Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

What are premenstrual syndrome and premenstrual dysphoric disorder?

Premenstrual syndrome and premenstrual dysphoric disorder are the medical terms used for the physical and emotional symptoms that some women have before their menstrual period begins. These symptoms vary from woman to woman. They can be mild to severe. The milder form of these symptoms is called premenstrual syndrome, or PMS. Premenstrual dysphoric disorder (PMDD) is a severe, disabling form of PMS.

As many as 85% of menstruating women have some symptoms of PMS. About 5% to 10% of these women have PMDD.

How do they occur?

The causes of PMS or PMDD are not yet clear. It may occur at any age. Some women may be more sensitive than others to changing hormone levels during the menstrual cycle. Stress does not seem to cause PMS, but it may make it worse. Researchers are studying the effects of a woman's hormones on the chemistry of the brain and the rest of the body. They are looking at the levels of the hormone testosterone in women, which may lead to the more severe symptoms of PMDD. Some scientists think PMDD may be caused by an imbalance of a chemical in the body called serotonin.

What are the symptoms?

The symptoms of PMS or PMDD occur in the week or two weeks before your period (menstruation or monthly bleeding). Physical symptoms are the same for PMS and PMDD. With PMDD, however, the emotional symptoms are much more serious. You may feel very depressed, angry, and hopeless.

Physical symptoms or PMS or PMDD may include:

• bloated stomach
• swollen feet or hands
• tender, enlarged breasts
• crampy pain in the lower abdomen
• weight gain
• headache
• nausea, vomiting, diarrhea, constipation
• appetite changes, such as a craving for particular foods
• joint or muscle pain
• fatigue, lack of energy
• hot flashes
• acne

Emotional symptoms may include:

• irritability
• anger
• depression
• anxiety
• tension
• trouble concentrating and remembering
• confusion
• crying spells
• feeling overwhelmed or out of control
• social withdrawal (not wanting to be around other people)
• lack of or decrease in sex drive

Many women have more troubles in their personal relationships when they are having PMS symptoms. With PMDD, these difficulties are severe. In addition to physical symptoms, the main symptoms of PMDD are mood disorders such as depression, anxiety, tension, and persistent anger or irritability. These symptoms can seriously disrupt daily life.

How is it diagnosed?

Diagnosis of PMS or PMDD is usually based on your symptoms, when they occur, when they get better, and how much they affect your life. Diagnosis can be difficult and may take several months of careful observation. Your healthcare provider may ask you to keep a diary of your activities, mood, and physical symptoms every day for 2 months. A diary is very important to find out if you have PMDD. Symptoms that always appear 1 to 2 weeks before your periods may be caused by PMS or PMDD. A diagnosis of PMDD may be made if your monthly symptoms seriously interfere with work, school, or relationships.

How is it treated?

Many treatments have been tried for easing the symptoms of PMS. However, no treatment has been found that works for everyone. For mild cases of PMS, some changes in your lifestyle may be all you need. In other cases, a combination of lifestyle changes and other treatments may be needed.

• Lifestyle and diet changes

  Adopt a healthier way of life. Exercise regularly, get enough sleep, choose healthy foods, don't smoke, and find ways to manage stress in your life.

  Try having less salt, caffeine, and alcohol, especially when you are having PMS symptoms. For example, not eating chocolate or drinking beverages containing caffeine may reduce breast tenderness and swelling. You may need to cut these foods from your diet completely or you may need to avoid them only during the last half of your menstrual cycle. Eat more whole-grain foods. It may help to take calcium (1000 grams) or magnesium (400 grams) supplements daily.

• Medicine

  Anti-inflammatory drugs, such as ibuprofen and naproxen, can help most premenstrual cramping and headaches. If your cramps are severe, you may need to start taking the anti-inflammatory drugs 1 to 2 days before you expect your cramps to begin. This can help prevent the production of cramp-causing chemicals by your body. These drugs can also help prevent the nausea, vomiting, and diarrhea caused by the same chemicals. You may need prescription medicine for PMS headaches.

  Your healthcare provider may prescribe a mild diuretic (water pill) for bloating and swelling. If you have severe breast symptoms, your provider may prescribe other medicines that might help.

  Some types of antidepressants, such as the type of drugs called SSRIs, can help many women with severe PMS or PMDD. These drugs reduce anger and irritability. Your provider may recommend taking an antidepressant every day or only on days you have symptoms.

  Hormone therapy, such as progesterone or birth control pills, may be prescribed. Progesterone may help bloating and breast tenderness. It may also help psychological symptoms. Birth control pills may help some physical symptoms, but they do not seem to help psychological symptoms. In some cases your provider may prescribe drugs that stop the release of an egg (ovulation) every month.

• Psychotherapy

  Counseling may help you deal with emotional or relationship problems. Cognitive behavioral therapy may also help with PMDD. It helps you change how you feel by helping you change how you think and react. Joining a PMS program for group therapy may also be helpful.

• Natural Remedies and Alternative Treatments

  Nutritional supplements are often recommended for mild to moderate PMS symptoms. Be sure that you are getting enough vitamins and minerals. Take a multivitamin every day that includes 400 micrograms of folic acid. Other supplements that may be helpful are calcium, magnesium, vitamin B6, and vitamin E.

  Acupuncture may provide relief for headaches, fatigue, depression, backache, and other symptoms of PMS and PMDD.

  Aerobic exercises are helpful in lowering the symptoms of PMS.

In very severe and extreme cases, when the problem is so bad that there is danger that you might hurt yourself or others, surgery to remove the ovaries might be considered.

How long will the effects last?

The symptoms of PMS usually start a few days before your menstrual period and continue until your period begins. For many women the symptoms go away once their period starts.

The symptoms of PMS change as you mature, go through childbearing age, and enter menopause. During menopause PMS symptoms may go away, but you may have other symptoms caused by menopause.

How can I take care of myself?

• Pay attention to how and when PMS affects you. You can then change your diet, exercise, and schedule in ways that help PMS to pass as smoothly as possible.
• If you have PMDD, make sure you get medical and psychological treatment.
• Join a support group for women dealing with the challenges of PMS or PMDD.
• Call your healthcare provider if you have severe symptoms or notice that your symptoms vary from one month to the next. There may be a more serious cause of your symptoms that needs treatment.

How can I help prevent PMS and PMDD?

There is no reliable way to prevent PMS and PMDD because the cause is uncertain.

For more information, contact the Depression and Bipolar Support Alliance (DBSA) or Mental Health America (formerly known as the National Mental Health Association or NMHA).

• For free educational materials, resource referrals, or information about a DBSA chapter or support group near you, call the information line at 1-800-826-3632. DBSA's Web site address is http://www.dbsalliance.org.
• NMHA's toll-free Information Center number is 1-800-969-NMHA. NMHA's Web site address is http://www.NMHA.org.