such as lithium and oral contraceptives, have been used to treat PMS. However, they have not been proven effective in clinical trials.What are the side effects of the treatments?

Medicines to lower prostaglandin levels can cause stomach upset and allergic reactions. Hormones can interfere with other body processes. Antidepressants and medicines to control anxiety can cause drowsiness, dry mouth, and allergic reactions. Diuretics can cause salt imbalances and dehydration. GnRH agonists can cause osteoporosis.

What happens after treatment for the condition?

For many women, treatment continues until they stop menstruating at menopause.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

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