Premenstrual Syndrome

Premenstrual syndrome (PMS) is a term commonly used to describe a wide range of severe, recurrent symptoms that occur from several days to two weeks before your period. Up to 40 percent of menstruating women have symptoms severe enough to require treatment. The symptoms of PMS can appear any time between puberty and menopause, although the most common age for it to start to become a problem is during the late 20s to early-30s. For some women, PMS symptoms may be so severe that they disrupt their lives and relationships.

Symptoms of PMS may get worse with age and stress, although the underlying causes are not well understood. Even women who have had hysterectomies can have PMS if at least one functional ovary is left. Women who are vulnerable to depressive illness, panic disorder, other psychiatric disorders or chronic medical conditions may also be susceptible to PMS, although these conditions may occur in women without PMS, as well. Heredity may also play a role: if your mother or sister suffers from PMS, you may find you experience it, too.

As many as 150 physical and behavioral symptoms have been assigned to PMS, but the number of PMS symptoms that most women experience is much more limited. The most common symptoms include irritability, mood swings, anxiety, depressed mood, fatigue, appetite changes, water retention and breast tenderness, among others. Bloating is the most common physical symptom, and irritability s the most common behavioral symptom.

Menstrual cramps, or dysmenorrhea, are not considered a PMS symptom, although women with PMS may experience cramps.

No one knows exactly what causes PMS. However, researchers do know that PMS is not just an imbalance of estrogen and progesterone or any other single hormone. Several studies found nothing abnormal in the levels or ratios of these hormones in women with PMS.

Another theory is that a complex interaction of brain chemicals such as endorphins or serotonin may trigger PMS. Exactly how these brain chemicals change with or affect the menstrual cycle isn't clear, however. But more focused studies on potential treatments that target these brain chemical imbalances are helping us understand the potential underlying cause for PMS, and may lead to a better understanding of the menstrual cycle and the effects of hormones on human behavior.

Calcium may play a role in PMS. In one study, researchers found that women who received 1,200 mg of calcium carbonate each day for three menstrual cycles saw their PMS symptoms improve by close to 50 percent -- particularly mood swings or depression, pain, cravings and water retention.

Dietary changes and exercise may also help relieve the discomfort of PMS symptoms. When symptoms are severe, antidepressant medication may be prescribed.

One of the most important strategies for coping with premenstrual discomfort is to be aware of any pattern your symptoms follow. The more aware you are of your symptoms -- when they start and stop and what works best to relieve them, for example -- the better you can develop strategies to recognize and cope with them -- whatever they may be.

Premenstrual Dysphoric Disorder (PMDD)
Approximately three to eight percent of women experience premenstrual dysphoric disorder (PMDD), a condition that like PMS is associated with the menstrual cycle. The symptoms of PMDD are the same as PMS symptoms; however, women with PMDD experience five or more symptoms and they are more severe. In fact, to be diagnosed with PMDD, symptoms must be severe enough to disrupt a woman's daily function. Symptoms must also meet diagnostic criteria specific to PMDD developed by the American Psychiatric Association.

The most important criteria for diagnosis are mood symptoms. Physical symptoms may also be present, but aren't as critical to the diagnosis. The difference between PMDD and mild PMS is like the difference between a mild tension headache and a migraine, experts say.

Women who have a history of depression are at higher risk for PMDD than other women. Treatment for PMDD includes medication known as selective serotonin re-uptake inhibitors (SSRIs), a type of antidepressant medication. A newly approved brand of birth control pills containing drospirenone (a progestin) and ethinyl estradiol (a form of estrogen) also has been shown to be clinically effective at treating the emotional and physical symptoms of PMDD.