Dr. MJ Bazos MD, Patient Handout
PMS: What you can do to ease your symptoms

What is PMS?
PMS (premenstrual syndrome) is the name of a group of symptoms that start 7 to 14 days before your period (menstruation). The symptoms usually stop soon after your period begins. If you’re going through menopause, you may have symptoms during and after your period as well. Most women feel some discomfort before their periods. But if you have PMS, you may feel so anxious, depressed or uncomfortable that you can’t cope at home or at work. Symptoms of PMS are listed below. Your symptoms may be worse some months and better others.

What causes PMS?
No one knows for sure. But PMS seems to be linked in part to changes in hormone levels during the menstrual cycle. PMS is not caused by stress or psychological problems, though these may make the symptoms of PMS worse.

Symptoms of PMS
• Acne • Bloated abdomen
• Constipation • Craving sugar, salt or chocolate
• Crying spells or feeling more sensitive than usual
• Dizziness • Depression
• Fast heartbeat • Feeling hungry
• Feeling irritable or tense • Feeling tired
• Feeling angry or hostile • Feeling anxious
• Headache • Joint pain
• Mood swings
• Not feeling as interested in sex or not getting as much pleasure from it
• Tender and swollen breasts • Thoughts of suicide
• Trouble concentrating • Trouble sleeping
• Swollen hands or feet • Wanting to be alone
• Weight gain

How is PMS diagnosed?
Your doctor may ask you to keep track of your symptoms on a calendar. If your symptoms follow the same pattern each month, they may mean you have PMS. Your doctor may want to examine you and do some tests to rule out other problems. He or she may also want to talk to you about your eating and exercise habits, your work, and your family relationships. Your doctor needs to know as much about you as possible to help give you the best treatment.

How is PMS treated?
That depends on your symptoms. There is no cure for PMS. But medicines may help your symptoms. Your doctor may prescribe medicine for you depending on what your symptoms are. You may need to try more than one medicine to find the treatment that works for you. Medicines that can be prescribed include diuretics, prostaglandin inhibitors, antidepressants and medicine for anxiety. Other medicines for PMS are being studied.

What about diuretics?
Diuretics help your body get rid of extra sodium and fluid. They can ease bloating, weight gain, breast pain and abdominal pain. Diuretics are usually taken just before you would normally have these symptoms.

What are prostaglandin inhibitors?
Prostaglandin inhibitors block your body’s production of prostaglandins. Prostaglandins are chemical substances that make your uterus contract more strongly during your period. Prostaglandin inhibitors can help ease the headache, and general aches and pains (such as cramps) that some women have with PMS. Prostaglandin inhibitors include naproxen (brand names: Anaprox, Naprosyn) and mefenamic acid (brand name: Ponstel). They’re usually taken right before and during the beginning of your period.

Do antidepressants help?
Antidepressants and medicine to treat anxiety can help with the severe irritability, depression and anxiety that some women with PMS have. These medicines are usually only taken during the time you would normally have these symptoms.

What other medicines are there?
Bromocriptine mesylate (brand name: Parlodel) may help prevent breast pain. Studies are still being done about using bromocriptine this way. Studies are also being done about using hormones to treat PMS symptoms. Female hormones, including progesterone and estrogen, may relieve the anxiety, depression and breast swelling that some women with PMS have. They may be given in many different ways, including by mouth as pills or as a suppository you put in your vagina.

What about medicines I can buy without a prescription?
You can buy some medicines without a prescription to help with the symptoms of PMS. These medicines usually combine aspirin or acetaminophen with caffeine, antihistamines or diuretics. Some names include Midol, Pamprin and Premsyn PMS. You can buy some prostaglandin inhibitors without a prescription. These include ibuprofen (brand names: Advil, Motrin, Nuprin), ketoprofen (brand name: Orudis) and naproxen (brand name: Aleve). These medicines can work quite well for mild or moderate PMS. Ask your doctor before you try one of these drugs. You may need to try more than one before you find one that works for you.

Tips on controlling PMS
• Eat complex carbohydrates (such as whole grain breads, pasta and cereals), fiber and protein. Avoid sugar and fat.
• Avoid salt for the last few days before your period to reduce bloating and fluid retention.
• Cut back on caffeine to feel less tense and irritable and to ease breast soreness. If caffeine affects you a lot, you may need to cut it out completely.
• Cut out alcohol. Drinking it before your period can make you feel more depressed.
• Try eating up to 6 small meals a day instead of 3 larger ones.
• Get aerobic exercise. Work up to 4 20-minute periods a week. Exercising even more often the week before your period may also help.
• Get plenty of sleep—about 8 hours a night.
• Keep to a regular schedule of meals, bedtime and exercise.
• Try to schedule stressful events for the week after your period.
• Join a support group of women with PMS.

Can I do anything to ease my symptoms?
Yes. See the box on page 3 for some tips on controlling your symptoms. Know what your PMS symptoms are and when they happen. Then you can change your diet, exercise and schedule to get through each month as smoothly as possible. While these things aren’t guaranteed to work for you, they have worked for many women. Try not to get discouraged if following these tips or taking medicine doesn’t work for you. Treatment varies from one person to another. Your doctor can help you find the best treatment.

What about vitamins and other home remedies?
You may have read that some vitamins and other supplements, such as vitamin B6, vitamin E, calcium, magnesium and tryptophan, can help relieve PMS. Studies haven’t shown this to be true overall, but they do seem to help some women. Vitamin B6 and especially vitamin E can cause side effects if you take too much. And tryptophan may actually make PMS symptoms worse in some women. Taking calcium pills may reduce symptoms of water retention, cramps and back pain. Taking about 1,000 mg of calcium a day probably won’t be harmful, especially because calcium has so many other benefits, such as being good for your bones. But if you’re thinking about taking any of these things, talk to your doctor first.

Will I always have PMS?
PMS usually goes away by itself before you reach menopause. It also goes away during pregnancy and after menopause.