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Premenstrual syndrome

PMS; Premenstrual dysphoric disorder; PMDD

Premenstrual syndrome (PMS) refers to a wide range of symptoms. The symptoms start during the second half of the menstrual cycle (14 or more days after the first day of your last menstrual period). These usually go away 1 to 2 days after the menstrual period starts.

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Premenstrual bloating
Relieving PMS

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Causes

The exact cause of PMS is not known. Changes in brain hormone levels may play a role. However, this has not been proven. Women with PMS may also respond differently to these hormones.

PMS may be related to social, cultural, biological, and psychological factors.

Most women experience PMS symptoms during their childbearing years. PMS occurs more often in women:

The symptoms often get worse in late 30s and 40s as menopause approaches.

Symptoms

The most common symptoms of PMS include:

Other symptoms include:

Exams and Tests

There are no specific signs or lab tests that can detect PMS. To rule out other possible causes of symptoms, it is important to have a:

A symptom calendar can help women identify the most troublesome symptoms. This also helps in confirming the diagnosis of PMS.

Treatment

Keep a daily diary or log for at least 3 months. Record the:

This record will help you and your health care provider find the best treatment.

A healthy lifestyle is the first step to managing PMS. For many women, lifestyle approaches are often enough to control symptoms. To manage PMS:

Symptoms such as headache, backache, menstrual cramping, and breast tenderness may be treated with:

Birth control pills may decrease or increase PMS symptoms.

In severe cases, medicines to treat depression may be helpful. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are often tried first. These have been shown to be very helpful. You may also want to seek the advice of a counselor or therapist.

Other medicines that you may use include:

Outlook (Prognosis)

Most women who are treated for PMS symptoms get good relief.

PMS symptoms may become severe enough to prevent you from functioning normally.

The suicide rate in women with depression is much higher during the second half of the menstrual cycle. Mood disorders need to be diagnosed and treated.

When to Contact a Medical Professional

Make an appointment with your provider if:

Related Information

Premenstrual dysphoric disorder
Major depression

References

Freeman EW. Premenstrual syndrome. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier; 2018:1111-1114.

Hudson T. Premenstrual syndrome. In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 202.

Marjoribanks J, Brown J, O'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013;(6):CD001396. PMID: 23744611 www.ncbi.nlm.nih.gov/pubmed/23744611.

Mendiratta V, Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 37.

Neithardt AB. Premenstrual syndrome. In: Ferri FF, ed. Ferri's Clinical Advisor 2018. Philadelphia, PA: Elsevier; 2018:1054-1055.

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Review Date: 4/19/2018  

Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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