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• PMS (Premenstrual syndrome)
• What is premenstrual syndrome (PMS)?
• What are the causes of PMS?
• How is PMS diagnosed?
• What are treatments for PMS?
• Preparation before the doctor’s appointment
• FAQ

PMS (Premenstrual syndrome)

Premenstrual syndrome (PMS) manifests as physical discomfort, such as bloating, and fatigue, and emotional changes like irritability and sadness before menstruation. Medications and lifestyle modification can effectively alleviate the symptoms.

What is premenstrual syndrome (PMS)?

Premenstrual syndrome (PMS) can cause tender breasts, food cravings, mood swings, fatigue, irritability, or even depression. Around 3 in 4 women develop some PMS symptoms.

What are the symptoms of premenstrual syndrome?

PMS symptoms are not predictable. Symptoms you experience in your 20s may change when you are in your 30s or 40s. However, it is common for symptoms to be both physical and emotional.

• Physical symptoms: Bloating, fatigue, cramps, breast tenderness, acne, and headaches.
• Emotional symptoms: Irritability, mood swings, anxiety, sadness, depression, brain fog, difficulty concentrating, food cravings, increased or decreased appetite, increased need to nap, trouble sleeping, and changes in your libido.

What is the difference between PMS, PMDD, and PME?

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS. Women with PMDD tend to experience intensified feelings of anger, severe depression, and anxiety compared to those experiencing PMS. Around 2% of women have PMDD.

Premenstrual exacerbation (PME) may be caused by other conditions such as

• Depression and anxiety can lead to mood swings, feelings of sadness, irritability, and social withdrawal may intensify around the menstrual period.
• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can cause fatigue, joint pain, and muscle pain which may heighten before menstruation. Women with ME/CFS may also experience heavy menstrual bleeding and early menopause.
• Irritable bowel syndrome (IBS) including bloating, gas, and cramps can worsen before menstruation.

What are the causes of PMS?

The causes of PMS are uncertain, but contributing factors include:

• Hormonal fluctuations during the menstrual cycle.
• Serotonin imbalances: Fluctuations in serotonin levels, a neurotransmitter crucial for regulating mood, can lead to fatigue, food cravings, and sleep disturbances.
• Depression: Severe cases of PMS may coincide with undiagnosed depression, although depression alone cannot account for all PMS symptoms.

How is PMS diagnosed?

Your doctor may ask you to track and record your symptoms for at least 2 months. This can help you to understand the pattern of your symptoms.

Your doctor will inquire about your medical history and family history to rule out other potential factors that may cause symptoms like those of PMS, such as anxiety, depression, chronic fatigue syndrome, thyroid disorders, perimenopause, and medications.

What are treatments for PMS?

1. Medications

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, paroxetine, and sertraline are typically the first-line treatment for severe PMS or PMDD (Premenstrual Dysphoric Disorder). You may need to take them daily or 2 weeks before menstruation.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen or naproxen sodium can be taken before or at the onset of menstruation to alleviate cramping and breast discomfort.
• Diuretics: In cases where exercise and salt restriction are insufficient in managing weight gain, swelling, and bloating associated with PMS, diuretics such as spironolactone can help the body eliminate excess fluid.
• Hormonal Contraceptives: Prescription medications like hormonal contraceptives prevent ovulation, potentially providing relief from PMS symptoms.

2. Lifestyle modifications

You can alleviate or minimize premenstrual syndrome symptoms by changing your diet and beginning an exercise routine.

3. Dietary Changes

• Opt for smaller, frequent meals to alleviate bloating and feelings of fullness.
• Limit your consumption of salty food or food that is high in sodium to prevent bloating and fluid retention.
• Eat foods high in complex carbohydrates, such as fruits, vegetables, and whole grains.
• Eat calcium-rich foods.
• Avoid consumption of caffeine and alcohol.

4. Start an exercise routine

Begin at least 30 minutes of brisk walking, cycling, swimming, or other aerobic activities most days of the week. Consistent exercise can enhance your overall well-being and mitigate fatigue and mood fluctuations.

5. Reduce stress

• Establish a new sleep routine by creating a consistent schedule and adopting habits conducive to quality sleep.
• Practice yoga, deep-breathing exercises, or progressive muscle relaxation to relieve headaches, anxiety, and insomnia.

6. Take vitamins, minerals, and dietary supplements

• Calcium: Studies suggest that calcium can alleviate symptoms such as fatigue, food cravings, and even depression associated with PMS. Dietary sources of calcium include milk, cheese, yogurt, and cereal or bread fortified with calcium.
• Magnesium: Some research indicates that magnesium may help alleviate PMS symptoms like headaches, stress, and anxiety. Magnesium can be found in leafy greens, nuts, and whole grains.
• Vitamin B6: Certain studies have shown that Vitamin B6 can improve symptoms related to mild and moderate PMS. Dietary sources of Vitamin B6 include fish, poultry, potatoes, and non-citrus fruits.
• Omega-3 and Omega-6: Research suggests that Omega-3 and Omega-6 fatty acids may ease PMS symptoms. Sources of these fatty acids include fish, flaxseed, nuts, and leafy greens.
• Herbal Supplements: Various herbal remedies such as black cohosh, dried chasteberry, and evening primrose oil can help alleviate symptoms. Before starting any herbal supplements, it's important to consult your healthcare provider to ensure safety.

7. Record your symptoms over 2-3 months

This can help identify patterns and triggers, enabling you to implement proper care.

How can we prevent PMS?

PMS symptoms cannot be prevented but can be managed with medications and lifestyle modifications.

Preparation before doctors appointment

• Write down your PMS symptoms.
• Make a list of medications, or dietary supplements you are taking.
• Prepare questions that you would like to ask your doctors.For instance:
  • What improves my PMS symptoms?
  • Can my PMS symptoms resolve on their own?
  • Are my symptoms indications of a more serious illness?
  • What treatment do you recommend?

Prepare answers to questions your doctor may ask you

• Are your symptoms severe?
• During which days of your menstrual cycle do your symptoms peak?
• Do you experience any symptom-free days during your menstrual cycle?
• Are you able to anticipate when your symptoms will occur?
• Are there any factors that alleviate or exacerbate your symptoms?
• Can you continue your daily activities while having the symptoms?
• Have you recently experienced feelings of sadness, depression, or hopelessness?
• Has anyone in your family been diagnosed with a psychiatric disorder?
• Have you been diagnosed with a psychiatric disorder?
• What treatments have you tried thus far, and what has been their efficacy?

Frequently Asked Questions (FAQ)

• How can I manage premenstrual syndrome (PMS)?
  PMS syndrome can be effectively managed through lifestyle adjustments and medication.
• When does PMS usually start?
  The onset of PMS symptoms varies. Symptoms may appear as early as two weeks before menstruation or as late as two days before. It's essential to observe your patterns.

A note from MedParks doctors

Notice your PMS symptoms and what triggers them can help you manage your symptoms. If these symptoms significantly affect your well-being, consider adjusting your habits and utilizing over-the-counter medications to alleviate them. If self-care measures prove ineffective, seek guidance from a healthcare provider to explore appropriate treatment options.