Do you experience mood swings, tender breasts, swollen abdomen,
food cravings, irritability, fatigue or depression in the days before
your period? If you experience some or all of these symptoms then
you may have the Premenstrual Syndrome (PMS). For many women the
signs and symptoms of PMS are an uncomfortable and unwelcome part
of their monthly menstrual cycle. While PMS has over the years been
the butt of countless female bashing jokes, it is a very real condition
that affects up to 80 percent of menstruating women in varying degrees
– and in some women it can be severe enough to interfere with
their daily activities, life style and relationships.
The symptoms of PMS are more likely to trouble women in their 20s
and 30s, and they tend to recur in a predictable pattern. The physical
and emotional changes may be more or less intense with each menstrual
A list of the common physical and emotional signs and symptoms may
be found in box 1. The symptoms occur in the second half of the
menstrual cycle (called the luteal phase), and disappear at or within
a few days of the onset of menstrual flow. Most women experience
only a few of these symptoms.
In a minority, PMS symptoms are so severe they're considered disabling.
In these patients, the disturbance markedly interferes with work
or school, or with usual social activities and relationships with
others (e.g., avoidance of social activities, decreased productivity
and efficiency at work). This form of PMS has its own psychiatric
designation - premenstrual dysphoric disorder (PMDD). PMDD is a
severe form of premenstrual syndrome with symptoms including severe
depression, feelings of hopelessness, anger, anxiety, low self-esteem,
difficulty concentrating, irritability and tension and requires
The exact cause of PMS is not known. However, several factors have
been identified as possible causes or contributors to the occurrence
of PMS. Changes in hormone levels appear to be a major influence.
Chemical changes in the brain also may be involved. One clue to
the cause may be traced to fluctuations of serotonin, a brain chemical
(neurotransmitter) that is thought to play a crucial role in mood
states, especially depression. Insufficient amounts of serotonin
may contribute to other symptoms of PMS, such as fatigue, food cravings
and sleep problems.
Occasionally, some women with severe PMS have undiagnosed depression,
though depression alone does not cause all of the symptoms associated
with PMS. Stress also may aggravate some of the symptoms, but alone
isn't a cause.
Some PMS symptoms have been linked to low levels of vitamins and
minerals. Eating a lot of salty foods, which may cause fluid retention,
and drinking alcohol and coffee, which may cause mood and energy
level disturbances, also have been identified as possible contributors
There are no unique physical findings or laboratory tests to positively
diagnose PMS. To confirm a diagnosis of PMS a doctor must establish
that your symptoms are: a) present in the five days before your
period for at least three menstrual cycles in a row b) End within
four days after your period starts and c) Interfere with some of
your normal activities. The best way to help your doctor establish
the diagnosis is to keep a record of your signs and symptoms on
a calendar or in a diary for at least three menstrual cycles. Note
the day, you first noticed the symptoms appear and disappear. Also
be sure to mark the day your period started.
Knowing about your symptoms, their triggers and being reassured
that they will disappear is the first step in getting a hold on
PMS. If your PMS is not so bad that you need medical help you can
manage or sometimes reduce the symptoms by making changes in the
way you eat, exercise and approach daily life. Try these steps in
box 2. Not all of them work for everyone. You will have to figure
out the one that works best for you. Maintaining a symptom diary
may help you optimize the timing of these life style changes.
Some dietary and non prescription supplements may also help. Taking
up to 1200 mg of calcium daily has been shown to reduce some of
the physical and psychological symptoms of PMS. Taking calcium also
reduces the risk of osteoporosis. Other supplements have not been
rigorously tested in clinical trials, but supplements like primrose
oil and vitamin E may help some women with breast tenderness. Vitamin
A and B6 are NOT recommended. Some women find relief with use of
herbal supplements like ginger tea etc. It is important to note
that herbal supplements are not rigorously tested by clinical trials
and a product label that says herbal or natural is not sufficient
guarantee that these are safe. When in doubt, talk to your doctor.
If you've tried managing your PMS with lifestyle changes, but with
little or no success, and the symptoms of PMS are seriously affecting
your health and daily activities, see your doctor. Your doctor may
prescribe one or more medications. The success of medications in
relieving symptoms varies from woman to woman. Commonly prescribed
medications for PMS include Non steroidal Anti-Inflammatory drugs
(NSAID s), diuretics, selective serotonin reuptake inhibitors and
hormones that regulate the menstrual cycle. These drugs must be
taken under medical supervision only.
It is important to involve your family in the management of PMS.
Have a frank discussion with them and let them know what you go
through and how you feel. Indicate to them the days that you don’t
feel so good. Some women, for instance, place a sad face on the
calendar, so that their family knows how they feel. Give yourself
space and don't expect to be super wife or super mom all the time.
Take care of yourself first, even if it means that others in the
family have to take up the load and do the cooking or the dishes
on those dishes. It is also a good idea, not to make major decisions
on your PMS days. They can wait till you’re back to the normal
Common Symptoms of Premenstrual Syndrome
1.Behavioral symptoms: fatigue,
sleeplessness, dizziness, changes in sexual interest, food cravings
2.Psychologic symptoms: irritability,
anger, depressed mood, crying and tearfulness, anxiety, tension,
mood swings, lack of concentration, confusion, forgetfulness, restlessness,
loneliness, decreased self-esteem, tension
3.Physical symptoms: headaches,
breast tenderness and swelling, back pain, abdominal pain and bloating,
weight gain, swelling of legs, water retention, nausea, muscle and
Life style changes to control PMS
- Modify your diet
- Try eating up to 6 small meals a day instead of 3 larger
ones to reduce bloating and the sensation of fullness
- Avoid salt for the last few days before your period to
reduce bloating and fluid retention.
- Choose foods high in complex carbohydrates, such as fruits,
vegetables and whole grains.
- Reduce coffee intake to feel less tense and irritable and
to ease breast soreness.
- If you drink alcohol stop. Drinking before your period
can make you feel more depressed.
- Increase your intake of foods rich in calcium
- Take a multivitamin supplement daily
- Incorporate exercise into your regular routine
- Engage in brisk walking or other aerobic activity at least
30 to 60 minutes most days of the week. Regular daily exercise
can help improve your overall health and alleviate symptoms
such as fatigue and a depressed mood.
- Get plenty of sleep
- At least eight hours a day. Make sure that you have a consistent
sleep and wake schedule during the second half of your cycle.
- Keep to a regular schedule of meals, bedtime and exercise
- Practice progressive muscle relaxation or deep- breathing
exercises to help reduce headaches, anxiety or trouble sleeping
- Try to schedule stressful events for the week after your
- Talk with your family
- Talking with others about what you are going through can
help. Sharing your feelings may help your family to support
- Indicate to your family the days that you are not feeling