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Peace Out, PMS!

Premenstrual syndrome (PMS) has a wide variety of symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from mild to severe. Symptoms start usually 5 days before the period for at least three menstrual cycles in a row and end within 4 days after the period.

What Causes PMS?

Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:

  • Cyclic changes in hormones: Signs and symptoms of premenstrual syndrome change with hormonal fluctuations during menstrual cycles and disappear following pregnancy and menopause.
  • Chemical changes in the brain: Fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
  • Depression: Some women with severe premenstrual syndrome have undiagnosed depression.

What are the Symptoms of PMS?

The common symptoms can be called Emotional & Physical Symptoms

Emotional and behavioral symptoms: Tension or anxiety, depressed mood, crying spells, mood swings and irritability or anger, appetite changes and food cravings, trouble falling asleep (insomnia), social withdrawal and poor concentration.

Physical signs and symptoms: Joint or muscle pain, headache, fatigue, weight gain related to fluid retention, abdominal bloating, breast tenderness, acne flare-ups and constipation or diarrhoea.

For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days of the start of the menstrual period for most women.

How common is PMS?

PMS is as common as 3 of every 4 menstruating women experience some form of premenstrual syndrome. It is generally most severe in women in their 4th decade of life. It is estimated that clinically significant PMS (which is moderate to severe in intensity and affects a woman’s functioning) occurs in 20% to 30% of women. About 3% to 8% of women are believed to have the more severe variant known as PMDD.

Can PMS Be Prevented?

Women cannot prevent PMS but sometimes manage it or reduce it. This is can be achieved by making life style changes in the diet, exercise and approach daily life.

Modify your diet

  • Eat smaller, more-frequent meals to reduce bloating and the sensation of fullness.
  • Limit salt and salty foods to reduce bloating and fluid retention.
  • Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.
  • Choose foods rich in calcium. If you can’t tolerate dairy products or aren’t getting adequate calcium in your diet, a daily calcium supplement may help.
  • Avoid caffeine and alcohol.

Incorporate exercise into your regular routine

  • Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week.
  • Regular daily exercise can help improve your overall health and alleviate certain symptoms, such as fatigue and a depressed mood.

Reduce stress

  • Get plenty of sleep.
  • Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia).
  • Try yoga or massage to relax and relieve stress.
  • Record your symptoms for a few months
  • Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.

Is there a treatment for PMS?

For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for premenstrual syndrome include:


Selective serotonin reuptake inhibitors (SSRIs)—which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others—have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or PMDD. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, Naprosyn, others) can ease cramping and breast discomfort.


When exercise and limiting salt intake aren’t enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.

Hormonal contraceptives.

These prescription medications stop ovulation, which may bring relief from PMS symptoms.


Finding ways to relax and reduce stress can help women who have PMS. Relaxation therapy may include breathing exercises, meditation, and yoga. Massage therapy is another form of relaxation therapy that you may want to try.

 Regular sleeping habits.

Some women find therapies like biofeedback and self-hypnosis to be helpful. Getting enough sleep is important. Waking up and go to sleep at the same times every day, including weekends—may help lessen moodiness and fatigue.

Alternative medicine

Here’s what’s known about the effectiveness of complementary remedies used to soothe the symptoms of premenstrual syndrome:


Consuming 1,200 milligrams (mg) in your diet or with supplemental calcium daily, such as chewable calcium carbonate may reduce the physical and psychological symptoms of PMS.


Taking 360 mg of supplemental magnesium daily may help reduce fluid retention, breast tenderness and bloating in women with premenstrual syndrome.

Vitamin E.

This vitamin, taken in 400 international units daily, may ease PMS symptoms by reducing the production of prostaglandins, hormone-like substances that cause cramps and breast tenderness.

Herbal remedies.

Some women report relief of PMS symptoms with the use of herbs, such as ginkgo, ginger, chasteberry, and evening primrose oil.

What is severe PMS: Premenstrual Dysphoric Disorder (PMDD)?

Few women with premenstrual syndrome have disabling symptoms every month that can disrupt your work and damage your relationships. This form of PMS is called premenstrual dysphoric disorder (PMDD).

PMDD causes extreme mood shifts. The signs and symptoms include depression, mood swings, anger and anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.

When Should You Visit the Doctor?

If you haven’t been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, see your doctor. There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it’s part of your predictable premenstrual pattern.

To help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also be sure to mark the days your period starts and ends.

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