Premenstrual syndrome, commonly referred to as PMS, is a cyclic, multisymptom disorder characterized by physical, behavioral, and emotional symptoms.
PMS occurs during the luteal phase (days past ovulation) of a woman's menstrual cycle, and is followed by a resolution of symptoms within the first few days after the onset of menstrual bleeding.
The exact cause of PMS is unknown, but normal ovarian function as well as fluctuations of estrogen and progesterone levels are considered possible causes of the symptoms commonly associated with PMS. Other factors that have been identified as contributors to PMS symptoms include genetics, stress, prior traumatic events, and sociocultural factors. Some theories suggest that chemical changes in the brain may be involved as well. Other theories suggest that PMS may be caused by multiple endocrine factors.
In surveys, approximately 40 percent of women describe their premenstrual symptoms as bothersome, another 10 to 15 percent describe their symptoms as severe, and 3 to 5 percent perceive their symptoms as having a significant negative impact on their quality of life. As many as 50 to 60 percent of women between their late 30s and 40s experience worsening of symptoms as they approach the transition to menopause. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS experienced by approximately 5 percent of women. Patients exhibiting severe PMS or PMDD symptoms should seek further medical evaluation or treatment.
Symptoms of PMS
The symptoms associated with PMS vary from woman to woman, but are typically consistent for an individual patient. Almost all women experience mild physical symptoms, food cravings, or mood changes before the onset of menses. These changes are considered normal signs of the ovulatory cycle, whereas PMS is defined as having at least one mood or physical symptom during the fives days prior to menstruation.
The number and severity of a patient's symptoms and their impact on overall well-being can assist health care providers in determining whether a patient has PMS or PMDD. The two most common physical PMS symptoms are bloating/weight gain/swelling and breast tenderness. Fatigue, anxiety, and irritability are also experienced by many women. Depressive and anxiety disorders are the most common conditions that overlap with PMS, and approximately half of women seeking treatment for PMS have one of these disorders.
Treatment should be tailored to meet the specific needs of each person, and typically requires a combination of therapies. Many experts recommend nonpharmacologic measures, including lifestyle and dietary modifications, regular exercise, and stress-reduction techniques, as the first line of therapy. Studies have shown that women who exercise regularly may experience less frequent and milder PMS symptoms compared with those who do not exercise. Reducing or eliminating intake of caffeine, salt, and alcoholic beverages as well as eating foods rich in complex carbohydrates and low in protein during the premenstrual phase may also decrease the incidence of PMS symptoms.
Approximately 80 percent of women use nonprescription products for symptomatic relief of PMS symptoms. Nonprescription agents that are marketed for management of PMS include nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, vitamins, minerals, and herbal products that contain evening primrose oil, chasteberry, or black cohosh. Combination products are also available that contain an analgesic (acetaminophen), a diuretic (pamabrom), and an antihistamine (pyrilamine maleate). Patients should be aware that combination products containing antihistamines may cause drowsiness.
The U.S. Food and Drug Administration has approved three over-the-counter diuretics—ammonium chloride, caffeine, and pamabrom—for relief of water retention, bloating, weight gain, and swelling. Pamabrom is the diuretic most commonly found in nonprescription menstrual products. Patients with a history of peptic ulcer disease or anxiety and insomnia disorders should not use products containing caffeine or pamabrom. Ammonium chloride is not recommended for people with renal or hepatic impairment due to the possibility of metabolic acidosis.