Dr. M.J. Bazos, MD. Patient Handout

About Your Diagnosis
Premenstrual syndrome (PMS) is a group of symptoms that occur in some women during the second half of a menstruating women’s cycle (after ovulation takes place). These symptoms include irritability, anxiety, depression, tension, emotional lability, and difficulty concentrating. Physical symptoms may also occur; the most common are feeling bloated (water retention), weight gain, breast tenderness or pain, lower abdominal swelling, headache, constipation, fatigue, and swollen hands and/ or feet. The exact cause of PMS is unknown. It is now felt that PMS is not caused by any excess or deficiency of hormones. However, the changing level of the hormones may trigger changes in chemicals made in the brain, causing some of the symptoms. Much research is being conducted to determine what causes PMS. Premenstrual syndrome is very common. It is estimated that approximately 50% of women have some degree of PMS during their reproductive years (when they are having their periods). Often PMS is diagnosed by keeping a calendar of periods and when the symptoms occur. If all the symptoms always occur within the 2 weeks before the period and the symptoms resolve during or after the period, then PMS is likely. There is no blood test or any other test that can confirm a diagnosis of PMS.

Living With Your Diagnosis
The symptoms of PMS are usually both behavioral and physical. The behavioral symptoms include irritability, depression, emotional lability (cries easily), tension, anxiety, difficulty concentrating on tasks, and possibly a change in sex drive. Physical symptoms include feeling bloated, breast tenderness, headache, lower abdominal swelling (many women complain of “feeling 5 months pregnant”), constipation, swelling of the hands and/or feet, and fatigue. The symptoms can vary from very mild to very severe. Most women are able to cope with mild symptoms. However, if the symptoms are very severe, then PMS can sometimes seriously affect family life, relationships with friends, and work. You do not have to experience all the symptoms to have PMS. In addition, during some menstrual cycles the PMS may be mild and barely noticeable, whereas during other cycles the PMS may be more severe. Sometimes women will have PMS during their 20s and 30s; other women may not have PMS until they are in their 40s. It is very common for women who are perimenopausal to have an increase in their PMS symptoms. By definition, postmenopausal women do not have PMS.

There are a variety of treatments for PMS. Sometimes one remedy will work for one individual but will not work as well for another. First, a healthy, well-balanced diet and plenty of exercise and adequate rest are recommended. It may be helpful to not schedule as many activities or commitments during the PMS period to minimize the stress and offset the fatigue. A diet especially high in complex carbohydrates (whole grain foods, i.e., pasta, breads, rice) may help alleviate some symptoms according to a recent study. An over-the-counter product called PMS Escape is available, which is simply a complex carbohydrate drink taken once or twice each day during the PMS period. There do not seem to be any side effects. Another over-the-counter product which has been shown to be effective in a study is Evening Primrose Oil. This product can be found in health food stores. It usually comes as gelatin capsules. The recommended dose is 1.5–2.0 grams twice each day during the PMS period. There are no reported side effects. Evening Primrose Oil may also alleviate breast tenderness that may occur before periods. Prescription antidepressants can also be used to treat PMS when symptoms are difficult to control with exercise, diet, and the over-the-counter remedies.

The DOs
• Eat a healthy, well-balanced diet. Especially take in a lot of foods high in complex carbohydrates (i.e., whole grain breads, pastas)
• Get lots of exercise regularly (even though this is the last thing you may feel like doing).
• Get plenty of rest and sleep during the PMS period.

The DON’Ts
• Avoid lots of sugar and caffeine.
• Don’t stop your regular exercise routine.
• Don’t schedule as many activities or commitments during the PMS period.

When to Call Your Doctor
• If your symptoms are interfering with your daily activities or ability to function at work or at home.
• If your symptoms are interfering with your relationships
with your family or friends.