What it is

Premenstrual syndrome (PMS) is a group of symptoms linked to the menstrual cycle. "Up to 85 percent of women experience at least one symptom of PMS," says Joseph T. Martorano, M.D., a New York psychiatrist and author of Unmasking PMS (M. Evans & Co., 1993). PMS symptoms occur in the week or two weeks before your period and usually go away after your period starts. PMS can affect menstruating women of any age. It is also different for each woman. PMS may be just a monthly bother or it may be so severe that it makes it hard to even get through the day.


PMS often includes both physical and emotional symptoms. Common symptoms include:

* acne

* breast swelling and tenderness

* feeling tired

* having trouble sleeping

* upset stomach, bloating, constipation, or diarrhea

* headache or backache

* appetite changes or food cravings

* joint or muscle pain

* trouble concentrating or remembering

* tension, irritability, mood swings, or crying spells

* anxiety or depression

Symptoms vary from one woman to another. Between 3 and 7 percent of PMS sufferers have symptoms that are so incapacitating that they interfere with daily life. PMS usually lasts two to five days, but may plague some women for up to 21 days out of each 28-day cycle. If you think you have PMS, keep track of which symptoms you have when and how severe they are to share with your doctor.


The causes of PMS are not clear. It is linked to the changing hormones during the menstrual cycle. Some women may be affected more than others by changing hormone levels during the menstrual cycle. Over the course of the menstrual cycle, estrogen and progesterone levels increase and decrease predictably. At the start of each 28-day cycle (defined as the first day of your period), estrogen and progesterone levels are low. Then, on about day seven, estrogen starts to rise. It peaks around day 13 or 14 (just before ovulation takes place), and then suddenly drops and stays low for several days. Estrogen levels spike again between days 21 and 24 before taking a final slope downward. This latter fall in estrogen is accompanied by a surge in progesterone levels around days 19-27.

Women with PMS have normal amounts of estrogen and progesterone, but their brains may be sensitive to changes in the levels of these hormones.

Who is at risk

PMS occurs more often in women who:

* are between their late 20s and early 40s

* have at least one child

* have a family history of depression

* have a past medical history of either postpartum depression or a mood disorder


Unfortunately, there are no tests to confirm that you have PMS, and relatively few treatments for it are available. This dearth exists because doctors are not exactly sure what causes the syndrome. Currently, the most-discussed medical theory is that PMS sufferers are extra-responsive to hormonal fluctuations.

Diagnosis of PMS is usually based on your symptoms, when they occur, and how much they affect your life.


Many things have been tried to ease the symptoms of PMS. No treatment works for every woman, so you may need to try different ones to see what works. Sometimes lifestyle changes may be enough to help ease your symptoms. Among them:

  • Eat healthy foods, including fruits, vegetables, and whole grains.
  • Avoid salt, sugary foods, caffeine, and alcohol, especially when you are having PMS symptoms.
  • Exercise regularly.
  • Get enough sleep. Try to get 8 hours of sleep each night.
  • Find healthy ways to cope with stress. Talk to your friends, exercise, or write in a journal.
  • Take a multivitamin every day that includes 400 micrograms of folic acid. A calcium supplement with vitamin D can help keep bones strong and may help ease some PMS symptoms.
  • Don't smoke.

Over-the-counter pain relievers such as ibuprofen, aspirin, or naproxen may help ease cramps, headaches, backaches, and breast tenderness.

In more severe cases of PMS, prescription medicines may be used to ease symptoms. One approach has been to use drugs such as birth control pills to stop ovulation from occurring. Women on the pill report fewer PMS symptoms, such as cramps and headaches, as well as lighter periods.

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