Guest Author - Denise Howard, M.D., M.P.H.

Premenstrual Syndrome also known as PMS is the cyclic occurrence of symptoms that interfere with the quality of life and is consistently and predictably associated with menses. These symptoms are either physical or emotional in nature. The physical symptoms include breast tenderness, abdominal bloating, headache and leg swelling. The emotional symptoms include depression, irritability, outbursts of anger, anxiety, confusion and social withdrawal.

PMS affects up to 80-85% of menstruating women. Most women have mild manifestations and it doesn’t interfere with daily functioning. Moderate to severe symptoms occur in 20-40% of menstruating women. They typically have 2-5 symptoms of PMS and report distress associated with these symptoms. More severe symptoms occur in 2-10% of women. The more severe form is called Premenstrual Dysphoric Disorder.

A symptom diary is typically utilized to make the diagnosis of PMS or PMDD. It is a record of both emotional and physical symptoms in relationship to the menses. It should be kept for at least 2 cycles. This record is important in making a diagnosis. PMS symptoms are limited to the part of the cycle that occurs after ovulation. This is known as the luteal phase. There are some women with other medical problems such as depressive disorders, migraine headaches and chronic fatigue syndrome in which the symptoms are magnified in the luteal phase. This can be confused with PMS.

The decision to treat is up to the woman who is experiencing the symptoms. There are no medical sequelae to not treating. Mangement of PMS/PMDD can include medical interventions or behavioral/lifestyle interventions.

Dietary and other lifestyle changes can improve symptoms of PMS. This includes decreasing the consumption of dairy products, refined sugars and high sodium food. Limiting caffeine intake and consuming a low fat and high fiber diet is also recommended. Nutritional supplements are also beneficial. Magnesium 400-800 mg per day, calcium 1200-1600 mg per day and Vitamin B6 50-100 mg per day have all been proven to alleviate symptoms of PMS. Chasteberry, Black cohosh, St. John’s wort, Ginkgo and Kava may also be beneficial in helping these symptoms. Aerobic exercises, yoga, light therapy, massage therapy, and other relaxation techniques may also be helpful especially if used consistently and probably in the mild to moderate cases.

Some women may elect to try medication to alleviate symptoms. Spironolactone, a diuretic, is helpful in alleviating the symptoms of bloating in PMS. In the past, oral contraceptive pills have been utilized. Until recently they have been of questionable benefit. Yasmin, a new contraceptive pill has been proven in to be beneficial in the treatment of PMDD. It contains drospirenone, a progestin which is an analogue of spironolactone. Menstrual suppression with hormonal methods such as Depoprovera and Mirena IUD should be effective and is easy to trial on an individual basis. GnRH agonist therapy, such as Lupron completely stops ovulation, thereby resolving PMS. It has limited usefulness since it cannot be used longterm.

Serotonin reuptake inhibitors (SRI) are currently the gold standard for treating PMS and PMDD. They are antidepressants and anxiolytics. Drugs in this category include fluoxetine (Prozac and Sarafem), paroxetine (Paxil), sertraline (Zoloft), clomipramine (Anafranil), fluvoxamine (Luvox), nefazodone (Serzone) and venlafaxine (Effexor). They can be taken daily or in the 7-14 days prior to menses when the symptoms occur.

Premenstrual Syndrome is a common disorder. Understanding these symptoms is an important first step in managing this problem. Medical options are available. Dietary changes, exercise and nutritional supplements may work for many. Consult with your health care provider to develop a strategy that is right for you.